Low back pain in CrossFit: Causes and Solutions

This article is for information purposes only and in no case replaces the assessment and prescription of an individualized treatment by a health professional.

We are going to deal with non-specific low back pain in general, without going into spinal pathologies and other alterations such as: disc herniations, protrusions, spodilolisthesis, tumors, etc.

If you have suffered or are suffering from low back pain, we recommend that you visit a physiotherapist or family doctor.

Low back pain and CrossFit

Low back pain is the second most frequent cause of consultation with the physiotherapist in CrossFit (36%) after shoulder pain (39%).¹. 

A very large number of CrossFit practitioners have suffered some episode of low back pain, and many of them end up having this type of episodes on a recurring basis.

However, despite the high incidence of pain in this region in CrossFit practitioners, we also know that they have a lower incidence of pain (41%) than sedentary people (69%).², Therefore, we cannot consider the practice of CrossFit as a risk factor for low back pain.

However, we must take into account certain considerations that can reduce our chances of suffering from these unpleasant episodes of pain.

Nowadays we know that low back pain is, most of the time (90%)³The pain is non-specific, i.e. no specific disease or structural cause can be pinpointed to explain the pain.

Not even when we have found in an imaging test some structural alteration, such as a hernia, protrusion or disc dehydration, among others, can we be sure that this is the source of the symptoms, since in many asymptomatic people these alterations are also present. ⁴.

As can be seen in the graph, these alterations become increasingly frequent with advancing age and may remain asymptomatic.

This is not incompatible with the fact that they should be taken into account in the evaluation and treatment of the person with low back pain, since some of these alterations require specific guidelines in order not to exacerbate the symptoms. 

The following are the most important most frequent causes of lower back pain in CrossFit athletes and we will try to shed light on what should be the pillars of its prevention and treatment.

The biopsychosocial model in pain

Before going into the causes of low back pain and its possible solutions, it is important to understand the concept of the biopsychosocial model to explain pain. 

The etiology and prevalence of low back pain, especially when it persists over time, has been shown to be multifactorial, so we cannot explain it from a single cause. We must understand pain within a context with biomedical or physical factors, but also psychological and social factors.

The term psychosocial is used when we refer to the interaction that takes place between the person and his or her social, work, family or sports environment.

These interactions directly influence the person's behavior, stress levels and, above all, attitudes and beliefs regarding pain, which affect pain levels, its evolution and even the efficacy of the treatments received.

Having clarified this term and without going into the individual context of each person, we will now focus on the biomedical or physical aspect, explaining what are the two most frequent causes of low back pain in the following cases CrossFit athletes.

Most common causes of low back pain in CrossFit

Altered contraction pattern

The first of the causes I would like to cite in this article, because of the frequency with which I observe it in the CrossFit athletes I help, is the altered contraction pattern between the deep lumbar musculature and the superficial musculatureespecially in traction movements from the ground. 

In recent years, thanks to the development of surface electromyography, which allows us to see in real time the speed and amount of activation of different muscles, it has been observed that there are significant differences between asymptomatic people and people with low back pain in the activation of the multifidus (deep musculature) and the spinal erectors, longissimus and iliocostalis (superficial musculature).

People with low back pain have a much lower activity in the multifidus and also activate them later, which is counteracted by a greater activation of the spinal erectors.

This is important, since these studies have also observed a increased fatigue in the superficial musculature due to such over-activation of the musculature and have been linked to the onset of pain.

The main hypothesis of the researchers is that this pattern is produced by a poor neuromuscular control in the lumbar regionWe do not yet know if it is really the cause of the problem or a consequence of it.

What we do know is that the work of this neuromuscular control in this type of alterations helps to revert the situation. in a relatively short period of time. 

Here are 2 of the simplest exercises that I give to most of my athletes with pain so you can start working on them today:

Banded cat & cow

Band resisted superman

The objective of both exercises is to improving proprioception on the lower segments of the lumbar spine, but in most cases they are not sufficient.

Once you have mastered this type of more controlled exercises, it would be advisable to add a progression in terms of difficulty and, subsequently, transfer this work to CrossFit movements, such as the dead weight, the squats, the snatch PRetc. 

For the latter purpose, it is very interesting to work with pauses in the ranges of motion where you lose the activation pattern.The loss is usually more evident in a specific range. 

Demand / capacity imbalance

The second most frequent cause, and with an easier solution, is the imbalance between the demands to which we are subjecting our lumbar spine and its capacity to tolerate them.

In other words, your training is being more demanding on your lumbar spine in terms of volume, intensity, density or frequency than your lumbar spine is prepared to withstand.

In this sense we will then have to apply 2 different strategies that we will perform simultaneously, giving more importance to one or the other depending on the irritability of the problem (how much the pain rises when we exercise the area), the pain or the training load that you are carrying at the moment. 

The first strategy will be load control and is intended to help reduce symptoms.

Depending on where your physiotherapist or trainer determines that the cause of the problem is, it will be interesting to modify one or several variables of the training (normally it is not necessary to modify all of them). Sometimes it is enough to modify the frequency with which we apply stimulus to the lumbar area (days/week), others the volume of work, and even others it is enough to modify the density.

It may also be interesting, when we know which structures may be the source of the symptoms, to apply modifications such as:

• decrease range of motion,
• change certain exercises for their variants (e.g. from hang), etc.

What all modifications have in common is that they will be a function of the irritability and amount of pain you have at the time.

If, for example, we use a scale of 1 to 10 to assess pain and at that moment you have a 1/10, but you are in a very irritable phase (with very little stimulus the pain is triggered at high levels), it will be convenient to apply a significant restriction of training.

Both factors must always be taken into account when scheduling the download.

The second strategy will be to increase the load-bearing capabilities of your lumbar spine. 

A priori it may seem counter-intuitive to apply an unload on the one hand, and use more load to improve your lumbar capacity on the other, however, this is because the exercises we are going to use for this purpose must have a very high specificity and be able to improve the load tolerance of our lumbar region without adding excessive stress. 

Among the core competencies that we must work on to improve this aspect are mobility, neuromuscular control or time under tension. 

• The good mobility of the lumbopelvic areaThe use of the hip, thoracic area and posterior chain will allow us, together with other capacities, to have a more favorable biomechanical position in the different phases of movement, which reduces the stress to which we subject the different structures of the lumbar spine.

• Neuromuscular controlAs we have already mentioned, it will allow a good muscle activation pattern and will also help in the technical and biomechanical aspects.

• The ability to withstand time under stressThe progressive workout is crucial to be able to maintain those less stressful movement patterns as fatigue sets in, which is when most low back pain in CrossFit athletes manifests itself.

Below I propose 2 exercises to work on each of these aspects (on neuromuscular control you have 2 in the previous point):

Lumbopelvic mobility:

Lumbar rotations in supine position

Jefferson Curl

Time under stress:

Romanian dead weight with pause

Isometric lumbar hyperextensions

Ineffective strategies for low back pain in CrossFit athletes.

If in the previous sections we have seen which strategies it is convenient for you to follow to recover your low back pain, it is also convenient for you to know which strategies have been discarded by scientific evidence for this purpose.

This does not mean that most of them are useless, but that they should never be the basis of treatment or replace the strategies described in the previous section.

Manual Therapy

Manual therapy, which includes massage, mobilizations, manipulations, etc., although it has proven to be effective in the punctual relief of symptoms, it has also proven to be an ineffective strategy in the management of low back pain in the medium and long term.⁵,⁶

Therefore, it will make sense to use this strategy only as a therapeutic window to be able to perform the exercise program with less symptomatology.

Electrotherapy

Another of the most widely used strategies in the treatment of low back pain is electrotherapy (stimulation by means of surface electrodes or needles), however, this has very poor evidence in relation to the treatment of this condition.⁷

Foam roller/vibration gun

If something is common in the CrossFit boxes is to see its users use the famous vibration guns or spend several minutes on top of a foam roller.

Although this type of strategy provides immediate relief of symptoms and an improvement in mobility and subjective perception of stiffness, its effect is very short termIt does not make sense to base our approach on these elements.

However, like manual therapy, they can be a strategy to accompany the exercise program to utilize the small therapeutic window they provide.

Antidepressants/anti-inflammatory drugs

A large percentage of athletes who come to me with low back pain have been prescribed this type of medication. However, it has not been demonstrated that this practice reduces low back pain in the medium and long term. In addition, many of these medications generate a high level of dependence.⁸

Frequently Asked Questions

Bibliographic references

1. Yuri Feito et al. A 4-year analysis of the incidence of injuries among CrossFit-trained participants. Orthop J Sports Med (2018).
2. Carla Sanchez. Impact of CrossFit on low back pain. Comparative study of low back pain in CrossFit practitioners and sedentary people. Final Degree Project. Faculty of Medicine and Health Sciences. Catholic University of Valencia (2023).
3. GBD 2021 Low Back Pain Collaborators. Global, regional, nd national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023;5(6):e316-29.
4. Brinjikji W et al. AJNR A J Neuroradial. 2015; 36(4); 811-816
5. HIDALGO B., DETREMBLEUR C., HALL T., MAHAUDENS P., NIELENS H. The efficacy of manual therapy and exercise for different stages of non specific low back pain: an update of systematic reviews. J Man Manip Ther [Internet]. 2014 [cited 29 August 2015]; 22 (2): 59-74.
6. MEREPEZA A. Effects of spinal manipulation versus exercise on adults with chronic low back pain: A literature review. J Can Chiropr Assoc [Internet]. 2014
7. ANGEL GARCIA, D.; MARTINEZ NICOLAS, I.; SATURNO HERNANDEZ, P.J. and LOPEZ SORIANO, F.. Clinical approach to chronic low back pain: synthesis of evidence-based recommendations from existing clinical practice guidelines. Anales Sis San Navarra [online]. 2015, vol.38, n.1 [cited 2024-02-20], pp.117-130.
8. Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating chronic back pain: time to back off? J Am Board Fam Med. 2009; 22(1): 62-68.