On Back Pain, "Good" Movement, and "Bad" Movement

Almost all new clients I see have the same question - "How should I be moving? What's the right way to move?" This question is especially prevalent among clients with chronic back pain. They've often been fighting with themselves, trying out a wide variety of modalities and strategies to get their pain under control, and trying to sort out good advice from bad advice for years.

I try to re-frame the question of "good movement vs bad movement". I'm interested in functional, useful movement. Movement doesn't exist in a binary - it exists on a spectrum. While there are general rules that should definitely be followed (ways to not sheer your joints, for example), the details may vary hugely person to person. Not all back pain looks the same.

This morning, I saw a new client with back pain who asked me that very question after getting mixed messages and no clear solutions from her other practitioners. I'll call her E. She's fallen into a very common pattern I see for protecting her lower back. She over-engages her abs and pulls the base of her rib cage in towards her spine, which many people mistakenly refer to as "core support". This achieves many things, none of which are very useful in most of daily life, and none of which relieve her back pain.

Spines are at their most functional and backs feel best when all vertebrae are free to move in all directions. No single vertebrae needs to move far, but as a structure, each one being able to move means we can bend and twist our spines in all kinds of amazing directions. When E pulls her rib cage in, the vertebrae attached to those lower ribs get stuck in one position. This means her spine cannot move in all directions, and causes muscles in her lower back to be constantly heavily engaged to make up for the lack of available support in her mid back. Constant muscle engagement is one cause of back pain.

Today, E learned that by lifting her rib cage a tiny bit from her sternum (not by arching her lower back) and freeing up those vertebrae in her mid back, a number of useful things happen:

  • Her whole spine become freer when her mid back is more mobile.
  • Her upper back muscles become engaged, taking some of the stress off her overworked lower back muscles.
  • She can breathe more easily.
  • Her lower back feels temporarily tired from working so hard for so long, but will feel better in the long run.

I stay away from calling movement "bad" because every movement has a use and a purpose. If you need to crouch and get through a small space, or if you need to hide and make yourself smaller, you better be able to pull your rib cage in like E does. However, if you're trying to be upright in everyday life, being able to carry your rib cage in a neutral place so your whole spine can support you is going to be much more useful.