One of the biggest physical issues facing adults in our modern world can be summed up in three words: low back pain.

Low back pain is a multifactorial issue which can occur due to problems with muscle, joints, nerves, and poor mechanics with exercise. Pain is also impacted by stress, sleep, nutrition, past experiences with pain, and beliefs–e.g. “My parents had low back pain and I do too.”

So how is low back pain different in high performing athletes? They’re so strong and fit. I mean come on, they work out for a living! Shouldn’t they be immune to problems like chronic back pain?


In athletes, low back pain is more likely due to two things: overuse and/or faulty mechanics. Remember, even professional athletes need rest/recovery days.

However, if you’ve so much as played a sport in high school, you know this isn’t the culture. Athletes are taught to push past the pain and ignore crucial cues from their body. They’re taught to condition and train for their specific sport, often to the overuse of specific muscle groups in specific patterns and combinations. Mobility is very often overlooked and many coaches still favor static stretches over dynamic ones (we all should be doing dynamic stretches by the way).

Athletes are more likely to try to manage pain on their own before they seek professional guidance. Sometimes there is the mentality that if they can just keep going, it will get better. They also may continue training in ways which keep the endorphins high because that work reduces pain during and immediately after.

Additionally, the body is smart. The body is very good at compensating for weaknesses and injury and finding ways to adjust. In athletes, some of our “bigger” mover muscles will compensate much longer before pain typically starts.

So how do we treat this? What do we do for low back pain in athletes at OrthoPelvic Physical Therapy?

Firstly, we do a full movement assessment. How are you doing your lifts/movements? We take video analysis which can be very revelatory for athletes to see exactly where and when they are compensating.

We then assess breathing and core activation strategies? Are you holding your breath? Are you inhaling when you should be exhaling? Are you engaging the rectus abdominis muscles (6-pack muscles that cannot handle much load) instead of engaging those deep core muscles?

After doing a complete and thorough assessment complete with everyone’s favorite feature, video-footage, we go to our first phase of work: mobility (this corresponds to lengthening in our LSR phase). We are not going to strengthen a dang thing until we have full movement.

After mobility work, we will then begin re-training muscle patterns to set the foundation to build us back up to a place where we can strengthen. Re-training often involves teaching those “smaller” stabilizer muscles to fire and coordinate so that your body isn’t cheating with those “bigger” mover muscles. Athletes tend to find this phase a bit tedious and think the movements are so simple and couldn’t possibly help them solve their low back pain. But in actuality, the foundational exercises are very difficult to do correctly, and it takes 3,000-5,000 reps to retrain a pattern. So repetition is incredibly important so that your body doesn’t default to its old patterns that caused pain in the first place.

It can be really humbling to be asked to do a sit-up only to be told you’re doing it incorrectly. But I’d rather be wrong than in pain. I would think most people are the same.

Once we have rebuilt our foundation on solid ground, then we can build back to speed, then to endurance, and then to POWER.

Everyone tends to really enjoy the power of it all because this comes during our Return phase where you’re feeling better than ever and we level up!

Does our representation of the athlete in pain remind you of anyone you know? Maybe your friend or spouse or child, or maybe yourself.

What if you told them that the state of pain isn’t inherent to their body, and we could actually retrain their body to function without pain?

That is what we do here every single day at OrthoPelvic PT. Let us help!

Curious to learn a little bit more? Schedule your  FREE 10-minute consult call today ✨

Be empowered in education,

OrthoPelvic Physical Therapy

Categories: FitnessHealth