Overcome Back Pain: Functional Pain Triggers

Tompfeiffer
Oct 12
4 min read

Identify functional causes of your back pain. These intolerance tests will help us identify patterns of your back pain.

For some people, these tests won't show much, but for other people these tests will tell us a lot. All you need is a chair and a small weight of 10-20lb. We're testing flexion, extension, load, rotation intolerance, and sciatica. There are 8 tests, let's get started.

Flexion Intolerance

With flexion intolerance, your back rounds habitually and you move at your low back instead of your hips.

You sit and stand with a habitually rounded spine and time in these positions causes discomfort.

Rounding forward while bending down causes pain.

Man demonstrates two back postures; "Neutral" with a green check, "Rounded" with a red X. Background: brick wall, yellow line arcs.

Rounding forward and then pulling down on your seat causes pain.

Man sitting on stool, shirtless, performing shoulder and neck stretch. Text: "Round forward" and "Pull down." Background: glass doors.

If you suspect flexion intolerance, these guidelines can help:

Avoid sitting for longer than one hour and change positions every 10 minutes.
Avoid rounding while sitting or standing by rolling your hips forward (pelvic anteversion).
When picking things up, avoid spine flexion and learn to hip hinge.
Lying on your stomach might provide relief.

Man in shorts demonstrating two positions: lying on a blue towel on patio. Position 1: elbows down; Position 2: torso raised on forearms.

Extension Intolerance

With extension intolerance, your low back arches habitually and you move at your low back instead of your hips or thoracic spine.

You sit, stand, or lie down with an arched spine and time in these positions causes discomfort.
Returning to standing after rounding forward causes pain.

Man demonstrating posture, with "Arched" (red X) and "Neutral" (green check) positions. Indoor setting with brick wall background.

Arching back and then pulling down on your seat causes pain.

Man sitting on a black stool, arching back and pulling down, as indicated by arrows and text. He's indoors, wearing dark shorts.

If you suspect extension intolerance, these guidelines can help:

Keep your ribs down and stacked over your hips to prevent rib flaring.
Avoid sitting at the edge of your seat with an arched spine and instead lean back.
Avoid sleeping on your stomach or lie on a pillow to decrease spinal extension.
When picking things up or reaching overhead, brace your core and move from your hips and thoracic spine, not your low back.
Child’s pose might provide relief

Diagram of four skeletons showing spine and diaphragm movement in various poses. Arrows indicate direction of motion. Red highlights muscles.

Load Intolerance

With load intolerance there is a lack of core stability and loading your spine with weight or dynamic movement is painful.

Raise a light weight (10-15lb) to shoulder height in front of you. If you feel pain, 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.

Man demonstrates kettlebell swing in a brick-walled room. Text highlights "Brace Core" and "Hold" with instructional arrows.

Perform a heel drop by raising up onto your toes and then dropping down onto your heels with force. If you feel pain, 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. However, if bracing increases your symptoms, you may be dealing with an end plate fracture of your spine.

Man in black outfit demonstrated in side view stands in front of brick wall; text reads "Lift up" with arrow and "Brace Core."

If you suspect load intolerance, these guidelines can help:

Avoid performing tasks that require you to lift or carry a heavy load and dynamic activities like running and jumping or any other tasks that place a load or shock through your body while your spine recovers.
Improve spinal stability by learning how to properly brace your core before lifting objects and while performing activities.

Rotation Intolerance

With rotation intolerance, you rotate and move excessively at your low back or have an imbalance that creates uneven forces on your spine. You might habitually sit unevenly or with one leg tucked under.

Lie on your stomach with your legs straight and extend one leg at a time off the ground. If you feel pain, 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.

Man in athletic wear on exercise mat, performing core exercise steps 1 and 2 with "Brace Core" text, against a brick wall background.

If you suspect rotation intolerance, these guidelines can help:

Stand and sit evenly - don’t shift your weight or lean to one side and don’t cross your legs.
Avoid rotating at your low back, and learn to brace 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.

Sciatica

Diagram showing a herniated disk compressing the sciatic nerve, causing pain down the leg. Includes labeled vertebrae and disks.

Sciatica is when the nerve roots along the spinal cord have increased sensitivity and pain radiates down the sciatic nerve to your buttocks, leg, or foot.

Perform the slump test by rounding your spine as you flex your toes up towards your shins, and if this nerve stretch causes pain it indicates sciatica.

Man performs a slump test on a wooden stool, wearing gray shorts. Background shows glass doors and greenery. Arrows indicate motion.

If you suspect sciatica, these guidelines can help:

Attempt to lie on your stomach to find a pain-free position. You can place a pillow underneath your stomach for more comfort.
Build hip coordination and strength with exercises like the single leg deadlift and glute bridge.
Stop rounding your back when bending forward to avoid nerve stretching.
Some people benefit from nerve flossing where you gently “glide” nerves like you would floss a tooth back and forth. If this makes your symptoms worse, stop and try again with less intensity or seek professional help.

Illustration of a woman performing nerve flossing on a chair, extending and flexing her leg. Text reads "Nerve Flossing." Arrows show motion.

Conclusion

These 8 intolerance tests are a starting point to identify patterns around your back pain. Make a note of what you notice. If you want more in-depth help identifying the functional causes of your back pain, schedule a consultation to work with me directly.

Hope this helps! - Tom

Man in blue patterned shirt and cap smiling on a boat with the Statue of Liberty in the background under a partly cloudy sky.