Blog 2: Lower Back Pain in Athletes
Part 2: The Real Drivers: Glutes, Hip Mobility and Thoracic Stiffness
Welcome back to Lower Back Pain in Athletes. In Part 1 we established what lower back pain actually is, the four main structural drivers, why athletes are particularly susceptible, and why the cycle of improvement and relapse happens so predictably. Now we go deeper into the physical factors that are behind most of the athletic lower back pain I see, regardless of which specific structure is involved.
Here is the truth about lower back pain in athletes: the lumbar spine is almost never the problem. It is almost always the victim. The problem is almost always in what surrounds it, the structures above and below that are supposed to do a job and are not doing it.
The Lumbar Spine Needs Its Neighbours to Cooperate
The lumbar spine sits between the thoracic spine above it and the pelvis and hips below it. Its job is to be stable, to transfer force efficiently between the upper and lower body without being the primary mover in any direction. When the structures above and below it are doing their jobs properly, the lumbar spine handles its load well. When they are not, it compensates. And compensating structures eventually fail.
The three most common neighbours that stop cooperating in athletes:
1. Weak and Inhibited Glutes
I have written about glute inhibition in detail in our Activate Before You Train series. For lower back pain specifically, the consequences of underperforming glutes are significant and direct.
The glutes are the primary hip extensors. They generate the propulsive force in running, skating, and cycling. They stabilize the pelvis during single-leg loading. And they protect the lumbar spine by absorbing the forces that travel up the kinetic chain from the ground during every footstrike and push-off.
When the glutes are not doing their job:
The lumbar erectors compensate for the missing hip extension force — working harder than they are designed to and accumulating fatigue and irritation over a training session
The pelvis loses its stability anchor — tilting anteriorly, which increases lumbar lordosis and loads the facet joints and posterior disc under every step
The hip flexors shorten further as they dominate an already unbalanced relationship — pulling the lumbar spine into extension and further compressing the facet joints
Single-leg stability degrades — every running stride, skating push, and golf swing is performed with a pelvis that is inadequately controlled, forcing the lumbar spine to absorb movement it was never supposed to handle
In runners this shows up as lower back pain that develops late in long runs. In cyclists it appears after sustained periods in the saddle when glute fatigue tips the system past its threshold. In golfers it is the lower back that takes the deceleration force of the swing because the glutes are not absorbing it.
2. Restricted Hip Mobility
The hip joint is designed for significant mobility in all planes; flexion, extension, internal rotation, external rotation, abduction, and adduction. When that mobility is restricted, whether from capsular tightness, hip flexor shortness, or structural limitations, every athletic movement that requires hip range of motion borrows it from somewhere. The lumbar spine is the most common lender.
How restricted hip mobility drives lower back pain:
Limited hip extension — when the hip cannot fully extend in the running stride or skating push, the lumbar spine extends to make up the difference. This is one of the most direct and most common mechanical pathways to facet joint irritation in runners and hockey players.
Limited hip internal rotation — essential for the lead hip in the golf swing and the stance phase of running. When internal rotation is restricted, the pelvis rotates through the lumbar spine instead. Rotational load on an already compressed lumbar spine is a reliable injury mechanism.
Tight hip flexors — the psoas originates on the lumbar vertebrae. When it is chronically shortened, as it is in any athlete who spends significant time sitting or cycling, it pulls directly on the lumbar spine with every step. The combination of anterior pelvic tilt and direct lumbar traction that results is a significant contributor to disc and facet loading.
The mobility assessment that reveals the most in athletes with lower back pain is almost always the hip. Finding and addressing restriction there is frequently the highest-return intervention available.
3. Thoracic Spine Stiffness
The thoracic spine, the mid-back, is designed to rotate. It is built for it. When it rotates well, the lumbar spine does not have to. When it does not rotate well, the lumbar spine picks up the slack.
In runners, a stiff thoracic spine reduces the counter-rotation between the upper and lower body that is essential for efficient running mechanics. The trunk becomes a single rigid unit and the forces of arm swing and leg drive have to be absorbed somewhere, often the lumbar spine.
In golfers, thoracic restriction is the most common mechanical driver of lower back pain I see. The golf swing demands significant thoracic rotation. When that rotation is not available, the lumbar spine rotates instead, in a direction it was never designed to move under load, repeatedly, across hundreds of swings.
In cyclists and desk workers who train, sustained thoracic flexion creates a kyphotic posture that is carried into sport. The lumbar spine then has to work against that kyphosis to maintain upright posture, creating sustained extensor muscle fatigue and posterior disc compression.
Up Next: Core Strength and Activation
We have established what is upstream and downstream of the lumbar spine that creates lower back pain in athletes. Part 3 of Lower Back Pain in Athletes addresses the third major driver; the core. Specifically, why most athletes think about core strength completely wrong, what the core actually needs to do, and what happens to the lower back when it does not. See you there.
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If your lower back pain follows a pattern that connects to hip restriction, glute weakness, or thoracic stiffness, a movement assessment with Dr. Keirstyn will tell us exactly what we are dealing with. Reach out to book yours at Endurance Therapeutics.
📍 Endurance Therapeutics | Oakville, Ontario
📞 905-288-7161