What a Toddler Can Teach You About Back Pain

Toddlers do something naturally that people with back pain (and some without pain) have a very hard time doing correctly.


And it’s cousin, bending and lifting.

When you watch a youngster get something off the floor, he drops his butt toward the floor more than he bends in the spine.

Adults tend to do the opposite.

And to keep back pain at bay, you need to move more like a kid.

How Kids Move

In technical terms, the way a kid moves is often referred to as disassociating the hips and spine or in other words, not moving the two parts together.

Children move this way partly because it helps control the center of gravity (keeping the trunk more upright helps keep the balance point more over the center of support) making it easier to stay balanced and partly because most kids have super mobility in the hips.

And where are most adults really stiff and move more like a rusty Tin Man?

Yep, the hips.

Specifically, hip flexion and rotation.

To squat down and keep the spine relatively still, you need really good mobility in the hips (mobility is using the flexibility you have so you need a certain amount of flexibility and the control over it) and strength / endurance of the lower body and low back.

When you lack the mobility in the hips, your body has to find a way to get the job done so you will naturally bend in the spine.

And it’s this repeated, low load bending force in the spine that leads to trouble.

And, sure, if you’ve never had a back problem and you move this way once in a while, probably not a big deal.

But what’s “once in a while?”

The occupational definition of “occasional” is no more than two-thirds of a typical work day. So, when it comes to squatting or bending or lifting, if the total time exceeds about two hours in a day, then you would be classified as “occasional”.

Of course this depends on your day; job, duties at home, etc. I think you might be surprised at just how much you bend / lift throughout the day.

For example, it’s not uncommon for parents to lift a 7-9 lb baby up to 40 times a day. And that’s just the bending / lifting relative to the baby not to mention other household chores, work, sports, training, etc.

Ok, so let’s just ditch the idea that you bend and lift once in a while.

You need to move like a kid to have a back that won’t act like a grumpy old man.

How to Move More Like a Kid

First thing to do is to check your hip mobility, hamstring flexibility, and how well you can separate movement between the hips and low back.

A great overall mobility test is the Overhead Squat.

If you can’t get to 90 degrees at the knee keeping your hands overhead, then try the assisted squat (see the image). If you can get to 90 in this form of squat, your hip mobility is pretty good (and the reason you can’t do it well with hands over head has more to do with shoulder and/or upper back mobility). If you can’t break 90 degrees at the knee, then most likely the limitation is in the hip (could also be in the ankle/foot but most people lack the mobility in the hip).

Now, for separating the hip and spine, you need to become a waiter. Sort of.

Here’s what to do:

  • Stand up. Feet about shoulder width apart. Bend the knees just a bit.
  • Find “spine neutral” (tilt you pelvis all the way forward then tuck it all the way backward then find the mid-point between the two).
  • Place the back of your right hand on your lower back and the palm of your left hand on your abdomen.
  • Now, bend forward only at the hips – keep the low back in the spine neutral position all the way forward.
  • Stop the forward motion when you feel your hamstrings tighten up (and notice how different the range of motion is compared to your test lying down).
  • To stand back up, tighten your butt muscles (gluteals) and push through the heels into the floor. Avoid using the lower back to create motion.

Watch this video for the general idea. I like the hand on the back and abdomen to give you some feedback about motion in the low back (the model in the video does not do this).

If you find this hard to do, well, that means you need to practice.

Now, you combine the idea of the neutral spine / Waiter’s Bow with bending and lifting movements. Whenever you pick something up off the floor, tie your shoes,  etc., you brace the mid-section and move at the hips doing your best to keep the spine relatively still. Depending on the type of motion, you may need to bend a bit in the spine. What you want to avoid is a movement that uses more spine motion than hip motion.

What to Practice

I like the Overhead Squat as a general movement training drill for mobility. If you find it hard to do, you can add a few pillows to a bench or chair to reduce the depth of the squat or you can practice the Assisted Squat and then move to the Overhead Squat. Since this is movement training more than muscle training, you can just practice this whenever you have some time. Do 5 to 10 repetitions then later in the day do some more. You’re going for smooth, graceful and almost effortless movement.

To help improve hip/low back separation and the flexibility of the hamstrings, practice the Waiter’s Bow. Hold the end position for 20-30 seconds, breathe deeply and slowly. Do this several times a day until you have a green score on the test and feel comfortable with the movement.

Your back will feel a lot better (and you reduce your risk of injury or re-injury too) if you can learn how to move more like a kid and less like the Tin Man.

How are your hips moving these days?

JH says

You don’t think femur length to tibia ratio has anything to do with squatting difficulty?

    DD Kelsey says

    Yes, good point. Biomechanics play a role although I think trunk to femur length may be more of a factor than femur to tibia but both come into play with deeper squats below about 100-110 degrees of knee flexion. My point though is that most adults have lost the ability to separate movement from the hip and spine and tend to move more in the spine. By learning how to first bend at the hip (waiter’s bow) and then incorporate the squat, they can move more safely and, I think, more easily.
    Thanks for commenting and raising the issue.

Omar says

You mention breaking 90 degrees at the knee with an assisted squat. What is a good angle at the hip to be able to achieve?

    DD Kelsey says

    Good question. Most studies that have analyzed the mechanics of a “squat lift” show hip angles ranging from 100 to 130 degrees. Why the large variation? Because it’s a multi-joint motion so, for example, if you can achieve a deep squat in the presence of low ankle mobility, that motion has to come from someplace. Could be the hip, the spine, etc. If you can break 90, have 110 deg of hip motion and decent ankle motion, I would be happy with that.

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