Ask any athlete or lifter what injury he’d consider to be the most debilitating and most would agree that low back pain would rank the highest. Like many reading this article, I pride myself on my hard-earned ability to lift heavy things. Unfortunately, like many reading this, the cumulative effects of years of improper training had taken their toll, resulting in chronic pain.

In an injured lifter’s world, gravity is magnified by pain. Warm-up sets performed with 135 pounds on the platform feel like five plates per side rattling together on the collars. Pulling with three plates per side feels like you’re ripping the bar from quick sand. Five plates per side? Forget about it. "Pedestrian-esque" pulling feats feel like PRs. Frustration boils over and dejection sets in.

For a number of years, I was this lifter. I watched my training partners and coaching colleagues soar to new heights on the deadlift while merely demonstrating a deadlift or initial pull of an Olympic lift with a lightly loaded bar for my athletes evoked off-the-charts pain. Something was seriously wrong, and I knew it. My training bravado could no longer mask the pain, so I stepped away from the platform, vowing not to deadlift until I figured out what was going on.

I figured that my lower back pain stemmed from a series of injuries that I had sustained when I was younger—an injury I had suffered while playing football (slipping on the wet grass as I reached overhead to make a catch before falling on my backside), and another I had suffered a few months later following a few sets of heavy leg curls. Initially, I thought these injuries had set the stage for my lower back woes, but I’d be remiss not to investigate the issue even further.

Before I got into coaching full time, most of my early 20s were spent sitting. I had held a number of jobs that involved being chained to a desk all day, punctuating hours of sitting with a trip to the fax machine, copier, or bathroom. During this time, I also neglected stretching and mobility. My workouts consisted of a few warm-up sets lumped together with little attention given to maintaining form and rest between those warm-up sets. I also made the critical mistake of jumping fifty to ninety pounds from set to set.

Because I sat for the majority of the day and went through the motions when it came time to warm up for my training sessions, I slowly began to lose hip mobility, specifically hip internal rotation, which is absolutely vital during athletic movements including squatting and walking. When the adductors shorten, the hip’s ability to internally rotate becomes compromised, thus impacting aspects of simple movement such as stride length while walking.

The adductor complex is a multi-layered collection of muscles that occupies the medial quadrant of the thigh. Together, they balance the pelvis during standing and walking and help generate force necessary in athletic movements and activities of daily living. The superficial layer, consisting of the pectineus, adductor longus, and gracilis, work in concert to adduct the hip. The most superficial of the group, the gracilis, also assists with flexion and medial rotation of the flexed knee. The middle layer consists of the adductor brevis, which adducts the hip and assists with hip flexion.

Lastly, the two-headed adductor magnus comprises the deep portion of the adductor complex and serves a large role in adducting the hips, influenced by its comparatively massive cross-sectional area. Its anterior head aids with hip flexion and medial rotation of the femur while the posterior head performs just the opposite, aiding hip extension and lateral rotation of the femur at the hip.

If the adductor magnus becomes overactive, internal rotation may become lost, increasing the rotational demands of the sacroiliac joints (SI)—structures stabilized by a number of muscles that tolerate compressive loads well but not designed to handle much rotation. The rotational stresses applied to the SI may trigger lower back pain and disrupt lumbo pelvic rhythm.

If pain is limited to activities involving lifting, they should be avoided. If pain is present during everyday activities such as standing, sitting, and walking, one should seek attention from a qualified professional. Pain is merely your body’s interpretation that something may be wrong. It doesn’t mean that your days of heavy lifting are over. Pain will subside once the underlying issue is corrected. In my situation, it was my tight adductors that created dysfunction, making deadlifting and squatting painful.

Throughout the past few months, I’ve consulted with a number of coaches, trainers, and a few physiologists regarding my ongoing lower back pain. Their suggestions, coupled with my research, has guided me throughout the initial stages of my journey in eradicating my lower back pain and attaining pain-free PRs on the deadlift and squat.

My process to getting healthy is as follows:

  • Static release of the adductor magnus while seated on a lacrosse or tennis ball: I’ll typically sit on a bench or plyometric box and wedge the ball beneath my adductor, exerting downward pressure on the ball for 20–30 seconds and repeating the holds two to three times.
  • Establishing hip internal rotation:In talking to people and from what I’ve read, the most problematic SI joint issues are unilateral. This may be largely attributable to foot dominance, commonly observed in runners, soccer players, kickers, and punters. If it’s the SI joint, typically you won’t have good same side hip internal rotation. I’ve incorporated a few helpful exercises to address hip internal rotation.
    • The first exercise involves standing on one leg while supporting your body with your hands placed on the wall. Focus on driving the knee of the opposite leg past the leg that you’re standing on while you rotate at the hips. As you drive the knee of the bent leg past the knee of the standing leg, you’ll feel a releasing sensation in the posterior capsule of the hip. Hold this position briefly before returning to the starting position. Repeat this 10–20 times on each leg for two to three sets.
    • The second exercise is your basic lying knee to knee stretch. I’ll brace the core to prevent lordosis from occurring. I’ll hold this for 10–20 seconds and repeat for two to three sets.
  • Designing and implementing a multiplanar warm up to restore hip mobility: I’ll progress from lower threshold, ground-based, activation drills such as rolling to a fixed supine position (bridging variations) and then a fixed supine position (planking variations) before getting up on my feet and performing warm-up drills in the sagittal, frontal, and transverse planes.
  • Limiting range of motion to maintain training effect on loaded exercises: I’ve incorporated pulls from blocks and rack pulls with great success here. There isn't any need to pull from the floor until underlying issues have been addressed.
  • Inclusion of anteriorly loaded exercises: Front squats have been my saving grace, and I’ve progressed rapidly on them in terms of the movement used (kettlebell goblet squat to barbell front squat) and the load.

Anterior core work should consist of a gamut of anti-movement core exercises such as unilaterally loaded walks, planks with rows, and posterior chain work consisting of glute bridges, hip thrusts, pull-throughs, and Romanian deadlifts. If you want to mitigate the influence of overactive muscles, you’ll have to activate and strengthen the surrounding musculature. A number of muscles stabilize the pelvis and lock the SI joints in place including, but not limited to, the gluteal complex, the hamstrings, abdominals, QLs, and obliques.

In summary, the role of the adductor group can't be overlooked in causing lower back pain. Strategies to address lower back pain, specifically SI joint pain, may involve focusing efforts directly on adductor tissue quality while strengthening neighboring musculatures. Lifters and athletes must improve and maintain hip mobility to prevent lower back pain, including pain stemming from SI joint pain. If pain prevents the carrying out of tasks essential to activities to daily living, attention from a qualified professional must be sought.