WHY FITNESS USUALLY CAUSES MORE LOW BACK PAIN
Author : Josh Henkin
I know, most of you have NO IDEA that I have a back problem (enter extreme sarcasm here). My motivation of speaking about my spinal disease isn’t really self pity (although I’m not above receiving some if you want to send it my way;), rather to speak as someone that truly knows what its like to have low back pain. Not the type where you did something the day before and maybe some Tylenol, stretching, a bit of rest and you are good again. No, I’m talking about the type that ruins your life, makes life extremely difficult, and being someone where fitness often fails them.
Trust me, I see many well intended professionals try to offer solutions for low back pain, but they often provide programs that are actually more damaging than helpful, or so far advanced that the person battling low back pain can’t really perform them. So, it is blogs like this that I get inspired to provide a bit more insight.
I’ve lost use of my legs AND arms due to my spinal issues and had to re-teach both to work again.
Myth of Strength and Low Back Pain
As spine expert, Dr. Stuart McGill points out, “As a spine biomechanics professor of over 32 years, I share with you an astonishing fact: Over half of the patients that had been referred to me for back pain were caused by personal trainers!
That is quite an indictment of the results from personal training, but make no mistake, I am the biggest supporter of trainers. Trainers, however, have the potential to be the most important determinant of a person’s lifelong health–perhaps more important than their family doctor, therapist, psychologist, or any other type of clinician. But personal trainers often misunderstand the true mechanics behind back pain.”
Why is that? It is pretty horrifying to read as both someone with a spinal disease and been fitness professionals for 25 years. That is because most people really don’t understand what is causing low back issues or how to address it. Most commonly, fitness professionals default to “strength” being the issue for most problems with their clients. In one sense, it seems reasonable right? If your low back is “weak” then if you strengthen the low back you will be better no?
People think exercises like the back extension is good for helping low back pain, but in most instances it can create more issues and doesn’t address the true problems.
That is a pretty big misunderstanding of what is happening in MOST situations with low back pain. As Dr. McGill so eloquently explains….
“Too many patients remain long-term patients because of their misguided efforts to train their back strength. In many cases, their training approach needs an overhaul. Think of strength in relation to the body like horsepower in relation to a car. If a souped-up 500 horsepower engine is put inside a dinky, broken down car and then raced around town at top speed, it’s only a matter of time before the mega-engine rips the frail frame and suspension to piece.
Similarly, a back patient who has developed a disproportionate amount of strength in relation to their current level of endurance can only expect further injury. We have measured this time and time again in strong back patients. Specifically, a resilient back has endurance matched to strength.
Back injuries are a result of putting a spine under load and then breaking healthy movement form. Maintaining proper movement patterns requires endurance. Therefore, we must always place endurance as a higher priority to strength when it comes to rehabilitating a patient with a spine condition. Only after the back-pained person has increased our endurance for sustaining healthy movement patterns, and in turn their stability and mobility, should they progress to more aggressive strength training.”
There are several keys in training people with low back pain and they ALL require a better understanding of why people are having issues and from an exercise perspective what they can do!
Step 1: Better Movement Patterns
Dr. McGill points out one of the first goals is to fix faulty movement patterns in low back pain. What are we talking about? First it is about learning to move from the hips and NOT the low back. The trunk should be thought of as always trying to maintain plank in some form (yes, the spine has movement to it, but under load and not under load are two different things as well as different people have different capacity levels of said movement. So, the best option is to teach most to plank in almost every movement).
A great example is using a movement like the deadlift. The deadlift (assuming loading is appropriate) can teach many of these qualities of better movement as physical therapist, Jessica Bento points out. While Jessica is pulling from the floor, most will have to start with the weight elevated because of their low back pain and potentially limited mobility and movement.
The Ultimate Sandbag works better for most people because they can create better upper body tension than with the barbell or kettlebell. This helps lock in that plank.
It is being able to take these movement patterns into more dynamic patterns that actually better represents becoming more resilience to low back pain than just going heavier and thinking “strength” in the way we normally think about it is the solution. Trust me, these movements require A LOT more strength than most people realize, just not in the typical form that most people go to that really doesn’t work!
Step 2: Build Better Core “Stiffness”
Another reason that so many fitness programs fail to address low back pain is that they don’t focus on the key concept of core “stiffness”. This is the same concept that Dr. McGill refers to as “bracing” to achieve core stability. Lacking the core stiffness is why exercises like back extensions and reverse hypers not only don’t help a lot of people’s low back pain, but actually increase it!
Reverse hypers (whether done from a bench, a stability ball, or an actual machine) often can cause more issues than they solve. I realize they are touted to help low back pain, but there are a few major issues here. For one, the core being artificially supported takes away the bracing we want to achieve in our core for that stability. Why take so much of the core OUT of our training?!
The second issue goes hand in hand with the first. When the weight comes upwards because we can’t create the core bracing, we can get a lot of lumbar extension like you see in the picture above (if that was someone’s spine during a deadlift we would have major issues in their form). Additionally, as the weight comes down that tractions the spine BIG time and can cause people with low back pain that don’t have tolerance to such stress to really flare up.
Bracing (also “stiffness) as Dr. McGill describes is “The greater the load that is placed down the spine, the greater the need for the musculature to stiffen the spine. How can this be? When muscles contract they do two things: they create force and they create stiffness. Stiffness is always stabilizing to a joint. Thus stiffness prepares the joint to bear load without buckling. Failure to appropriately stiffen is the biggest cause of joint injury, although not the only cause.”
That is why Dr. McGill has his “Big 3” core stability exercises that include side plank, bird dog, and a very specific curl up. Being someone who has been at the lowest level of function, I can tell you that doing personal training 101 of these movements won’t help. In DVRT, we create very specific strategies that help people understand how to create the “stiffness” for better results.
The side plank is often severely misunderstood and people compensate in ways that make the exercise far less effective.
When it comes to helping something that can be as complex as low back pain, we have to understand what are the common causes and what we are trying to teach people to do better by using smarter exercises. These drills take good cuing and great execution, which means you have to spend time being VERY thoughtful about them and not just throwing them into a workout and expecting people to get better without great coaching! The details mean everything and it can make you a magician, or cause great frustration for both you and the client. Taking time to practice these yourself will help you be a better coach.
Josh Henkin is a CSCS and Master RKC with twenty years of experience. His innovative Dynamic Variable Resistance Training (DVRT™) has allowed him to present in more than 13 countries and publish in top outlets like Men’s Health and the Wall Street Journal