Categoriesmindset personal training

The Hard Truth About Back Pain

Happy Labor Day to my American readers.

Happy Monday to everyone else…;o)

Today’s guest post comes courtesy of TG.com regular, Shane McLean. Most will be able to commiserate because it deals with an annoying topic most of us are very familiar with: Cross-Fitters low-back pain.

We can seemingly do everything perfectly – lift with impeccable form, do our mobility work, even do an extra set or two of deadbugs & birddogs – and yet still be clotheslined by a bout of back pain.

It stinks no matter which way you look at it.

But it’s not a death sentence.

Copyright: belchonock

The Hard Truth About Back Pain

Google back pain and you come up with about 1,550,000,000 results.1  There’s no shortage of information about back pain, the symptoms, the different types, how to treat it and how to prevent it. When you’re suffering from back pain, it’s easy to be overwhelmed with all this info.

Plus, not to mention all the conflicting advice because various treatments and exercises work for different people. What worked for me might not work for you. Pain and healing are highly individual things, I think.

Back pain causes loss of income, loss of mobility, stress,  large medical bills and costs employers big money because of sick leave, health insurance etc.

Back pain is a big deal, no doubt.

You can do all the right things, diet, exercise and move right but back pain doesn’t care. It can rear its ugly head at any time you move suddenly, bend down to pick something up off the floor or when you’re wrestling with your kid.

Then you’re in a world of hurt.

There’s a school of thought that suggests back pain is preventable if you strengthen your core, have good posture, get strong and not sit or stand too much. But back pain doesn’t care. You control what you can control and let the chips fall where they may.

Truth About My Back Pain

The truth about my back pain is it was my fault.

See, I love to deadlift, but I was doing it all wrong. Rounding the lower back while pulling a barbell from the floor repeatedly is NOT a recipe for a healthy spine. Eventually something had to give. And it did.

Around nine years ago I felt a ‘snap’ in my lower back and didn’t think anything of it. Some low-grade pain around my lower back and I ignored it like any gym meathead would, hoping over time the pain would go away.

But the more I ignored it, the worse it became, to the point where lifting, playing with my kids and sleeping didn’t happen. The pain had taken over my life and it was all-consuming. To cut the world’s smallest violin story short, I had three herniated disks.

Now the disks have healed but my pain has not. More on that later.

When You’re In Pain

If you’ve ever put your back out, you’re probably thinking you’re the only one who’s suffering (because pain is all-consuming) but this is not the case. 80% of the population of the US, at some point will suffer from chronic or acute back pain.

And about 2% to 10% of people who experience low back pain develop chronic back pain.

A lot of people choose to go under the knife to fix this because of their doctor’s recommendation, but this doesn’t always work, as shown here. Plus, I’ve encountered many people who have had multiple back surgeries and they’re still in tremendous pain and their quality-of-life sucks.

Sometimes the solution causes more problems.

Get Back On The Horse

You’ve heard the saying ‘get back on the horse’ when you’ve been knocked down.

Get up, dust yourself off and go again.

You cannot change what happened. Dwell on it, yes but you cannot change it. Better to wipe the slate clean and go again.  And this is usually great advice but for back pain it’s a little different.

via GIPHY

The countless times I’ve come back to the deadlift after injury there’s a real fear, I’ll do it again. The more I focus on correct form and set up doesn’t make this fear go away. But this fear is a two-way street. It forces me to do it right, which is a good thing.

But I lose confidence in my body to perform because of this fear and this is a bad thing.  You may think this is mumbo-jumbo, but injuries have both physical and psychological consequences, and a common post injury response is elevated fear of re-injury. (1)

The loss of confidence is real and is a little talked about consequence when coming back from an injury.

Another ‘Truth’ About Back Pain

This is a case study of N=1 (me) and my experience with back pain and training clients with back pain. Barring lower back strains and waking up on the wrong side of the bed, once you’ve damaged your spine, like herniated disks the pain doesn’t magically go away.

The injury may have healed but the pain remains.

In the case of herniated disks, the fluid that leaks out between the disks which causes the nerve pain and discomfort gets dissolved by the body over time. Then there’s nothing pressing up against the nerve so the pain should all go away, correct?

I’ve suffered from low-grade (1-2 out 10 on the pain scale) and extreme lower back pain (5-7 out of 10) almost daily for the past nine years. Granted it’s not the same level of pain generated by a herniated disk and it’s not constant, but it’s still pain.

Low grade back pain doesn’t stop me from training, but it does make me more aware of my set up and form. It makes me more conscious of my posture and daily movements too and this is all positive. Extreme back pain almost puts me on the ground.

This is not.

After surgery, rehab, Physical Therapy or Chiropractic care for back aliments, the severe pain may go away but the discomfort may haunt you like Casper the friendly ghost.

Wrapping Up

Back pain, whatever form it takes, sucks.

You lose confidence in your ability to perform everyday movements and fear re-injury. But it does make you aware of taking good care of it. Because if you don’t, your back will tell you in no uncertain terms.

Note From TG: As an adjunct to Shane’s sage words, I’d highly recommend reading THIS article I wrote recently on why training with pain present is an inevitable (if not important) part of the healing process.

About the Author

Shane “Balance Guy’ McLean”  is an A.C.E Certified Personal Trainer working deep in the heart of Louisiana with the gators.

References

  1. Chao-Jung Hsu et al. Fear of Reinjury in Athletes. Sports Health Mar/Apr 2017;9(2):162-167. doi: 10.1177/1941738116666813. Epub 2016 Sep 20.
CategoriesCorrective Exercise Program Design

4 Exercises to Strengthen Your Core and How to Program Them For Lower Back Pain

Raise your hand if you watched The Royal Wedding this weekend.

*raises hand*

But I only tuned in because Julian was up so early Saturday morning and there was nothing else to watch.

Yeah, yeah….that’s it.

Anyway, I’ve got an excellent guest post for you today from Florida based trainer William Richards covering a topic pretty much everyone can get on board with…..

…..low back pain and how to choose or modify the best bang-for-your-buck exercises to help nip it in the bud.

Copyright: lightwise / 123RF Stock Photo

4 Exercises to Strengthen Your Core and How to Program Them For Back Pain

When it comes to core training and sensitive lower backs I have been through the gauntlet.

I have experimented on myself and have worked with so many frustrated clients who want to train their core but always seem to re-injure their backs or stay on what I call their own pain cycle.

They go to the gym with minor inflammation thinking a good workout is what they need. They knock out what they think is a “safe” workout and spend the last 20-30 minutes hitting some hanging leg raises, decline sit-ups and maybe even some weighted jumping ball slams (because they heard a stronger core will beat their back pain). The intention behind this workout was good and hopeful but they go home and slowly start to experience this gradual increase in pain and tightness in their lower back.

Fast forward 24 hours and mornings feel like you have a tree branch wedged between two vertebrae.

Forget bending over to tie your shoes let alone put pants on. You feel 80 years old until the Extra Strength Tylenol and Ibuprofen concoction kicks in and you get a small glimpse of what it feels like to be pain-free and healthy. For most this is the only sense of relief they will ever experience.

We all know lower back pain can be complex. There could be a lot of different factors at play here but one of the key topics I want to shed light on is the core training approach.

How Should I Approach Core Training With Lower Back Pain?

In my experience with coaching corrective core training for sensitive backs, there are three key points I find myself covering over and over again.

(1) Safe modified approaches to “modern” exercises that have the sensitive back in mind.

When you here modification you immediately think “an easier version of what your showing me.” Which is true in most cases, but when dealing with a sensitive back your not looking for “easy” you’re looking for a certain pain threshold that the individual/you can control.

This threshold is extremely important to coaching sensitive backs because that very threshold can put someone on the couch for a week popping pain meds or training and moving towards freedom and a faster recovery.

So when picking and executing your core exercises think more about how the variation is affecting the way your lower back feels in the moment AND 24 hours after doing it.

Nothing you should be doing will consists of training through pain. Often times any irritation or discomfort from an exercise will kick in the next day once all the feel good chemicals have worn off.

(2) The correct coaching through these modifications to safely progress to the level of difficulty that is safe for you.

Once you have dialed in on your own safe threshold it’s time to start modifying the exercise to fit your needs. There are tons of ways to do this so I will highlight a few of my top cues here.

If you’re experiencing pain:

-1- Check the position of your pelvis.

Is it neutral?

Especially with exercises like the ones you will see below it’s paramount that you take unwanted stress OFF the lumbar spine. Some of this stress is commonly caused by an overextended or flexed lumbar spine. If you’re experiencing pain, simply being overextended or over flexed will only get worse when you add compression or a form of challenge to the position.

Note From TG: Here’s a great way to teach/cue people how to (safely) move their spine into flexion and extension IN CONTROL. Sometimes back pain is the result of being “stuck” in an over extended or flexed position. Allowing people “access” to range of motion can be a game changer.

 

-2- Bring the loads or limbs closer to your body.

Wait, what?

Try this out: If you have back pain, take a 10 lb plate and hold it straight out in front with your arms stretched out. How does that feel on your lower back?

Now bring the weight closer to your chest. Did that bring relief?

The majority of instability issues will produce pain with the outstretched arm. The closer the load or limbs are to your body the less your body (in this case your lumbar spine) has to work to keep you upright.

You can apply this cue to exercises such as the plank (side and front) or a Pallof press. The more fully weight bearing you are with the plank the more stress it will put on the irritated lower back. The same goes for the Pallof Press.

 

The further outstretched your arms are the more demand it will place on the lower back.

The more sensitive the lower back the more pronounced this will be.

(3) A Mindset Change

When training your core for back pain relief you have to adopt this way of thinking.

It’s not about the exercise you’re doing but the position of your painful points when doing the exercise. I did a quick 1-minute explanation of what I mean below:

Where Should I Start With Core Training?

Now that we have covered how you should be approaching core training, let’s get into applying what we learned. Below I want to show you four of my favorite exercises to use and modify for various levels of clients.

Let’s dive in.

1. Banded Quarter Crunch

 

One of the biggest reasons I love this exercise so much is because of the full upper body muscle recruitment it requires. Sometimes as new lifters or even those who are more seasoned we forget that bracing the trunk and engaging our body with a certain movement requires a lot of interaction between joints and muscle fibers.

To save on energy we subconsciously do the bare minimum to get the exercise done.

This is where weak links in our chain are created.

When doing these banded crunches I want you to think about bringing your arms down and out and engaging your lats before you begin moving anything. When in position be sure your spine is neutral, shoulder blades are tucked down and back and your chin is pulled in towards your neck.

When you go for lift-off, the goal is to move everything together and using the trunk as your primary mover while everything else upstream stays rigid and stiff. One way I like to cue this exercise so that the person isn’t trying to do too much of a sit up is to think about pushing your for-head up towards the ceiling. This will actually make the exercise seem a bit harder and trigger an even more intense muscle fiber recruitment.

You can get creative with this when it comes to the sets and reps scheme. You can do just reps or holds for a number of breath cycles. One rep would be a lift-off followed by a full cycle of breathing (inhale and exhale). For holds, after lift off, you can cycle 3-4 breaths before returning to the starting position.

2. Banded ISO-Deadbug

 

The dead bug can be a major let down for someone with a sensitive back. Most articles you find on the internet for lower back pain and core training you will find the dead bug. Unfortunately, those who take the dead bug at face value and don’t know how to tailor it to fit them are the ones who quit on the exercise before any benefit is seen.

In this video, I show you four variations that you can work from easy to more difficult with this exercise. We are going to use a similar band like the exercise above to help with upper body engagement.

3. Banded Sit Backs With ISO Hold

 

One thing I am a huge fan of other than hole-in-the-wall (probably should get shut down) Mexican restaurants are exercises that are designed or coached not only to make the individual stronger but to teach and groove healthy movement patterns.

One of these movements I see butchered is the hip hinge.

We do tons of exercises that include the hip hinge but with every rep and set we are putting ourselves in more danger than anything else. It’s hard to find an extra 30 minutes a day to practice proper bracing, coordination or healthy movement patterns separately. Which is why I will always work them into my workout like you see in this video.

Key points to remember with this exercise.

The most import thing is what I said HERE

I care more about the integrity of your body position then I do how many sets reps or weight you can do. You have to earn those gradual increments.

You want to stay within your pain threshold. No pushing through the pain to get a better burn. Leave that to the people who enjoy soaking in salt baths every night and are popping muscle relaxers and Percocet just to sleep at night.

4. Banded Birddog

This is another one of those exercises that can lead to frustration and more pain if not taken in small increments depending on how sensitive your back is to this type of movement.

I didn’t respect this exercise when I first introduced it into my personal rehab program. Instead, I just did what it LOOKED like I should be doing and went from there.

I want to help break this habit of the copycat approach. The more you know WHY you’re doing the variation of the exercise the better you will understand what you’re doing.

When doing this exercise, I want you to focus on the different modifications that are available with this move. We talked earlier about your specific pain threshold. These modifications should help keep in the safe zone.

Key things to remember:

Don’t rush the exercise. Start by breaking it down into segments and make sure there are no gaps or missing factors that are causing your pain.

You can attach the band to both the wrist or ankle to add difficulty to that individual limb either in the full Bird Dog or broken segments.

I Know What You’re Probably Thinking

Well, what exercise should I start with or which one is best for _________.

Don’t fall into this trap.

Remember, It’s not about what exercise you’re doing that will unlock your potential for long-term relief. It’s how you approach the exercise that you’re using. Focus on the position of your body BEFORE you even start the exercise then use the exercise to challenge that healthy position.

If you apply this to every core exercise, or any exercise for that matter, your ability to train towards lasting relief will significantly improve.

About the Author

After rupturing my L5-S1 disk over 7 years ago I was told that surgery and pain meds were my only option for a “pain-free” life.

I made a choice as a fitness professional to relentlessly pursue the truth to whether or not exercise could truly be the secret to getting relief.

After 10+ years coaching in the fitness industry I now focus the majority of my time teaching people how to pursue their own drug and surgery free path to back pain relief.

Aside from coaching you can find me on the Gulf Coast of Florida, surf fishing with my two kids and wife or eating my weight in Mexican food. For more info on me and what we have going on you can check out my website HERE.

CategoriesExercise Technique Exercises You Should Be Doing

Exercises You Should Be Doing: HBT Front Squat March

In my career as a strength coach I’ve worked with numerous athletes and non-athletes alike dealing with back pain. And while much of the time my initial “go to” exercises are things like the McGill curl-up, birddogs, deadbugs, and various planks I also recognize that, after awhile, some people would rather wash their face with broken glass than perform another rep of any of those exercises.

Copyright: stylephotographs / 123RF Stock Photo

 

Curl-ups, birddogs, and planks work. There’s no denying that. Coaching people up on those three movements alone and having them perform them on a consistent basis will clean up a lot of aberrant movement reduce pain in a symptomatic back.

However, it’s just, you know, they get boring after a while. As much as I’m a fan of those movements (and could care less how bored someone gets if it’s what they need to be doing to get better), part of my job as a coach is to help people not feel like a patient and to find other means to elicit a training effect.

I mean, raise your hand if this sounds familiar:

Athlete/Client: “Ready to train coach. What are we doing today?”

Coach: “You’re in for a treat. We’re getting after it with birddogs today. Holla!”

Athlete/Client:

via GIPHY

Like I said, it’s not to bemoan the birddog – it’s lovely exercise – but it’s not to say we can’t toss in alternative exercises that are just as conducive to working through low back pain AND more palatable for those looking to actually train.

HBT Front Squat March

 

Who Did I Steal It From? – a combination of Dr. Joel Seedman and MA based strength coach, Ryan Wood.

What Does It Do? – I’ve discussed the concept of HBT before in THIS article, but to reiterate:

“HBT = Hanging Band Training.

It’s exactly what is sounds like. You take some bands, hang some stuff off them, and do stuff. Because, science.

While at first glance it comes across as a bit gimmicky, HBT training does have a fair amount of efficacy. As Dr. Seedman explains in the article linked to above, the oscillatory characteristics of this brand of training provides a unique training stimulus that challenges stabilization, increases core demand, helps “excite” the CNS, and also has a bit of carryover to muscle gain due to the increase in time under tension.”

Germane to this exercise, the oscillatory effect of the kettlebells (or plates if you don’t have access to KBs) works wonders with regards to challenging the core musculature to stabilize and in helping to build a more resilient back.

The exercise itself can work in one of two ways:

1) If you have the space to do so, you can have someone unload a barbell from a rack and have him of her walk a specific distance.

2) Or, if you’re like me, and have a smaller studio, you can just as effectively have someone stand in place and march it out, like my client Dima is doing in the video above. Like a boss.

Key Coaching Cues: This is a fairly intuitive exercise. The KBs hanging from the bands is going to jostle the individual every which way if they’re too lazy and not CONTROLLING the barbell. The objective is to resist the movement of the KBs.

I like to tell my clients to “keep the KBs quiet.”

Some other things you want to be on the lookout for is too much leaning back and/or any excessive lateral flexion (side bending). The idea is to “stay tall” as one alternates back and forth from foot to foot.

You can either shoot for a specific time (say, 30-40seconds) or a specific number of steps. Give it a try and let me know what you think.

CategoriesProgram Design Rehab/Prehab

What’s the Deal With Spondy? An Attempt to Solve the Riddle in Less Than 1500 Words.

Q: Hey Tony – I suffered a pretty severe L5 spondylolisthesis a couple years ago, and it took me nearly a year to recover.  I’m now back training again and feeling pretty good.  From what I’ve read, I realize I need to make sure I’m not in an anterior pelvic tilt position, so should I try to focus hard on developing glute, hamstring, and hip strength? 

I also realize that maintaining core strength is important.  Besides planks, side planks, anti-rotation exercises, and roll-outs, is there anything in particular you would do to make sure the lumbar spine is strong and healthy so I can prevent any possible re-injury?  Thanks for you input!  Really enjoy your educational videos and blog posts.

A: First off, I’m really sorry to hear about your injury. Speaking bluntly, back pain is about as fun as a bag of dicks – there’s really no way to sugar coat it. As someone who recently went through a spell of back issues (albeit not the same injury) I can commiserate.

Spondylolisthesis (along with it’s fraternal twin, spondylolysis) is definitely an injury that we’ve seen sporadically here at Cressey Performance, so we know how much work it takes to get back into groove of things – especially with regards to training.

For those reading, scratching their heads and thinking to themselves, “spondy- say what?,” lets take a moment to clear the air.

Spondylolysis refers to a fracture of the pars interarticularis portion of a vertebra (95% of the time, it’s L5). The pars essentially connects the vertebral body in front with the vertebral joints behind.

Presence of spondylolysis runs the gauntlet in terms of who it effects, but its highest prevalence is among weightlifters. That said we’ve seen a huge influx amongst young athletes as well, especially those who participate (and specialize too early) in sports that require excessive extension and rotation (ie:  baseball).

More pertinent to this conversation, spondylolisthesis is a lower back injury involving a forward slipping of one vertebra over another (far right picture above). It’s a very common diagnosis in athletes that participate in sports that have extreme axial strain on the low back (think powerlifters and strength athletes), but it’s also common in the general population as well.

With the geeky, spinal shenanigans out of the way, lets get to the fun stuff.

Off hand it sounds like you’ve got a fairly firm grasp on what to do moving forward, but I do have a few candid thoughts to add:

1.  Yes, correcting any EXCESSIVE anterior pelvic tilt would be wise.  You have to remember, though, that there is an “acceptable” range of APT (natural lordotic curve of the spine), but it definitely bodes in your favor to address any excessive tilt that may be playing into your symptoms.

2.  Expounding on the above point a bit more, most will say that you need to stretch the hip flexors, which, if you delve into the normal parameters of Janda’s lower cross syndrome (“tight” hip flexors, weak core/glutes) isn’t a bad place to start.  But as with anything, it’s not always quite THAT simple.

For instance, you can stretch your hip flexors until the cows come home (or George Clooney gets married, whichever comes first)…….but if your anterior core is weak – which is generally the case 100% of the time  – it’s a waste of time and effort.

Almost always, I place a premium on improving anterior core strength.  Things like Pallof press, various chops and lifts (done with spot on precision: abs braced, trailing leg glute firing, minimal compensation in the torso), as well as planks are a great place to start.

NOTE:  Most people will just haphazardly throw in planks because that’s what they’ve always been told to do.  Cool.  But most people absolutely BUTCHER technique.  To that end, you have to make absolutely certain that you’re doing these correctly!  Which is to say, they shouldn’t look like these epic balls of fail:

Or this:

In both scenarios each person is literally hanging on their spine and not doing their passive, ligamentous restraints any favors.

If you’re going to perform planks, at least do them correctly!

Another exercise to consider (for those who are a little further along in recovery such as yourself) is the reverse crunch.  As my colleague and business partner, Eric Cressey, has noted on several occasions: flexion from an already extended position to neutral is different than flexion from “neutral” to end-range lumbar flexion.

The external obliques help to posteriorly tilt the pelvis, but because they have no attachment points on the sternum (unlike the rectus abdominus) we don’t get all the nasty compressive forces on the spine.

Maybe serving as the rule of thumb above ALL of this is the notion that improving spinal stability is kind of a big deal.  Unless this addressed, all of the above won’t matter since all you’ll be doing is placing dysfunction on top of fitness.  Which, as we all know, would make Gray Cook punch a baby seal in the mouth!

On that point, my boy Dean Somerset wrote a fantastic post HERE which discusses in waaaaay more detail than I could ever cover.

3. Taking things a step further, anything that “encourages” more of a posterior pelvic tilt is most likely step in the right direction.

In addition to anterior core work, a healthy dose of glute work would be in order as well.  I’d start simple and perform supine bridges several times throughout the day.

While not shown above, I actually prefer glute holds, holding each rep for a 5-10 second count at the top.

You can then progress these to 1-legged variations and then proceed to perform 1-legged hip thrust, starting with your back on a bench and feet on the floor.  From there, if you’re feeling confident, you can add in a bit ROM and place your feet on a bench.

For my own edification – it’s important to note that there should be absolutely no lumbar compensation when performing these movements. Everything should be glute, glute, and more glute.  If you do tend to “feel” it more in your back, I’d regress the movement and make sure you’re firing the glute.

In case you missed it, you should feel these in your glutes.

Key Word: Glute.

4.  Above all, and this probably should have been point #1, you just need to make absolutely certain that you’re maintaining as much of a “neutral” spinal position as possible.

At. All. Times

We’ve had people with “spondy” deadlift with the trap bar with a lot of success, but we’re on top of them in terms of performing them correctly.  These may be a little too aggressive for you, so I’d be inclined to recommend exercises that won’t place a lof of direct loading on the spine to start:

Pull-Throughs.

1-Legged Hip Thrusts (see above).

Various single leg work.

And even Goblet squats may be acceptable here.

Nevertheless, getting lifting weights and attaining a training effect will undoubtedly help in that you’ll be making your active restraints (muscle) stronger and take the burden off your passive restraints (ligamentous tissue).

Anyways, that is in no way a thorough overview of the issue at hand, but my hope is that it sheds some light on the topic and points you in the right direction.