I’m not a doctor and this is not medical advice. If you’ve had an accident, go see a doctor.
The following tests can help you identify common functional causes of back pain. If you identify with one of these intolerances you can quickly eliminate your back pain and allow your body to heal by avoiding your intolerance.
Flexion intolerance Tests
Your back rounds while sitting and standing and you move at your back instead of your hips.
Sitting with a rounded spine. Pull down on the chair to add load while rounding.
While standing, round forward and hold.
Lower down into a deep squat and hold.
If you felt pain with these tests, you might be flexion intolerant. These guidelines can help:
Avoid sitting for longer than 50 minutes at a time and change positions every 10 minutes.
Avoid slouching while sitting or standing by rolling your hips forward (hip anteversion)
Lengthen your abdominals and hip flexors
Strengthen your glutes and improve core stability.
When picking things up, avoid spine flexion and learn to hip hinge (keep reading)
Sit at the edge of your chair to avoid slouching and practice tall sitting (keep reading)
If lying on your stomach feels good, stay there for a few minutes every day or any time your back starts to hurt. This position allows for gentle extension of your lower back that can help if you have flexion intolerance from a posterior disc bulge. If lying on your stomach causes pain, place a pillow under your stomach to reduce the amount of extension. Extending your hips by squeezing your glutes can provide additional relief if this position causes discomfort. If you still have pain from this position, avoid this position as it’s likely you have extension intolerance.
Extension intolerance Tests
Your back arches excessively and you move at your back instead of your hips.
Lying on your stomach causes you pain
There is a large arch in your back (lordosis) while standing or lying down
Sitting at the edge of your seat with an arched spine is painful. Pull down on the chair to add load while arching.
If you felt pain with these tests, you might be extension intolerant. These guidelines can help:
While standing, keep your knees and hips soft and don’t excessively raise your chest up.
Avoid sleeping on your stomach or place a pillow under your belly to decrease the amount of extension.
Lengthen your hip flexors
Strengthen your glutes and improve core stability.
Consider leaning back against the chair to avoid over arching your spine and practice stretchsitting (keep reading).
When picking things up, move from your hips, not your low back.
Rotation intolerance Tests
You rotate excessively at your spine or have an imbalance that creates uneven forces on your spine. You might habitually sit unevenly or with one leg tucked under your hips.
Lie on your stomach and keep your knees straight as you extend one leg at a time off the ground and hold for 5 seconds. If you feel pain, reset, brace your core and try again. If you had pain the first time but not the second time then you have rotation intolerance that is fixed with proper bracing.
If you are rotation intolerant, these guidelines can help:
Stand and sit evenly - don’t shift your weight or lean to one side and don’t cross your legs while sitting.
Avoid rotating at your low back, and instead brace your core and rotate at your hips and chest.
If you carry a bag, switch sides regularly or use a rolling bag.
If you’re a side sleeper, place a pillow between your knees to limit rotation at your hips that places uneven forces on your low back.
Load intolerance Tests
You lack core stability and loading your spine recreates pain.
Sit on a chair and pull down to apply compression force.
Raise a light weight (5-15lb) to shoulder height in front of you.If you feel pain, reset, brace your core and try again. If you had pain the first time but not the second time then you have load intolerance that is fixed with proper bracing.
Perform a heel drop by raising up onto your toes and then dropping down onto your heels with force. If you feel pain, reset, brace your core and try again. If you had pain the first time but not the second time then you have rotation intolerance that is fixed with proper bracing. However, if bracing your core and performing the drop test increases your symptoms, you may be dealing with a possible end plate fracture of your spine.
If you felt pain with these tests, you might be load intolerant. These guidelines can help:
Avoid performing tasks that require you to lift or carry a heavy load.
Avoid activities with dynamic loading like running and jumping or any other tasks that place a load or shock through your body.
Improve spinal stability by learning how to properly brace your core before lifting objects and while performing activities (keep reading).
These intolerance tests can help you quickly identify the functional causes of your back pain, and this is where I recommend starting if you have chronic back pain. If none of these tests identify the cause of your back pain, great! We've eliminated some of the simpler causes. Each assessment you complete takes you one step closer to identifying your unique cause of pain.
If you'd like to read more about these intolerance tests, I recommend Rebuilding Milo by Dr. Aaron Horschig. If you have any questions, leave a comment below!