Building off the two previous blogcast posts, an area that patients and athletes frequently continue to ask me about is the low back (“Lumbopelvic Fulcrum”). The following is another excerpt from my book, “Fulcrum-Lever-Sport: A Handbook of BioMechanics for Improved Performance and Injury Prevention”.
In this, I discuss what the literature has to say about low back biomechanics and how to train the area.
The Lumbopelvic fulcrum is often referred to as the low back and encompasses the lumbar spine, the pelvis, the sacroiliac joints, the glutes, and the muscles of the low back. This area is a very common cause of pain and dysfunction, known as “low back trouble.”
In his landmark study, Biering-Sørensen (1984) found two things. First, individuals with more mobility in their low back, known as hypermobility, had an increased risk of developing low back trouble. This is especially common in men. Paradoxically, this hypermobility is commonly experienced as stiffness and tightness due to reactive muscle guarding. This makes sense, as the area is designed to be stable, rather than mobile. If it’s not stable and allows too much mobility, the system is dysfunctional and causes the individual to walk around with reactive fulcrums, rather than proactive fulcrums. A flexible lumbopelvic fulcrum is not a healthy, nor durable, fulcrum.
Second, individuals who are unable to maintain a back extension hold for a sustained period of time have a significantly higher risk of developing low back trouble in the following year. The back extension hold is when the subject extends off the edge of a bench or table, while their feet are held down. In this study, the subjects were slightly extended and mildly hyperextended off the edge of the bench.
Biering-Sørensen had a large group of subjects complete a long list of tests and measurements on day one. A year later, he gave the same subjects a questionnaire and asked them how often they experienced back trouble over the previous year. The individuals who could hold this position the longest had the lowest instances of low back trouble over that year period.
Back Extension Static Hold
Biering-Sørensen discovered that those who could hold this position for up to four minutes had the lowest risk of developing low back trouble.
Four minutes may seem like a long time, but remember: for even a short run, the lumbopelvic fulcrum needs to stay stable for much more than four minutes. In order to walk for a period of time, go to the gym, or work in the yard, the lumbopelvic fulcrum needs to be stable enough to keep up. That’s a long time, in comparison to the four minutes needed to maintain that lumbopelvic stability.
Since this study, other researchers have looked at dynamic training and testing of the lumbopelvic fulcrum. Some researchers had individuals perform back extensions in repetitions off of a slightly higher device. The subjects were told to flex and extend in order to test the dynamic endurance capacity of the muscles of the lumbopelvic fulcrum. These studies indicated that individuals who could complete at least 50 repetitions had a decreased risk of developing low back trouble.
Fifty repetitions may seem like a lot. However, this number is low in comparison to the 1,500–1,800 repetitions that occur with just a mile of levering activity, such as walking or running. For example, many people focus on reaching 10,000 steps a day. This means that their lumbopelvic fulcrum needs dynamic stability to lever 10,000 times. With research stating that an individual only needs to complete 50 back extensions in order to decrease the risk of low back trouble, this should be easy in comparison to these 10,000 steps a day.
Back Extension Repetitions
Lumbopelvic Fulcrum Training Homework
In order to train your lumbopelvic fulcrum, there are two parts to focus on: static (isometric) stability and dynamic durability. First, for the isometric part, position your pelvis on a contact at least four to six inches off the ground. If you’re too close to the ground, you will have too much support, which doesn’t allow you to train the muscles properly. The ideal position is illustrated below.
Back Extension Static Hold
Place your hands across the front of your shoulders and hold yourself in a slightly hyperextended position. This may feel moderately uncomfortable, but attempt to hold the position for as long as you can. The amount of time that you’re able to hold yourself in this position is your hold test number (hT). Once you’ve established this number, complete the following routine every other day. First, aim for one set of 50% of your hold test number. Once you’ve completed this, rest for one minute. Then, repeat the hold and aim for 75% of your hold test number, and then rest for another minute. Finally, complete your last hold and aim for 125% of your hold test number, for a total of three holds.
Lumbopelvic Fulcrum Static Hold Training Program
Test For Your Maximum Effort Back Extension Hold = hT
Then:
Every Other Day
Hold for 50% of hT
Rest 60 Seconds
Hold for 75% of hT
Rest 60 Seconds
Attempt to Hold For 125% of hT
For example, imagine a person found their test hold number to be 60 seconds. For the first set, they would aim to hold for 30 seconds (50%), and then rest for a minute. For the second set, they would hold for 45 seconds (75%), and then rest for a minute. For the last set, they would attempt to hold for 75 seconds (125%).
If you’re unable to reach 125% during your last set, that’s okay. The goal is to reach a maximum effort hold, and eventually work yourself up to 125%. When you can reach this goal for three sessions in a row, start over and repeat the initial test to find a new hold test number. This will give you a new number to base your future sessions off of. Repeat this program, and retest every time that you achieve three sessions in a row at 125%.
In order to follow research and the progression of Stability then Mobility then Function, or Fulcrum then Lever then Sport, the goal is to maximize your hold for up to four minutes. Feel free to continue doing other activities, but work to implement this exercise into your overall workout program to help prevent, and perhaps treat lumbopelvic fulcrum imbalances and injuries. This will help increase the stability and durability of your lumbopelvic fulcrum, which will increase your overall performance. Once you reach four minutes, you can move onto the next phase: repetitions.
For the next part, we will follow the same program, but with repetitions. First, on a significantly higher platform, complete a test where you extend down towards the ground, and then come back up to engage your full range of motion. Complete as many repetitions as you can.
Back Extension Repetitions
This will serve as your repetitions test number (rT). Every other day, perform 50% of your repetitions test number, and then rest for a minute. Then, perform 75% of your repetitions test number, and rest for another minute. Finally, finish with a maximum effort in an attempt to reach 125% of your repetitions test number.
Lumbopelvic Fulcrum Dynamic Training Program
Test For Your Maximum Effort Back Extension Repetitions = rT
Then:
Every Other Day
Perform 50% of rT
Rest 60 Seconds
Perform 75% of rT
Rest 60 Seconds
Attempt to Perform 125% of rT
For example, if a person determines that their maximum effort is 12 repetitions, their first set would consist of 6 repetitions (50%). Then, the second set would be 9 repetitions (75%), with the maximum effort reaching 15 repetitions (125%). When they can reach 15 repetitions in three consecutive sessions, they would repeat the initial test to find their new repetitions test number, with the ultimate goal being 50 repetitions. If you’re unable to reach 125% during your last set, that’s okay. The goal is to reach a maximum effort hold, and to eventually work yourself up to 125%.
Over the course of training, an ideal program would be to alternate back and forth between these two training programs over the course of a year. Spend three to six months working on stability, or the isometric hold. Next, spend another three to six months working on durability of the lumbopelvic fulcrum by completing back extension repetitions. Alternating back and forth will help ensure that your lumbopelvic fulcrum has both static stability as well as dynamic durability. This combination will serve to thoroughly train the lumbopelvic fulcrum, both isometrically and dynamically, in order to improve performance and decrease injury.
As always, if you have any questions, please email me at ross@drtri.com
-Michael Ross DC, CSCS, DACRB