Back Pain: The Postural-Structural-Biomechanical (PSB) Model & The Bio-Psycho-Social (BPS) Model

Back pain is a crazy topic to examine in the literature – it’s all over the place. In the video below, I discuss two different models of back pain: one pertaining to the body’s structure, posture, and biomechanics, and the other pertaining to biological, psychological, and social phenomenon. It is very important for those who work with individuals in back pain to understand each model. These two distinct but interrelated models help explain both acute and chronic low back pain.

Notes

Here are the notes I took for the video:

Postural Structural Biomechanical (PSB) Model

Applies more to athletes & lifters and acute pain

This model makes sense to strength coaches – they’ve witnessed it

Posture

Structure

Biomechanics

Shape, size, length, strength balances, posture

Anatomy does influence likelihood of pain & injury in sport and weightroom

Merging of functional anatomy & physics

Anterior pelvic tilt/lumbar hyperlordosis

Posterior pelvic tilt/lumbar hypolordosis

Sleep in awkward position – hurts next day

Round back deadlift – hurts next day

In lifting, often biomechanical explanation

Knees hurt due to knee valgus

Back typically hurts due to excessive motion under heavy load

Hip mobility, core stability, glute activation, motor control – doesn’t work for everyone

If all you have is a hammer, everything looks like a nail

Biopsychosocial (BPS) Model

Applies more to non-athletes and chronic pain

Biology

Psychology

Sociology

MRIs – most of us are jacked up at most joints and also discs

Pain = brain, nerves – pain signal must go up and back down

PSB not highly correlated to chronic pain – pain is a physiological process

Depression, # of friends, confidence (and even smoking) correlated with chronic back pain

Knowledge is first step

Movement, exercise, and manual therapy work but often by different reasons

Altering brain’s perceptions and nervous system’s response

Decreasing fear and threat-response

Start with pain-free movement and gradually progress

Touch

Praise

Increase confidence, decrease depression & fear

backache - isolated on white digital composition

Recommended Links

Dr. Stu McGill

Soma Simple

Recommended Articles

Enough is Enough

A Revolution in the Understanding of Pain and Treatment of Chronic Pain

The Myth of Core Stability

The fall of the postural–structural–biomechanical model in
manual and physical therapies: Exemplified by lower back
pain

Is a postural-structural-biomechanical model, within
manual therapies, viable?: A JBMT debate

Biomechanics of Lifting and
Lower Back Pain

Biomechanics of back pain

Recommended Videos

Lorimer Moseley – Why Things Hurt

Pain. Is it all just in your mind? Professor Lorimer Moseley

Biomechanics of the Lumbopelvic-Hip Complex and Applications to Resistance Training

42 Comments

  • jeff teta says:

    Great stuff Bret! Thanks so much

  • jessephysio says:

    Well done Bret, really amazing seeing a S&C coach diving into the issues. You’re going to make a lot of your colleagues look back with your drive to learn more and understand the full spectrum of issues your clients may present with.
    very good talk

  • Andy... says:

    Diet is also a key issue, maybe THE MOST important.

    Diet can degrade/calcify/inflame joint problems (sugar/alcohol/dairy products). Diet can also affect/destroy the brain thus crebrospinal fluid production.

    What has happened is that we have become our own worst enemy.

    Fix the diet first.

  • Thanks for posting Bret.

    I would say in the UK the healthcare system & physiotherapy services have swung too far towards the BSP model, as you state at start of vid. Now this could be because of the demographic of the people who see an NHS physio, and also the length of referral time, by the time some people see a physio 12 weeks have passed – so they are now chronic and have had no treatment for 3 months – everyone elses pain has either resolved or they have sort private help.

    I’ve been on exercise for low back pain management & chronic back pain courses and really all that was talked about was BSP. To such an extent, that it was said that any exercise would be helpful, it didn’t matter – even down to playing bingo! Which, of course, may be relevant to the house bound 50 year old with chronic pain but not the motivated 20 year old rugby player with injury.

    Also wouldn’t underestimate the role of 1) litigation (where theres a blame theres a claim) 2) and long term disability benefit in affecting chronic back pain & BSP. This doesn’t mean the pain the person is feeling isn’t ‘real’.

    Lastly, the New Zealand Acute Low Back Pain Guide is really useful for assessing psychosocial yellow flags. Its a free pdf from acc.co.nz . But you may already be aware of it with your New Zealand connections

    Cheers

  • Graeme says:

    Bret have you seen this study. Looks encouraging for chronic back pain sufferers with disc problems

    http://www.sciencebasedmedicine.org/antibiotics-for-low-back-pain

    • Bret says:

      Hi Graeme! I check that journal (European Spine Journal) each month for my research review but must have glossed over that one as I wasn’t aware of it. Very interesting – time will tell. Thanks!

  • Graeme says:

    Bret I got prescribed the antibiotics earlier this week. Will try run it for 3 months. Had a l5/s1 microdiscetomy like Ben Bruno but still get inflammation. Will keep you posted

  • Hi Bret,

    Firstly, addressing the antibiotics and back pain – there is a large COI. The researchers were on the board that certifies doctors in antibiotic therapy. (http://www.rheumatologyupdate.com.au/latest-news/back-pain-study-failed-to-disclose-coi)

    I haven’t read the study, so I can’t comment, but I just wanted to raise your awareness on this point.

    Regarding the PSB model, I think early in your video you have confused injury and pain.

    Certain biomechanics, particularly under load, can lead to increased likelihood of structural deformation/injury, but this does not always cause pain.

    Conversely, those PTs (and other practitioners) that primarily (or solely) use a BPS model don’t argue that tissue damage from an injury doesn’t cause/contribute to pain, but they are aware of the limitations in blaming the injury solely on pain.

    Anecdotally I have seen this in my clinical practice, where a patient presents with an acute injury and I can treat and alleviate their pain, whilst the injury is still present. This is also the case with medication.

    Your second point, that doing a lot of hyperextensions can cause pain may be valid, but is it applicable to real life. Any very unfamiliar activity, particularly those that can cause tissue damage/deformation (like resistance training) can pose a perceived threat and result in a pain output.

    However, if you gradually built up your tolerance to that workload, would you experience pain? Would the tissues not adapt, as your hypothesised in your article on spinal flexion exercises?

    There may be an increased risk for injury, there may not be. However to definitely say they will cause pain only strengthens the BPS model – your belief system contributes to the brain output, both conscious and unconscious.

    Also, what determines an anterior pelvic tilt? Or posterior? What if that is that persons normal? You have continually mentioned (on your blog) many high level athletes exhibit what would be termed an anterior pelvic tilt – do they have increased risk of injury? Do they experience more or less pain than the average trainee?

    Additionally all the preventative measures you mentioned (stretches, strengthening etc) do work, but by what mechanism? Threatening/noiceptive afferents are decreased, and there might be inhibition of these afferents via descending dorsal columns – this can decrease pain output because the movement is no longer threatening.

    Of course – as I mentioned, tissue damage/injury can contribute to pain, but as I questioned, does the body adapt to ‘bad form’ from a tissue basis?

    This is a great topic to address, and one that needs more discussion both in manual therapy and strength and conditioning, so thank you for bringing it to light.

    Also, please understand, I may be wrong, I am still learning myself, and whilst I have questioned what you have said, I am not attacking you personally, and I am happy to have my understanding clarified.

    • Bret says:

      Nick – excellent comment. Appreciate the heads-up on the antibiotics study. The authors seemed cautious in their conclusions and recommended more research, so again, time will tell.

      Great job clarifying the relationships of load, deformation, injury, and pain.

      I suppose we can say, “The Biomechanics of Low Back Injury” and examine the physics behind anatomical/structural damage, but not “The Biomechanics of Low Back Pain” as there is no such thing. Pain is a physiological response that isn’t always predictable or related to damage/injury.

      Good point about tissues adapting, and while they certainly do with bone and muscle, I also think they do with discs (but no research has shown this to a degree that I can say with confidence). However, only to a certain point. Obviously we don’t want to throw caution to the wind and purposely try to induce structural damage to more delicate tissues just because pain isn’t predictable or can be overridden.

      Great point about the belief system contributing to brain output!

      And with APT, the research shows that they do not have more pain, but in my experience as a trainer they often require modifications with certain exercises. But I could be biased as I’m aware of no research supporting my claim. The risks of APT are often grossly exaggerated by those who champion the PSB model for sure.

      I suppose corrective exercise can decrease pain in two ways. First, by improving form which would decrease the deformation on certain structures and prevent the pain alarm. And second, by increasing familiarization/confidence and removing the nociceptive afferents and pain efferents as you stated.

      I’m still learning too my friend – great critical thinking skills!

      • I totally agree about throwing ‘caution to the wind’ regarding biomechanics – I’m not about to go about doing my deadlifts round backed anytime soon – but I realise that my beliefs as much as my biomechanics play a role in whether I experience pain afterwards (as an aside: I lift KBs, and competitively, the snatch is often performed round backed, with 32 kg for hundreds of reps per week with no ill effects reported anecdotally).

        I think you are definitely on the right track here, and I’m really happy to see the BPS model get such good exposure in the fitness field, considering how well read you are.

        Regarding models, as you most likely know (please indulge me here), science can’t prove anything directly, only disprove it. We use models to explain our observations.

        So when the BPS model can explain things in the PSB model, but the inverse is not true, I would lean toward the BPS model being superior at this point in time, given the current body of knowledge.

        Just to clarify your point where you stated:

        “I suppose corrective exercise can decrease pain in two ways. First, by improving form which would decrease the deformation on certain structures and prevent the pain alarm. And second, by increasing familiarization/confidence and removing the nociceptive afferents and pain efferents as you stated.”

        There is no pain alarm. The deformation would result in change to sensory afferents (if the deformations deformed nerves) – which could lead to a pain output.

        I see you linked to Soma Simple in your post, I actually posted a thread about this post there, with my comment attached for critique by those more knowledgeable than me. I invite you to come and participate in the thread.

  • Conrad says:

    Very Nice!
    Completely agree that understanding this is essential when working with people, especially as an MD/PT/DC. Good to at least be familiar as an exercise professional. Initial confusion when learning about BPS model seems pretty normal. I know I felt like I needed to be a psychologist or something to deal with chronic pain when I first learned about it.

    Very good differentiations between acute and chronic pain and how there are some additional considerations or differences when dealing with active/sport/exercising populations.

    Love your brief discussion on ART and fascia.

  • martos says:

    Hi Bret, thanks for all the great information. I haven’t found time tot read it all, but probably this weekend i have the time tot do. I have one quick question: i read the conclusions of the article ‘the myth of core stabilization’. There saying that bracing manoeuvres should be discouraged. What does this for example mean for deadlifts: that you shouldn’t brace the core what most coaches recommend? And what about exercises likes planks where you actively try to tension the trunk muscles? Maybe it’s just me, but i get a little confused with all the opposite information we get nowadays. Thanks.

    • Bret says:

      Martos, I’ve seen this topic come up quite often and I’ve given it great deal of thought. Some recent discussion is that you shouldn’t try to overly squeeze the muscles (brace, etc.) as this will lead to a high-threshold strategy which can create problems. Other folks like McGill recommend the brace. Louie Simmons recommends pushing the abs out into a belt during squats. Chek still advises to suck in to activate the TVA. What’s my take? You don’t need to brace on many exercises. If you’re specifically trying to teach the body to activate certain muscles better, such as glutes or obliques, then it’s okay to purposely contract them (some would say this is overkill). If you’re maxing out, then you should brace, but this should come automatically – thinking about it will detract from performance. So it should be something you’ve done time and time again in training. And the type of lift matters – a high bar full squat or power clean might not require a brace, whereas a low bar sumo squat or deadlift probably will. Hope that helps!

  • Patrick says:

    Hi bret, i like the balanced approach you’ve taken with this stuff. I do think there is a dualism trap we can fall into when we start talking acute vs chronic pain. Its tempting to think more biomechanically when an injury is acute. The difficulty inherent to assigning causality of symptoms to mechanical factors is not so much that it doesn’t happen, but rather, the extent to which we as Therapists/trainers are able to assess a given biomechanical pattern/set up as injury causing. I think what typically happens is that we tend to fool ourselves into thinking that we have very sensitive assessment routines that pinpoint a specific problem, we set about addressing that problem and confirmation bias sets in if/when the client’s symptoms resolve. What is more likely though, is that we have simply provided novel and non threatening, graded sensory inputs (movement experiences) that bring about a reduction in defensive outputs (pain, defensive motor output). I think adjustments/monitoring of frequency, volume and duration are more important than mechanics.

    For those who do think they are abke to accurately assess and address specific biomechanical faults or injury causing postures, please consider the following questions:

    Mechanical requirements:
    Are humans proportionately similar enough (in terms of bone length and shape) to make generalizations about the mechanical requirements for a given task?
    Assuming there exists a degree of variation across the human population, doesn’t that mean that at best, we can only ever theorize a range of mechanical requirements for the performance a given task?

    If such a theory was quantifiable (accounted for the variability across the whole human population), would we be left with a narrow or broad range of mechanical requirements for the performance of a given task?

    Tissue damage
    Do human tissues adapt/fail similarly enough across the whole population to make generalizations about dosage parameters (frequency, intensity, duration) for preventing tissue breakdown? Assuming there exists a degree of variation across the human population, doesn’t that mean that at best, we can only ever theorize a range of dosage parameters within which tissue breakdown is preventable?

    If such a theory was quantifiable (accounted for the variability across the whole human population), would we be left with a narrow or broad range of dosage parameters for the prevention of tissue breakdown?

    Pain
    Do humans experience pain as a result of tissue breakdown similarly across the whole population? Assuming there exists a degree of variation across the human population, doesn’t that mean that at best, we can only ever theorize a range of “tissue breakdown values” within which pain should be absent?
    If such a theory was quantifiable (accounted for the variability across the whole human population), would we be left with a narrow or broad range of tissue damage values that we could label as painful tissue damage?

    Putting it all together
    Given the variability of each category above, if you were to do a mashup and calculate the variability across the population for mechanical variation, tissue adaptability and emergence of pain, would we be left with a very broad or very narrow model for relating biomechanics, tissue damage, injury and pain?
    What would assessment and treatment routines look like if they reflected the actual variability between biomechanics, tissue adaptability and emergence of pain across the human population?

    Do you think your current assessment and training routines reflect an understanding of a broad (non linear) or narrow (linear) relationship between mechanical requirements, tissue adaptability and pain?

    Great discussion.

    • Bret says:

      Hi Patrick. I haven’t quite “crossed the chasm” as Jason Silvernail might say, but I’m getting there. Some of it may just be semantics too.

      I give a client a 315 lb deadlift and he keeps good form – no pain.

      I bump the weight up to 345 lbs and he ends up rounding his back.

      The next day, he wakes up and his low back hurts, and he’s stiff all day.

      McGill’s research shows that the nucleus will gradually work it’s way through the layers of the annulus until the disc eventually herniates if the range of flexion motion is sufficient, the compressive loading is sufficient, and the frequency is sufficient.

      Let’s say I don’t correct the client’s form and I keep having him go heavier and heavier.

      Maybe he adapts to the task and his body no longer perceives it as a threat, so he feels no pain.

      But then one day the straw breaks the camel’s back and he herniates a lumbar disc – say L4/L5.

      Now he’s in agony.

      Over time he may be able to deadlift again but the point is that we should recognize the links between poor biomechanics, tissue damage, and pain associated with heavy lifting.

      I agree that posture and biomechanics aren’t that big of a deal with every day, sendentary folks. But with heavy lifting, we have to be more careful, especially with the lumbar spine IMO.

      At the end of the day, I suppose that all we can say is that there is “the biomechanics of tissue stress and damage” and there is “the physiology of pain,” and there is a relation (albeit far from perfect) between the two.

      I see your points about the variability in structure, posture, biomechanics, and damage in the population, and trust me, I’ve seen some of the things that gymnasts do and it’s clear that the body can adapt and build up a tolerance to movement, no matter how crazy it seems.

      I’m still wrapping my head around all of this and formulating my thoughts. Would love your input. – BC

    • Conrad says:

      I wanted to chime in on this as well. I read your post about 5 times, I like your thinking. I think I get what you’re saying but forgive me if I missed the point.

      If I understand, I think you are saying that there is a significant enough variability between humans in these categories that it becomes very difficult to come up with SPECIFIC quantitifiable requirements that really fit each individual. I would agree and therefore TRY to use the PRINCIPLES of these categories, knowing that I don’t know exact answers but the principles get me somewhere close enough to be a confident practitioner and build confidence in clients. After all, part of incorporating the BPS model would be that the client feels like someone knows what is wrong with them and knows how to “fix” them.

      Thoughts?

      I like how Bret summarized it, that we have the RELATIONSHIP b/w biomechanics, stress, and damage and the physiology/psychology of pain and plenty still left unanswered and still to learn.

      Some people pick one side and exclude or have no awareness of the other side and therefore truly miss the boat.

  • Patrick says:

    Hi Bret,
    I think your efforts to integrate all this into the training environment is admirable and also very necessary.

    As we increase the load/weight of a given task, I suspect that the range of mechanical strategies/options a person has to complete the task narrows. E.g. There are a hundred ways to bend down and pick up 5lbs from the floor… But our human anatomy is such that there are far fewer ways to lift 300lbs from the floor. So it’s not that a given technique for lifting heavy weights is wrong/injury/causing, it is more a case of, if you want to lift very heavy weights, technique “a” allows you to use your anatomy more effectively to complete the goal of lifting a heavy weight than technique “b” or “c” or “d”.

    The grey area is how much variance do we allow from technique “a”? We don’t have any good data on this. So we’re left to processes of trial and error. I think that what we typically recognize as “good lifting form” is the product of a kind of survival of the fittest, culling of techniques that over time, have proven ineffective for lifting heavy weights. The ineffective techniques may have been culled because trainers noticed that people kept getting injured when they used them. And it would be tempting to make the link and say “the technique caused the injury”. But that would be a correlation/causation error.

    Although we can’t be sure of a causal link, I still think that a strong correlation between certain lifting techniques and injury/symptoms is sufficient to warrant the teaching of the technique that best utilizes our human anatomy (for the purpose of lifting heavy weights). We just need to be more modest and less specific in our explanations of why we use that technique. Because the onset of low back pain following a rounded back dead lift for example, could be the result of a bunch of pathology other than a disc injury. Instead of “you need to be less lordotic during squatting or you’ll run the risk of herniating a disc”, perhaps we could say “let’s try tilting your pelvis this way a bit for a couple of repetitions. How does it feel to do it that way? Do you feel like you’re more balanced? Do you feel like you have more power from that position?” I think we can interact with the client to find a technique that feels the most comfortable/right/novel for them. And then we can add weight/load to it, ask more questions, make more adjustments, see how the client likes it etc etc.

    It would make sense that the client is less likely to wind up with an injury if they use a technique that they have confidence in, one that feels safe, powerful, supported, repeatable, stable etc etc. But the only way to really avoid injury when lifting heavy weights, is to lift lighter weights. I think we need to be transparent about that with clients… Lifting heavy weights, near to client’s maximal capacity is risky, regardless of technique.

    The best way to avoid an injury while lofting heavy weights is to lift lighter weights.

    • Bret says:

      Agree with everything you said Patrick. Asking clients more questions is something we should all do more of, in addition to being more transparent.

  • Joe Brence says:

    Bret,
    While I commend your efforts in attempting to understand the importance of a biopsychosocial model and pain, I think you may have made a few logical fallicies. I invite you to participate in the discussion over at somasimple and I think you could sharpen your understanding of pain and the biopsychosocial model: http://www.somasimple.com/forums/showthread.php?t=15451

    • Bret says:

      Oh shit haha! I pissed off some of the big dogs. I freakin’ love the folks at SomaSimple so nobody needs to worry about getting squashed 😉

      I’m unable to post on there as I don’t remember my password. And I’m in S. Carolina right now speaking at the Sorinex Summer Strong conference.

      Would love to be on the same page as everyone at SomaSimple. If Ken, Barrett, or Jason would like to write a critical response to my post, I’d be very happy to post it.

      I have no ego here and would love to learn from the experience. In fact, I may write a blog in a month or two correcting my work – just need to find the time to read up more on the topic and get everything organized in my brain (do more brain curls).

      I do have some questions that I’d like answered though…maybe I could do a Skype interview with one of the SomaSimple folks. Next week I’ll figure out my password and post on the forum. Cheers Joe!

  • Keats Snideman says:

    Great post Bret and nice discussion. This is such an important topic and one that needs to be introduced to all fitness/sports and rehabilitation professionals who are still operating on the old postural-biomechanical model.

    Although most people will be in for a heavy dose of cognitive dissonance when first hearing some of these concepts (as I experienced some years ago when I first really embraced this neuroscience approach to pain), it can only improve the way we teach and explain things to our clients/patients.

  • Keats Snideman says:

    I forgot to post that I am not against the biomechanical model, just that is doesn’t fully explain why we have pain and certainly doesn’t explain chronic pain whatsoever since people can have pain independent of the actual physical/structural health of their tissues.

  • Ben says:

    Hi Bret, I’m really glad you’re sharing this info and great follow-up comments by everyone so far. I’m a little late to the party but hope I can still share my thoughts on this for the sake of continuing the discussion:

    If someone is attempting to adopt the BSP model while ignoring biomechanics, I think that’s a misunderstanding on their part and not a flaw of the model. The way I’ve come to understand it, the BSP model doesn’t complement the PSB model, it integrates it. (and there’s an interesting thread on SomaSimple which discusses whether BSP is even the most appropriate term) I don’t think this is just a semantic distinction and it’s important for at least two reasons:

    1) Giving the PSB model precedence when it comes to injuries might perpetuate the belief that “perfect” biomechanics can/will prevent pain or injury. That may not be what you meant, but this idea does get repeated over and over and there doesn’t seem to be supporting evidence. Maybe even more critical is that it can reinforce the belief that less-than-ideal form or posture, supposed strength imbalances, etc., WILL lead to injury and that in turn just perpetuates fear-avoidance behaviors, which can up-regulate the pain response. Even if a particular movement or posture is taken to be associated with excessive wear on a joint, is it really that movement itself, or is it a lack of movement variety?

    2) While biomechanics become less and less relevant as pain persists, that doesn’t mean the nervous system (or the BSP model, or the neuromatrix model) becomes any less relevant when it comes to acute injuries. One simple example of this is how much pain you can feel when you stub your little toe, but usually there is no serious damage and you can go from debilitating agony to walking it off within a few minutes. Pain really isn’t a reliable indicator of actual tissue damage, even though it might seem like it sometimes. The fact that the PSB model cannot explain or account for this is good reason to discard it. That’s my opinion anyway, based on my current understanding after spending many sleep-deprived nights reading through the forums and materials on SomaSimple…

    Looking forward to your future posts and btw would love to see you do a Soma interview!

  • Anoop says:

    Nice post, Bret! This was long due, atleast after my article 🙂

    Jason Silvernail would be a nice person tp interview. He can put his thoughts in words very well.

  • Anoop says:

    Hey Bret,

    And the biopsychosocial model covers the biomechanics too.

    What do you think the ‘bio’ stands for? 🙂 Though the emphasis is certainly more towards the biological changes in the nervous system, it also refers to the structure / mesoderm.

  • Jeff says:

    Hey Bret,
    I was wondering if you have ever read any of Dr John Sarno’s books (The Mind Body Prescription, Healing Back Pain, or The Divided Mind)? I found them very informative and helped me understand pain better. Great video by the way.

  • Kory Zimney says:

    Getting into neuroscience and understanding of a brain that knows things that you don’t even know it knows can tie us up in knots real quick.

    Whenever pain is involved it is an output of the brain, so pain will always be a BPS issue and not a PSB (unless new research proves otherwise, but that is where our understanding is at this time). The PSB model is one input into the brain neuromatrix. Unfortunately we can not predict what any individual brain will do with that input because there are other inputs and once the brain gets a hold of the inputs it will produce an output that is an emergent phenomenon.

    I applaude you for taking on a very difficult topic and one that is probably very contraversial in your area of strength and conditioning, that has historically been entrenched in the PSB model. Getting into the BPS model forces us to look at everything from another layer above the PSB model in regards to what the nervous system (brain) is doing with our biology of the body systems (endocrine, immune, posture/structure/biomechanics, etc) as well as the biology of the nervous system and then add in the sprinkles of psycho and social areas.

    While I personally would disagree with some of what you have posted in that it may not be fully accurate with current pain neuroscience understanding as I have researched it, but also agree with some of what you have posted as well (isn’t that what many of us do when we read something on the internet: blindly agree or rudely disagree). I mostly want to applaud you for bringing a topic like this out for discussion in an open forum such as your blog. It should only help all those that want to understand it deeper and get us all to start to question things. It is through these discussions and questions that should bring us all to better understanding, which will help those we interact with.

  • smithjhon says:

    Thank you, for explaining all this to people. It is a great help! A big thank, you for the post and to your website at all.

  • Cliff says:

    Good article – after suffering from lower back pain for years, I finally found that a combination of strengthening the back (through bird dogs and similar exercises), and addressing the BPS model (lowering stress through meditation, etc.) finally helped my pain.

  • Hind says:

    I stumbled on your website a few days ago and was surprised with the quality of your writing and work! I’m so impressed that I added you to my RSS feed after just 2 articles, keep up the great work we need more trainers like u!

  • pang kheng says:

    hi Bret,
    great post man, do you have information about proper back squat to avoid lower back pain and relating injuries, thanks man.

  • alex says:

    I want to talk about Lamar Gant s posture when deadlifting, squating or else. His back is arched and you would think it is not a proper posture. He has severe scoliosis. I have got scoliosis myself but much less severe. I think Lamars posture is quite good for him considering his scoliosis. I noticed on myself that glutes muscles activate far better when i maintain an arched posture ( in my lower back ) when lifting than when using a traditional correct posture ( in the case of a person without scoliosis ) . In that case i feel no glutes working but mostly my lower back. Scoliosis in my case implies a hyperlordosis. I have a c shaped dextroconvexe thoraco lombar scoliosis. When i lift i try bringing my hips forward so that the legs would lift the most of the weight and not the lower back. Also , the knees are behind the toes. What do you think of my opinion ? After all, it s a question of biomechanics , but of a different shaped spine.

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