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Hi, 

I'm Maximilian, my goal is to help keep the BJJ community injury free.

Lower Back Pain in BJJ

Lower Back Pain in BJJ

Lower back pain in Brazilian Jiu-Jitsu athletes is extremely common and if you are reading this, the odds are that you have experienced it at one point or another. A recent study composed of Brazilian Jiu-Jitsu athletes reported that chronic lower back pain was present in 80.6% of the surveyed athletes. Professional BJJ athletes were found to have a 16.7% higher chance than recreational athletes, along with the severity of the pain being almost twice as much (1).  Due to physical demands of Brazilian Jiu-Jitsu, that is getting twisted and stacked, it is really no wonder that the lower back cops a beating. 

A few theories have been suggested as to what it is about BJJ that causes lower back pain. Researchers have suggested that "breakfalls", "throws" and being "unbalanced by the opponent" might cause it. In my opinion it is often due to the accumulative micro-trauma caused by repetitive lumbar flexion, rotation and compression that we enjoy in positions like getting stacked, doing berimbolos, and inverting that causes injury to the lumbar discs. Another cause to consider is the muscular imbalances developed over time by regularly playing on a preferred side in a preferred position.

Developing Persistent Lower Back Pain

The idea that most first episodes of lower back pain will get spontaneously get better, is proving to be a misconception. Studies have shown that 65% of people who have had their first episode of lower back pain will continue to have pain 1 year later (6). This holds especially true for those who do nothing to change the activities that cause the issue in the first place.

I've met many people along the way who have done nothing for their backs and have come to believe that they have "learnt to live with back pain". Unfortunately this is not without problems as the consequences go beyond simply withstanding the pain experience. In BJJ balance is crucial, and it is now known that chronic lower back pain significantly reduces balance (2). Pain is also well known to inhibit muscle activation, which therefore makes you weaker and less co-ordinated (3). Additionally, pain can lead to protective muscle spasming which hinders mobility. To sum it up, pain messes with performance in many ways. If you are interested in taking your BJJ game to the next level, it might require taking a step back to deal with your back pain.

Strategies for sparing the lower back

The next question becomes how do we do something about it. One of the tricky things about lower back pain is that it is not a homogenous condition, meaning that each case is unique and what might help one lower back will often worsen a different lower back. Generic recommendations like suggesting yoga or pilates for everybody with lower back pain is dangerous. While some of these recommendations may help a large portion of people, they often further injure an equally large portion of people if used at the wrong time in the rehabilitation process. For these reasons, it is imperative to visit a skilled practitioner for an appropriate diagnosis - whether it be a sports chiropractor, physiotherapist, osteopath or exercise physiologist. After you have been appropriately diagnosed, you should only then consider whether or not these activities are right for you. With all this in mind, we will delve into some key principles for sparing the lower back. 

1. Identify Your Triggers and Limit Their Exposure.

It is crucial to think about which movements or positions trigger the lower back pain in BJJ and outside of BJJ, so that their exposure can be reduced. A good analogy is to imagine you had a bruise and you kept hitting it - the tissues would become increasingly sensitised, irritated and the healing process would be delayed. It is important to note that sometimes these triggers might not feel bad at the time but can be noticeable the day after training. 

For myself, I've had to reduce the time spent in spider guard, doing triangles and armbars as a part of injury avoidance as these movements triggered my lower back pain. At times this has even meant tapping out whilst in a dominant position. This however will likely be different person to person as different tissues (facet, disc, muscle, ligament) are strained in response to different directions of movement.  Depending on the injured tissue and body type, your game might need to be altered differently for a varying period of time to permit adequate recovery.  Limiting exposure to your triggers is the number 1 thing you can do to help permit recovery. Unfortunately for some backs this will mean having to take time off of the mats. 

2. Ensure Adequate Mobility

Ensure there is adequate mobility in the adjacent joints such as the hip and thoracic spine. In this respect BJJ really is all in the hips. Maintaining adequate mobility in the hips and thoracic spine is vital for reducing the stresses that are transmitted to the lower back (4). *Please note that this not mean make your lumbar spine more flexible and it does not mean do a bunch of hamstring stretches incorrectly in a hunched over lumbar position - it must be done in a spine sparing way. 

3. Core Endurance is Key

Studies have shown that poor core endurance is predictive of lower back pain, while strength is comparatively a much less significant determinant. It is important to note that training core endurance involves training all of the muscles around the torso including the muscles at the back and sides. Isolating one group like the abs will most likely provide little-no benefit as the training has to be balanced and symmetrical.

When training core endurance it is important for it do be done in a spine sparing way - that is no lower back pain should be elicited and it should be done in a neutral spinal position (e.g. planking and not situps!). Interestingly, many people will find that their hip mobility will also improve after they have improved their core endurance (7). 

4. Slow Down Your Game!

This might involve spending a little more time in the gi as opposed to no gi, and utilising grip fighting to a greater degree. Half guard might be another useful tool for slowing down your game. Focussing on positional dominance rather than going for submissions might also be a useful method for some. 

5. Isolate Positions

Don't hesitate to ask your training partners to isolate positions with you that you feel comfortable in. For a flexion intolerant back this might mean working on your pressure passing and top control. For an extension intolerant back, this might mean conversely isolating your guard. Once again this depends on your individual triggers. 

6. Limit Lumbar Flexion

Reduce the time spent sitting down in a flexed position before class and between rounds. Sitting down in a sustained hunched forward lumbar position can result in progressive stretching of the ligaments in the spine (this is called 'creep'). When the ligaments have stretched it permits micro-movements of the lumbar joints and it reduces the capacity of the stabilising muscles to activate which further reduces overall spinal stability. Prior to class and between rounds it is a good idea to maintain a more neutral spinal posture where possible in either the kneeling or standing position. 




References:

1. Reis FJ, Dias MD, Newlands F, Meziat-Filho N, Macedo AR. Chronic low back pain and disability in Brazilian jiu-jitsu athletes. Physical Therapy in Sport. 2015 Nov 1;16(4):340-3.

2. Berenshteyn Y, Gibson K, Hackett GC, Trem AB, Wilhelm M. Is standing balance altered in individuals with chronic low back pain? A systematic review. Disability and Rehabilitation. 2018 Jan 30:1-0.

3. McGill SM. Low Back Disorders, 3E. Human Kinetics; 2015 Oct 22.

4. Cibulka MT, Sinacore DR, Cromer GS, Delitto A. Unilateral hip rotation range of motion asymmetry in patients with sacroiliac joint regional pain. Spine. 1998 May 1;23(9):1009-15.

5. Itz CJ, Geurts JW, Kleef MV, Nelemans P. Clinical course of non‐specific low back pain: A systematic review of prospective cohort studies set in primary care. European journal of pain. 2013 Jan 1;17(1):5-15.

6. Itz CJ, Geurts JW, Kleef MV, Nelemans P. Clinical course of non‐specific low back pain: A systematic review of prospective cohort studies set in primary care. European journal of pain. 2013 Jan 1;17(1):5-15.

7. Moreside JM, McGill SM. Hip joint range of motion improvements using three different interventions. The Journal of Strength & Conditioning Research. 2012 May 1;26(5):1265-73.

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