How to Fix Lower Back Pain From Overhead Press
It may seem counterintuitive that overhead movements, like strict/military press, can cause low back pain. However, from personal experience dealing with my own low back injury, as well as coaching and rehabbing many others, low back pain can come from, or be aggravated by, virtually any overhead movement. In this blog, we’ll discuss why overhead movements could be the cause of your low back pain and how you can fix it.
Overhead movements are performed in nearly every workout for CrossFit athletes and Olympic weightlifters. Experiencing low back pain with overhead lifting in CrossFit is less recognized and not as obvious than low back pain with squatting or deadlifting. But even though overhead motion is unassuming, it is a common cause of low back pain. Overhead movements can also aggravate a previous or existing low back injury.
Lower back pain can result from a more static movement such as overhead squats, strict shoulder/military presses, or more dynamic variations like push presses and jerks. I’ve also seen athletes with back pain during handstand push-ups, kipping pull-ups, and overhead kettlebell swings.
Dynamic overhead movements were the most problematic for me when I had an annular tear at L4-5 and L5-S1(a tear in the ligamentous structure around the vertebral disc in the spine). Surprisingly, I had no pain with deadlifts or squats. Dynamic movements require more core control and stability and are easier to lose your spinal position as the overhead loads are often much heavier.
Movements like the overhead press can cause the low back to arch or hyperextension, thus causing more spine compression. This is typically from insufficient mobility, control, and/or strength, which leads to positional compromises that place strain on the low back. More specifically from:
Decreased shoulder mobility
Lack of strict overhead strength
Poor core control causing a rib flare
Interestingly, coaches and healthcare providers often tell athletes who have low back pain to stop doing lower body exercises and just focus on upper body movements but that could be making the problem worse.
Instead, let’s look at ways to decrease low back pain with overhead press and other overhead movements.
Improve shoulder mobility
Improve scapular upward rotation
Improve thoracic spine extension
Increase strict overhead strength
Learn how to engage your core and improve core control overhead
Improve Shoulder Mobility
Normal shoulder flexion is 180 degrees
The shoulder joint is often the site of some major mobility restrictions that trickle downstream and can lead to faulty spine mechanics and low pain back.
Many people fall far short of the normal amount of shoulder flexion, which is 180 degrees. You can see from the picture how even lacking 10-20 degrees of motion at the shoulder joint could lead to compensations like overarching the low back in order to achieve a full overhead position.
The CrossFit movement standard for things like overhead press, overhead squat, American kettlebell swings, and thrusters is that an athlete’s hips, knees, and arms are fully extended and the bar or weight is directly over or slightly behind the middle of the body. In order to get weight overhead, have control, and meet the standard, many athletes loose the stacked position of their torso, spine and pelvis and therefore overextend through the low back.
In order to achieve this movement standard, many athletes will arch through the low back.
You can use the Back to Wall Shoulder Mobility Test to test your shoulder range of motion overhead. You sit back to wall with hips, spine and head touching. Then hold a dowel or PVC pipe with a shoulder-width grip and try to touch your forearms on the wall as you raise it overhead. Ideally your forearms touch the wall without your low back coming off the wall.
A common culprit of restricted overhead shoulder mobility is tightness in the lats and/or pecs. Therefore, tight pecs and tight lats can lead to low back pain during overhead lifting. You can mobilize the lats by lying on your side on a foam roller. The pecs are easier to access standing facing a wall and placing a lacrosse or mobility ball just below your collarbone near your armpit. For either area, add in active movement by reaching your arm overhead 10-15 times.
Another way to mobilize the powerful v-shaped lat muscle is with a Box Lat Stretch using a PVC or dowel.
Improve Scapular upward rotation
The scapula rotate around the rib cage during overhead movements.
Movement of the scapulae is also essential for full overhead range of motion. A lack of scapular upward rotation is a common issue that decreases shoulder mobility and leads to compensations lower down the spine that can contribute to low back pain.
During overhead movement, your humerus (upper arm bone) and scapula (shoulder blade) work together in what’s known as scapulohumeral rhythm. They move at a 2:1 ratio meaning, if you can achieve 180 degrees of shoulder flexion, 120 degrees should come from the humerus and 60 degrees from scapular upward rotation.
Many people spend all their time trying to improve their shoulder mobility by stretching the lats, but don’t consider that they might be lacking movement in the scapula. A simple mobility exercise to free up this area is using a lacrosse ball around the edge of the shoulder blade, either while lying on the floor or standing against a wall. Again, adding in active overhead reaching to achieve the best results.
Not only is tissue mobility important, but it is also key to gain strength at the end range of overhead motion. The Slider Reach with Y Lift Off is a great drill to focus on strengthening the muscles around the shoulder joint and mid back, like the lower trap and serratus anterior, that will not only improve your scapular upward rotation and strength overhead, but also make lasting changes in your mobility.
Sometimes there are bony structural changes that can happen in the shoulder joint like arthritis or having a curved or hooked acromion. These can cause shoulder impingement, decreased range of motion, and pain. If you have sharp, pinching pain overhead you’ll want to meet with a physical therapist to find exercises that are best suited for you. But even with anatomy challenges, these correctives could still help improve your overhead capacity and prevent compensations in your spine.
Improve Thoracic Spine Extension
It's also essential to get the last bit of overhead motion through thoracic extension. Thoracic mobility is limited for a lot of people because daily postures can promote a hunched and flexed position, which restricts the last part of movement overhead. Try rounding your mid-back and then lifting your arm overhead. Then sit up tall and repeat. Easier right?
If there is limited mobility in the thoracic spine, our bodies will get it from somewhere else, usually in the junction between the thoracic and lumbar spine (T12 to L1) and lumbar spine and sacrum (L5 to S1). There can be a lot of shearing forces in these “junctions”, which are weaker because of structural differences in the vertebrae. The result? Pain and potential damage over time.
You can improve thoracic extension when you’re sitting during the day. Simply reach your hands above your head and lean back over the top of a chair. Try to keep your low back pressed into the back of the chair so you’re focusing on the t-spine.
One of my favorite exercises is using a lacrosse ball peanut (two lacrosse balls taped together) along the mid back and adding overhead movement.
Increase Strict Overhead Strength
As I shared in a previous post, a great way to enhance motor control in the shoulders, thoracic spine, and core – which will also reduce the chances of movement faults causing low back pain – is to improve strict strength. Often, athletes overcompensate during dynamic variations like push presses and jerks without even knowing it because they lack upper body strength but are still able to perform the lifts using momentum from the lower body.
A couple times a week, try incorporating strict overhead press variations like:
barbell strict press
single arm dumbbell press
These can also be good modifications to use in CrossFit WODs if you have a lower back injury until you gain more strength and control overhead.
You might also implement a program that’s dedicated to accessory exercises. Improving strength and stability in the shoulders and t-spine through strict variations and tempo work will transfer to dynamic movements and reduce the risk of low back pain through proper positioning.
Learn how to engage your core and improve core control overhead
If you can learn how to engage your core and increase your control, it can help improve mobility and stability in the t-spine and shoulders. Maintaining control of your lumbar spine and awareness of what it feels like to keep it stable in overhead positions will also avoid positional changes that can cause low back pain.
I often use the analogy of keeping your “bowls closed” or “bowls stacked”. Imagine that at the bottom of your rib cage you have an upside-down bowl and at your pelvis, there’s a regular one. You need to keep them stacked throughout overhead motion. Having a rib flare during overhead movement is a common compensation. Cueing “close your top bowl” can help engage the core by pulling the rib cage down to shorten the distance between the belly button and the rib cage, avoiding hyperextension of the low back.
Some people find this hard because they’re weaker in their upper abs, as most people tend to concentrate on the lower abdominals. Hollow holds can help, as well as dumbbell crunches that focus on the motion from the rib cage to the belly button.
During the hollow hold, make sure to lift your shoulders off the ground - using the upper abs to pull your rib cage down.
The real cause of low back pain during overhead movement is often missed because people wrongly correlate good shoulder mobility with sustainable overhead movement. If during a shoulder mobility screening you had full range of motion, that’s great, but that may miss the fact that you lack control and stability during overhead movements. This is especially important if you’re a hypermobile athlete like me. This is also more likely to happen during those more dynamic overhead movements like the push press, jerks, and kettlebell swings that require more core strength and control.
Start by mastering your low back position during strict presses and shoulder height kettlebell swings before progressing to push presses, jerks and overhead kettlebell swings. Awareness is a key factor. Once you become aware of your form you can apply the necessary muscle control, steadily progress the load so you avoid over stressing your low back.
Here are a couple great drills to work on keeping your rib cage down by engaging the core, while adding overhead movement.
Use these drills combined with improving your shoulder, scapular, and thoracic spine mobility and increasing your strict strength overhead will help you achieve an overhead position that has less compensations and hopefully less lower back pain with overhead press!
