Lower back pain is extremely prevalent in our society. The majority of people reading this have probably experienced some type of back pain already in their lives. If you are one of the lucky ones that has not experienced back pain, at some point in your life you will most likely suffer from it in some way, shape, or form.
We sit down all day long, hunched over our phones or computers. This alters our posture by pushing our head forward and re-aligning our spine. Many experts will tell you that this change is posture is more than likely leading to your back pain.
This is logical and reasonable. However, the bad posture may not be what is causing the pain at all. According to the research, poor posture has, at best, a weak correlation to causing pain. If it is not your poor posture that causes pain what can it be?
Our tissues are not the only things that are affected by prolonged sitting. Our nervous system also suffers some changes. Our body will always choose the path of least resistance. When we alter our joint angles, our body will alter the timing that certain muscles fire, as well as what muscles are actually firing.
The world we live in puts a lot of stress on the front side of our bodies. One muscle group that gets chronically tight are the quads. The quads becoming tight can alter our posture in a couple of ways. For one, the rectus femoris connects to our pelvis. If this muscle gets tight it is possible for it to pull us into anterior pelvic tilt.
I do not believe this to be the case in most people. The rectus femoris is a biarticulate muscle group, meaning that it crosses more than one joint. When we sit the hips are flexed which shortens the rectus femoris at that joint, but the knees are bent so it is given slack at that end. The overall change in length of the muscle is very minimal.
The other three quad muscles do not cross the hip joint, but connect on the femur itself just a few inches away from the hip joint. When these three muscles get tight they can pull and rotate the hip joint into less than favorable positions. This is an often overlooked problem with this muscle group. Basic anatomy texts tend to blame the rectus femoris because it crosses the hip joint and the others do not. Just because a muscle does not cross a joint it does not mean that it can’t affect it.
The femur and pelvis make the hip joint. If these muscles get tight they will move that femur around, altering its position in the joint. This altered joint position changes how our body recruits muscles to perform dynamic actions.
In this situation, if we try to squat we can run into some issues. The glutes and hamstrings need to be able to pull the femur back into the hip joint to make room for the movement to occur. If the femur starts in an altered position, the body may choose to use a muscle such as our TFL to try and organize the joint. We get to a certain point in the movement and we run out of room.
The femur actually runs into tissue in our hip joint. Amazingly, our body will still get into positions that we need to so it will utilize movement at another joint. In this case you may see a butt wink in the squat. Under submaximal weights, a little bit of butt wink is more than likely not going to lead to back pain.
The more pressing concern is the altered body mechanics. Over time these poor mechanics can create wear and tear. How long it takes for that wear and tear to accumulate is dependent on a few individual variables. Some people will never have pain, others will bend over to tie their shoe and suffer a painful injury.
It is not the static posture causing pain, but the inability to control posture, get into necessary positions, and move properly that is. You do not have to have perfect posture to be pain free, you just need to be able to control it. This is why fixing movement is extremely important to preventing injury, as well as helping those that are in pain.
When people come into my office with back pain I always assess their quad length. I do this by laying them face down and passively pulling their heel to their butt. The heel should be able to touch the butt without the back moving. Often times you will see the heel stop moving towards the butt and the butt start moving to the heel. This is the body altering movement to get a job done. The quad ran out length so the movement is being done through the back.
People with tight quads almost always have a hard time balancing on a single leg. When our hip joint position is altered and recruits larger secondary stabilizers as primary stabilizers, we tend to not be as stable as we should. This lack of stability in single leg stance often leads to tightness in the QL. The stance knee collapses in and rotates the pelvis so the QL tightens up to attempt to provide enough stability to stop us from getting hurt.
When we get this tightness we tend to want to just lay on a foam roller and lacrosse ball to try and loosen it up. The problem is we need to address the cause of the tightness, not just the tightness. We also probably do not want to release that tightness without giving the body the necessary tools to stabilize itself.
What we need to do is lengthen the quads and retrain the person how to properly organize and stabilize their body. We can start with breaking up that tight tissue. Instead of just rolling over a roller, soft tissue work works better if we move the joint throughout a range of motion. Find a tight spot, keep the lacrosse ball there, and flex and extend your knee 10 times and then move onto the next spot. Spend 1-2 minutes here doing this.
Next I like to have people perform a couch stretch. This lengthens their quads in ½ kneeling position which teaches them how to stabilize their hip. Make sure the abs are tight and they are squeezing the glute of the leg that is being stretched. Squeezing the glute helps pull the femur back into a better position as well.
From here we need to strengthen good movements when we train. Often times people with strong quads have weaker hamstrings and will slide the knees forward in the bottom of the squat. Box squats are a great exercise to teach them how to load the hamstrings and glutes in the squat and help balance out the strength between the hamstrings and quads. It also helps fight all of the stress we put on the front side of our body’s every day.
If you suffer from lower back pain, find a qualified professional to assess your movement. The cause of the pain is often times not what you think it is. Also, don’t just try to release tight tissue without being assessed. That tightness may be protecting you, and chances are you do those releases daily without much change. Fix the movement and the pain tends to decrease and the tightness subsides.
I found I had a similar problem to this but it was with my glutes instead of my quads. Digging a tennis ball into my glutes helped a ton with some back pain I used to experience – but boy let me tell you, using that tennis ball was painful! You just have to grind it out and keep in mind that at the end of it you’ll stand up and have no more back pain. Seriously, it’s like a miracle.
Can you show photos or videos of the stretching you refer to? It is really hard to visualize what your are referring to.
Great article .I would also consider an evaluation of the iliopsoas muscle. With my lower back patients and even those with pain at the throaco-lumbar junction I evaluate the psoas-QL connection. Big fan of your work!