After all, our paleo predecessors had enough manual dexterity to hoist their entire body up a tree with their spindly arms. Why can’t we modern day Homo sapiens do the same?

The short answer? We’ve evolved. Evolution imprinted our DNA with strengths from the past and facilitated many adaptations for our future. Our brain has developed to assist us with thought and risk assessment. Therefore, we need to be cognizant while lifting.

Think before making action. And structurally? We are taller and less robust then our ancestors. Our bones used to be as dense as the Stone Age. Our present structure has a higher center of gravity. Being upright has its advantages and disadvantages.

Bipedalism, the ability to stand upright, is a result of a well-developed psoas and increased curvature of the spine. The spine is a flexing spring mobilized by the lower body, glutes, and legs. The pelvis is the hinge connecting the two.

Our erector spinae muscle group is strong enough to support our eighty-plus pound torso and approximately twenty-pound cranium when we stand upright. In the case of bending forward and extending back upright, however, the integrity of the spine is compromised.

What Happens When We Lift From the Low Back?

There are many sensations felt if the knees are not bent and the strong power of the legs is not used while lifting. In one of the more common injuries, you may feel a strain from the psoas muscle pulling on the lumbar spine. This can occur if there is a lack of “reciprocal inhibition.”

Reciprocal Inhibition is when one set of muscles (agonist) engages and the opposing set (antagonist) disengages to facilitate movement of a joint. In the case of lifting, when the glutes and erector spinae are flexed, the body releases the psoas and hip flexors to enable the torso to extend upright.

If you lean forward, with legs straight/extended, and add the weight of picking up an object, your hamstrings stretch and your lumbar extensors act as the primary lifters. Legs are like hydraulic lifts or jacks that have supreme pressing power to lower and lift the trunk of the body. The glutes stabilize movement between the legs and trunk.

If reciprocal inhibition is not present between these two muscle groups, the psoas and hip flexors will continue to stay engaged pulling the top of the pelvis down against the action of the back. The low back becomes the hinge as the torso and legs are both facing down. It’s a deadlift with a rounding low back. What may occur then is a low back strain due to overstretched QL (quadratus lumborum) and longissimus (at lumbar). This area is being pulled in two different directions when disengaged.

How Do You Lift an Object Properly?

Ensure reciprocal inhibition of the psoas by bending your knees and flexing your glutes and erector spinae muscle group when lifting. The result will be released psoas and hip flexors, so you decrease risk of low back strain or disturbing the intervertebral discs.

Your back will generally increase in strength and the glutes will become well conditioned for future bending. Secure your torso by flexing the abdominal muscles and press off of the legs during an inhale. An inhale naturally forces the body into opening and extending out. If you exhale during a squat, it decreases oxygen force and lessens the intake needed to pump into the large muscles for power.

And try this right now. Don’t take my word for it. Notice the difference. It can make a marked difference in your lifting approach.

The post Why You Lift With Your Legs, Not Your Back appeared first on Breaking Muscle.

After establishing that there is no “best” universal exercise to prescribe for a lower back problem in my last article, I’ve received a lot of questions about kettlebell swings and their use in low back rehab. This article will examine the swing in detail, and why I find it highly effective in rehabilitating the lower back – but only for the right athlete, and at the right time.

When prescribed correctly, kettlebell swings can be instrumental in later stage low back rehabilitation.

Force Application for Rehabilitation

Lifting weights comes at a cost on the lumbar spine that can be understood in terms of spinal compression, when the force is produced down the spine, and shear, when the force is applied across it. One of the most important factors in later stage low back rehabilitation is building lumbar spine musculature endurance. The aim is to create lumbar spine neutral control endurance while increasing these compression and shear force loads.

The ideal kettlebell swing here creates a hip-hinge deadlift style pattern, with an unnegotiable vertical tibia decreasing the joint movement at the ankle and knee. I don’t want a squat-style-swing where the knee and ankle movement will decrease spinal sheer and compression forces. The patient will be tolerant to those at this point, so it becomes about building strength endurance.

A Step-By-Step Implementation

Knowing if the patient would benefit from a kettlebell swing prescription takes a strong understanding of their goals and sport requirements. Swings can be programmed for most people, but is not the choice of exercise to use in an acute disc injury, for example, as pain fundamentally alters movement. The kettlebell swing should be used only when pain has been abolished and the rehabilitation path is aimed at restoring athletic performance. If you have read my previous articles, you will already know that I don’t consider an athlete restored to function unless they can flex their lumbar spine painlessly, and under a load that relates to tasks their sports require.

I’ve treated a few surfers over the years. In all cases, swing work was the moment their progress leaped forwards.

The first step is confirming the patient can tolerate spinal compression without pain, then applying manual shear force to the spine to ensure that the shear forces are also painless. At this stage of rehabilitation, I’m focussing on neutral spine control and optimisation. The patient must pass these tests to move on to the swing. This is not negotiable.

When rehabilitation commences, I begin with a deadlift-based technique. This is in line with clear research evidence that hip dominant flexion patterns are safer than lumbar dominant ones. I teach the hip hinge as a preferred movement pattern. If necessary, I will have done significant work to produce an excellent hip hinge by this point with a variety of hip hinge patterning and neutral spine hip hinged deadlifting.

I start with kettlebell deadlifting before barbell deadlifting, as this brings the mass closer to the patient’s centre of gravity. This would begin in sumo stance before proceeding to conventional form. To progress to the swing, it is critical that the patient demonstrates excellent deadlift technique beforehand.

The Surfer and the Swing

Here’s an insight into clinical application. I’ll use a case study of an international surfing athlete who came to me with a multitude of lumbar spine issues dating back many years, including two major disc bulges with neural involvement. Over a period of six months, I had reached the point of implementing kettlebell swings into his rehabilitation. Although progress was slow, it had been constantly progressive and he was able to surf during this time, with limitations as high as pain levels allowed.

“The kettlebell swing is the safest exercise for low back pain, but only when the patient has progressed through all the other best exercises beforehand.”

The start of the swing work was the moment that his progress leaped forwards. Initially, I prescribed sets of 3-5 reps. I looked for perfect form, as I always do, and only increased repetitions when that was clearly demonstrated. Within two months, he was performing 3 sets of 60 reps using a 20kg kettlebell twice per week. Soon after, he was enjoying two-hour surfing sessions without pain for the first time in years. I have had a few surfers over the years, and the hip-hinge-deadlift-patterned-swings I have detailed here all led to huge improvements in their tolerance to time spent in the water.

An Athlete-Focused Prescription

I treat people with different body masses and anthropometrics, and prescribe the swing with a specific focus to the athlete’s performance demands. That is what I teach across the board: knowing when the right exercise is to be applied, and getting athletes back to the top quickly and safely, using objective markers. Keeping this in mind, the kettlebell swing is the safest exercise for low back pain, but only when the patient has progressed through all the other best exercises for low back pain and has regained excellent neutral spine control and hip hinge patterning. After this level of rehab, much more can and should follow.

To understand the swing in rehab requires an understanding of the science of low back injuries. I’ll be teaching on this with weekend courses throughout 2016 both in Australia and the US. The first one is a 2-day event in March that I’ll co-present in Melbourne with Andrew Read and Greg Dea. Click here to book your tickets.

Photo 1 courtesy of Rich Manaro.

Photo 2 courtesy of Shutterstock.

The post The Kettlebell Swing: Mindful Prescription for Low-Back Rehab appeared first on Breaking Muscle.

Back injuries are the price of doing business if you’re training at the right intensity. So get off your high horse and listen up. It’s just a matter of time until the iron takes you as its next victim.

5 Steps to Safely Train Around Lower Back Pain

This isn’t your physical therapist’s handcuffing list full of dainty recommendations to lay off the weights. These tips will have you maintaining your hard-earned muscle armor and dominating your stat sheet while letting your lower back recover, thus reducing the risk of another debilitating injury.

TREAT IT: Super D Video: Treating Lower Back Pain

1. Assess the Severity of Your Pain

Dominating sets can wait a day. We have to first figure out if you’re able to get back in the saddle or whether you’re going to wet your saddle. With every case of lower back pain presenting in a unique fashion, it is necessary to determine whether you are dealing with just another muscle tweak or an amount of structural and functional damage.

Before you pick up the phone to throw your name on the weeklong waiting list to see your primary physician (who is probably a triathlete, if he trains at all), go through this checklist. If you are having any of the following symptoms, then you were right, your best bet is to go ahead and make that call:

1. Tingling or numbness
2. Loss of sensation
3. Loss of motor control (inability to coordinate voluntary movements)
4. Loss of bowel or bladder function
5. Severe immobility, inability to walk

2. Skip the Trip to Your Orthopedist

If you made it through the checklist above with a clean slate, chances are you are dealing with a purely musculoskeletal issue. Without neurological involvement, you will be able to independently manage your painful episode. Lucky you.

The ability to successfully self-treat will save you time, money, aggravation, and your general sanity. Through my years of treating lower back pain as a sports performance physical therapist, I can confidently say that 95% of expensive diagnostic imaging procedures are downright worthless.

“The ability to successfully self-treat will save you time, money, aggravation, and your general sanity.”

Sure, today’s imaging techniques can show structural damages in high definition, but have we forgotten about functionality? There are guys playing on Sundays in peak physical condition with imaging that would indicate a train wreck, but they’re still cashing big checks and doing it pain free. There are also desk jockeys out there hindered by gut-wrenching pain but showing clean scans.

As Tyler Durden might say, “You are not your fucking MRI.”

If your back pain is a chronic or recurring issue, the current symptomology should present in a consistent manner as previous injuries. And guess what, if you’re not willing to do things that you have never done before to rid yourself of this literal pain in your ass, then your orthopedic surgeon will be more than happy to grab the knife and open you up, cashing another absurdly large paycheck from the fat cat insurance company in the process. The choice is yours. I suggest you choose to be your own best advocate.

3. Classify Your Painful Pattern

Individuals with active and painful lower back symptoms will all be uniquely inadequate in their own dysfunctional ways. Despite the fact your recumbent bike-riding spine doc has classified your condition as “special,” it can still be categorized into one of two distinct groups: flexion- or extension-based pain and dysfunction.

Flexion-based pain and dysfunction is most prevalent within our culture of sitting, slouching, and overall piss-poor posturing. On the opposite end of the spinal spectrum, extension-based dysfunction presents more in active populations, especially those stuck in an anteriorly tilted pelvic position for extended periods of time.

FIX IT: How to Unlock Your Athletic Potential Through Good Posture

If you don’t know what I’m talking about, turn on ESPN. CrossFit has produced some of the fittest men and women on the planet, but also some of the most poorly positioned backsides for elite athletes in recent memory. And we wonder why CrossFitters continue to get injured.

Using two clearing tests popularized by the Functional Movement Systems (FMS), you will be able to determine your prominent movement dysfunction by the presence of pain while completing the motions below. If either of these tests illicits pain, that is considered a positive test. The most painful test classifies you as either flexion or extension intolerant.

Spinal Flexion Clearing Test

Spinal Extension Clearing Test

The results of these clearing tests will differentiate the daily movements and positions that will aid your path to recovery from those that will leave you flat on your back for the next three weeks, wishing you would have taken this classification system seriously.

For flexion-based dysfunction, avoiding sitting and slouching is imperative. As for extension, hanging out in an extended spinal position for long durations can exacerbate your current symptoms, delaying your recovery for a few more painful weeks.

For both painful patterns, keep moving and change positions as often as possible. Keeping your body mobile, while routinely giving your spinal structures a break, will speed up the recovery process and have you pushing new personal records in no time.

4. Avoid Heavy Front-Loaded Hip Hinges

The position you were in when you got hurt should be avoided. But don’t try to reinvent the wheel. Just stay off these movements until you earn the right to program them back into your routine:

• Deadlift
• Barbell Row
• Good Mornings
• Full-Range Crunches/Sit ups
• Back Extensions
• Low Bar Back Squat
• Leg Press

5. Increase Your Work Volume

In order to overload your lower body while staying within the parameters of the above programming, the overall work volume of a training session needs to increased. Volume can be most effectively manipulated by adding both sets and reps for each movement.

For single-leg primary strength movements, it is imperative not only to push as hard as possible, but to program with primary strength loads that keep you within a range of four to eight reps. Overall volume of your workout will be increased in these primary movements because they replace the traditional power work (between one to four repetitions) that is commonplace for many strength athletes. As long as you can maintain spinal positioning and stability, work towards fifty total reps per leg for single-leg work.

“In order to overload your lower body while staying within the parameters of the above programming, the overall work volume of a training session needs to increased.”

During split-stance work, strength and hypertrophy parameters are most advantageous to continue the pre-exhaustion of the lower body, while also putting an emphasis on increasing the total volume of the session. Stick to sets of eight to fifteen reps per leg, while working your way to sixty total reps per leg.

For any single-leg movement, make sure to complete all your reps on one leg before moving on to the opposite leg. This will allow you to maintain maximal tension and stability through the pillar, while not having to reset your spinal position over and over. For example, for step ups, complete six reps on the left, followed directly by six reps on the right.

You’ll know its time for bilateral work when you start shaking, are walking a little butt-hurt, and are contemplating going to the bathroom to release your demons. This is called pre-exhaustion, and the work that is put in after this level of trashing is what will keep you progressing, even with a painful lower back.

RELATED: The Best Back Workouts

Bilateral work is saved up for extended sets, finishers, and conditioning. Pick two movements that meet the criteria for safe lower-back programming (my favorite is the trap bar deadlift off platforms and isometric bodyweight squat holds), and crush them. Bilateral work is maximal effort, so go hard. Don’t worry about stressing the core. Your legs will be so fried that they will be the limiting factor to every set. Keep loads relatively light and reps to the max. Shoot for three sets of twenty-plus reps for two bilateral movements to put the final nail in this workout’s coffin.

If you have questions on this approach or how to work your way through these steps, please post them to the comments below.

Photos 1, 2, & 5 courtesy of Shutterstock.

The post 5 Steps to Safely Train Around Lower Back Pain appeared first on Breaking Muscle.

And, oh, how miserable it is not being able go to the gym, not being able to follow your detailed training plan, and possibly not even being able to tie your shoes. So how can you get back to feeling good and back to regular exercise?

Learn to Love Yoga to Heal Your Lower Back Pain

In a twelve-month study conducted in the U.K., researchers discovered that yoga was a highly cost-effective way to manage and heal lower back pain. Not only that, but the people in the study who did the yoga also took fewer sick days than the non-yoga-doing control group. So, your back hurts less and you get sick less often? Sounds awesome as far as my training aspirations go!

But which yoga poses are the best for your low back? And is there something you can do on your own without attending yoga classes? Yes, indeed. Yoga expert Julie Rader has a sequence of five yoga poses she suggests you do daily in order to relief back pain. At the very least, you should do these after every workout:

1. Supine Hamstring Stretch
2. Two-Knee Twist
3. Sphinx
4. Pigeon or Thread the Needle
5. Legs Up the Wall

For detailed instructions on how to work through this sequence, read Julie’s article “Heal Your Lower Back Pain With These 5 Yoga Poses.”

Low Back Advice From a World-Champion Powerlifter

Maybe yoga isn’t your thing and you’re more of a powerlifting athlete. In fact, maybe that’s why your back hurts to begin with – but don’t worry, we won’t judge you for that. We know that more weights is more better, and we’d hate to have you give up lifting heavy, so here’s a video from one of our resident powerlifters, Donnie Thompson, to help you out.

Donnie knows a thing or two about both lifting heavy and low-back pain. His powerlifting total is 3,000lbs and for his day job he specializes in helping other athletes stay healthy with physical therapy techniques. Check out his advice on how to treat your back pain. You’ll need some rubberbands and a rack (and you may want to make sure none of your friends have their cameras on hand):

Swim Your Back Back to Health

If your back pain has sidelined you to the point that weight training just isn’t an option – even with a good yoga warm up or band routine like Donnie’s – then consider switching to a different activity for a while: swimming.

Swimming and CrossFit coach Hannah Caldas herniated a disc a few years back and she found swimming to be incredibly helpful during her recovery phase. She opted not to undergo surgery and instead showed up to the pool three days a week. According to Hannah:

There are a few main reasons why swimming is a good rehabilitation tool:

1. It is low impact. (Unless you are training to be an elite swimmer at which point you will be putting your body through a more intense, higher impact workout.)
2. It is a form of active stretching – swimming technically will ensure full range of motion movements for many different body parts.
3. It provides just enough resistance from water to provide, over time, sustained aerobic conditioning to the rehabilitating subject, allowing them to continue to workout while rehabbing at the same time.

If your low-back pain is severe enough that even swimming seems daunting, you can start small. Hannah suggests you begin by getting into the water up to chest height and simply walking in the water. This is similar to what many therapist will have you do in their therapy pools. Once you’ve done this for a number of sessions and you feel good enough to swim, opt for the back stroke as the water will help support your back and thus relief some tension.

For more on how swimming helped Hannah get back to competitive sports, read her article “Rehab Your Back Injury With Swimming, Not Surgery.”

What to Do If You’re Stuck Sitting All Day

Despite your active lifestyle, we know that many of you get stuck sitting for long periods of time, whether at your desk, driving a car, or flying to your next awesome fitness-adventure destination. In this video, yoga expert Jon Kolaska shares a simple stretch you can do while seated that will bring your lower back some relief:

Take the Time to Slow Down and Heal

For most people, while back pain is a setback, it will be a temporary one. Refusing to acknowledge that you have to slow down, though, could result in your back pain becoming chronic and/or more severe. So take your pain as a sign that you need to change your speed and intensity for a bit. It doesn’t mean you can’t be active, but you may need to adjust your activities a bit.

Have you experienced low-back pain? What sorts of stretches, mobility work, or exercises helped you heal? Post your experiences and thoughts to the comments below.

Photo courtesy of Shutterstock.

The post How to Stop Your Lower Back Pain appeared first on Breaking Muscle.

Postural problems are caused by a variety of issues, such as immobility in the hip and shoulder joints. These factors then result in various back problems, like hypermobility of the lower spine or excessive movement at the junction between the lumbar and thoracic portions of your spine. The latter problem is most noticeable when you look at athletes performing an exercise like the overhead press and their ribs begin to pop out as their hands go overhead.

This will cause pain in the lower back, and especially the middle-lower portion. In this study, the researchers compared two traditional exercises to an exercise called the Lewit, created by Dr. Karol Lewit. All of the maneuvers were performed in the same position: supine (on the floor, face up) with the legs elevated in the air. The hip and knee joints were each flexed to ninety degrees. Generally in this position the lumbar spine flattens to the floor, so the participants rotated their hips to create a small, natural curve in the lower spine.

The first traditional exercise from here is called hollowing. Hollowing is when you draw your abdominal musculature in toward your spine. The second exercise was bracing, in which the participants would flex their abdominals hard, as if they were preparing for a punch to the stomach. Both of these movements are frequently used to strengthen the abdominal muscles, stiffen the spine, and eliminate pain.

The Lewit is performed in the same position, but at the end of each breath the lips are pursed and all of the remaining air in the lunges is forcefully expelled. The idea has to do with the associated role of the abdominals on breathing. The ribs are drawn downward during the expulsion, with the goal of maintaining a neutral spine.

Due to the similar body positioning, there was no difference in any of the exercises in terms of spinal positioning. I’d be curious to see the result of this with a legs-straight supine position, especially on the ribs. This is good news though, as none of the exercises caused negative postural adjustments. However, the Lewit did allow for a lower rib position.

Muscular activity, on the other hand, was superior in the Lewit to the hollowing. For the deep abdominal musculature, the Lewit was as effective as bracing, but less effective at working the rectus abdominus (the superficial ab muscles).

In the end, when developing the deep abdominals with corrective exercise, the Lewit is a great option. According to this study it is just as effective as other methods for developing strength, but better at maintaining good rib positioning. Try adding this one to your repertoire.

References:

1. Boyd Badiuk, et. al., “Exercises to Activate the Deeper Abdominal Wall Muscles: The Lewit: A Preliminary Study,” Journal of Strength and Conditioning Research, 28(3), 2014

Photo courtesy of Shutterstock.

The post Science Compares Solutions for Low Back Pain appeared first on Breaking Muscle.

When I practiced massage therapy, clients frequently came to me seeking treatment for lower back pain. Now, as a coach, I see that coaches will encounter many athletes with back pain, as well. In order to best help your clientele, it’s important for coaches to understand the muscles of the back, what can cause back pain, and treatments (after physical therapy, of course).

Anatomy of the Back

The back is extensive and consists of many muscles that run all the way up to the occipitus. Before going into the musculature, we have to know the vertebral column. The vertebral column consists of seven cervical discs, twelve thoracic discs, five lumbar discs, and then the sacrum, which is a fusion of five discs.

The discs of the vertebral column gradually get bigger in size, with the cervical spine being the smallest of the disc structures. Cervical discs, thoracic discs, and lumbar discs have similar structures – including the lamina groove, spinous process, body, transverse process, and vertebral foramen.

The most common piece of back musculature that most people are familiar with is the thoracolumbar aponeurosis. An aponeurosis is a tendon that is a sheet-like structure that is long and cable-like.

Other muscular structures of the back include the erector spinae, multifidi and rotatores, longissimus, spinalis thoracis, iliocostalis, serratus posterior inferior, quadratus lumborum, intertransversarii (located between the transverse process), and iliopsoas.

Many include iliopsoas with the muscles of the hip area, but when it comes to back pain, often the source of the pain comes from the psoas (that’s short for iliopsoas). We will also examine how the lower body muscles, like the hamstrings, have a huge impact on back pain.

Types of Back Pain and Injuries

There are many types of back pain, so we will go over sports-related injuries that occur with back pain and their symptoms:

Back Muscle Strain/Back Ligament Sprain

In my personal practice, this is the most common type of back pain I see. This condition involves a stretch or tear of one or more back muscles, ligaments, or tendons. The cause is usually a violent twist, jerking motion, or over-extension of the back muscles during a lifting session or even during bodyweight movement (think violent kips).

The problem with this type of injury is that if the athlete is not fully rehabilitated, the chances are extremely high for it to develop into chronic lower back pain. All you athletes who like to go to, maybe, two physical therapy sessions and go back to training – it may not be in your best interest to half-ass your therapy.

If you want to go back to training, follow the treatment plans of your physical therapist, massage therapist, or chiropractor before going full force into training.

Herniated Nucleus Pulposus (HNP)

This type of injury is where preventative care is most important (and we will go over that part more). Excessive weight bearing and stress can damage the intervertebral discs. These round flat cushions act as a shock absorber between each vertebra in your spine.

Unfortunately for us, we only have one disc between each vertebra. Each disc has an outer ring of fibers called the annulus and a jelly-like center called the nucleus pulposus. A herniated disc causes pressure to the disc’s outer fiber causing it to rip and for the nucleus to rupture out of its normal space.

Symptoms of this condition include numbness, change in reflexes, and tingling in extremities. This type of injury requires that the athlete see a sports medicine doctor or chiropractor for treatment.

Spondylolysis

As of right now there is no definitive cause of this disorder. Spondyloysis can be found in children as a bone defect or in adults as an injury. Spondyloysis is commonly found in those who participate in sports that have frequent hyperextension of the lumbar spine.

Spondylolysis can be asymptomatic, but if symptoms occur the condition usually feels like chronic back pain. The pain can stem from mechanical (structural) or compression (pressure on the nerves). Suggested treatment is physical therapy or chiropractic care.

Mechanical Lower Back Pain

This may sound like its not an injury at all, but it is a frequent condition among athletes. Symptoms include general back pain, stiffness, and restricted motion. Usually the pain is localized to a specific area and without nerve pain.

There are several causes including past injuries that have not healed, anatomical abnormalities, faulty posture, and poor physical conditioning.

The concern with this type of injury is that because of the pain the athlete will unconsciously not engage the muscles of the back to perform activities and exercises, which only worsens the situation. With this type of injury it will be best to see a physical therapist regularly.

Preventative Care for Back Pain

There are many treatments for back pain that a physical therapist, doctor, nurse practitioner, physician’s assistant, or chiropractor will give you. Whatever the treatment you have elected, you should always follow your practitioners program in its entirety.

So the real question becomes what an athlete should do before needing treatment or after completing treatment.

Preventative care is extremely important for athletes especially if they want to be competitive. Physical therapists, doctors, and chiropractors can catch certain symptoms before they start and begin rehabilitation at the sign of a problem. They can also educate athletes on how to prevent injuries from occurring.

A study was conducted in the Journal of Chiropractic and Osteopathic College of Australasia on the role of chiropractors as educators for preventative back injuries in the work place. In the study, chiropractors lectured participants on spinal injuries and how they could be prevented, including risk factors for injury and workplace awareness (so think gym-place awareness and athlete risk-factors).

The cost of reported back injuries went down by 57%. The dollar amount allocated to treatment was $451 in the six months prior to the training from the chiropractors – and only $194 in the first three months after. This is proof that getting educated on caring for your lower back can save your money and your gym performance.

Gym Guide to Low Back Health

Your time in the gym can be valuable in either preventing low back problems or rehabilitating them. But first and foremost, always be cleared by your therapist before going full force into the gym. You must start slowly when coming back from injury. Athletes often feel they can come back to the gym and do a hundred back extensions, when in reality, getting back up to speed is something that must happen slowly.

There are certain specific things to consider when it comes to lower back health:

• Lower back flexibility to encourage normal curvature of the spine. Without this flexibility, forward and lateral movements are disrupted, which can cause strain on the hamstrings, leading to lower back and hamstring pain.
• Hamstring flexibility allows for anterior rotation (tilt) of the pelvis in forward flexion and posterior rotation in a sitting position. Without this, the pelvis is restricted, which can cause disc compression.
• Hip flexor flexibility can achieve a neutral pelvic position. Those with tight hip flexors have an exaggerated anterior pelvic tilt, which can cause compression.
• Abdominal strength and muscular endurance will maintain proper position of the pelvis and reinforce the back extensor fascia. Weak abdominals exaggerate anterior pelvic tilt causing strain on the back extensor muscles.
• Back extensor strength and endurance provide stability for the spine, maintain posture, and control forward flexion. Weak back muscles increase stress on the spine and can cause compression.

Lower back pain can be irritating, but it can be healed. Hopefully proper therapy, a slow pace coming back into fitness, and preventative measures will help athletes have a healthy lower back again. Being pain free is always the goal and if you know you have these issues take the necessary precautions to insure your back is safe.

References:

1. Micheli, Lyle J M.D., The Sports Medicine Bible (New York: HarperCollins, 1995), 184-194.

2. Biel, Andrew LMP., Trail Guide to The Body (Colorado: Books of Discover, 2005), 176-196.

3. Tate, Phllip., Seely’s Principles of Anatomy and Physiology (New York: McGraw Hill Companies, 2012), 230.

4. Gelb, Daniel M.D. et Al., “Lower Back Pain in Athletes.” University of Maryland Medical Center (2013): eFirst, accessed January 27, 2014.

5. Tuchin, PJ., “Spinal Care Education as a Preventative Strategy for Occupational and Health Safety: a New Role for Chiropractors.” Journal of Chiropractic and Osteopathic College of Australasia (1998): 7(1) 8-14, accessed January 27, 2014.

Photos 1, 2, & 6 courtesy of Shutterstock.

Photo 3 by By OpenStax College [CC-BY-3.0], via Wikimedia Commons.

Photo 4 by [Public domain], via Wikimedia Commons.

Photo 5 by Hellerhoff (Own work) [CC-BY-SA-3.0], via Wikimedia Commons.

The post Low Back Pain: A Guide for Coaches and Athletes on Anatomy, Types, and Treatment appeared first on Breaking Muscle.

Take that red pill and you can never go back. In our case taking the red pill in regards to disc bulges means finding out the back pain rabbit hole goes a whole lot deeper than you ever imagined. In my series of articles you will learn what the world is really made up of. You will see some professions that treat your back pain are just snake oil salesmen in white coats. They won’t want you to understand your problem for fear they will lose money and they will lose your family and relatives that they told you to bring to them. They will put up your x-rays and tell you all that is wrong with you, but after taking the red pill you will see through them, those agents of the back pain matrix. I’m trying to free your mind. But I can only show you the door. You’re the one that has to walk through it. Education (the red pill) will set you free.

Having received a tsunami of mail regarding the athlete who I treated successfully that competed with a significant disc injury, I’ll do my best to help guide you through the disc bulge minefield. The biggest problem with low back problems, and disc problems in particular, is that most medical and paramedical professionals (let alone the local fish slapper) have never had enough education within their various undergraduate degrees to truly understand disc problems. It is a specialist’s area. Don’t let that scare you off, though. I don’t mean you cannot understand it. I mean it takes study and experience with patients to gain a depth of skill when dealing with afflicted people. Not afraid of a little hard work are we?

If you want to be a great trainer or you have a back problem and you want to understand it, here is the best place to start. I have to teach you anatomy. Understand this beast and study its habits before you engage it in battle. After the anatomy, I’ll teach you function, simple physics, and how to understand symptomatic and non-symptomatic disc problems. I’ll show you the “traffic light” system for safe exercise progression, and a whole lot more. I also figure that is going to take a lot of words, so get ready for this to be part one.

Let’s be clear. I love language. Language is specific. Words have nuances that can change whole meanings and this especially applies to scientific language. So the biggest irritant I get is when people who are not experts try to write articles on subjects that are specific and can be complex, such as disc injuries, and then totally fuck up the terminology.

In their paper Nomenclature and Classification of Lumbar Disc Pathology, doctors Fardon and Milette spent twenty pages on the clarification of the types of injuries that can occur to a disc. Dude, they never once used the term slipped. So, don’t you use it either, unless you happen use it when you say to someone who has just used the term slipped disc, “Sorry, my open hand just slipped against the side of your head rather forcefully, you idiot.”

Print out the sentence below and paste it to your favorite family photograph:

The definition of a diagnosis does not determine the symptoms.

Dammit, I think I’m going to put it on t-shirts and sell it. A specific diagnosis is a part of management consideration, but it does not dictate the treatment. Complete understanding of the nature of the symptoms and a definitive diagnosis of the problem are part of the paradigm I use to treat each individual. So, contrary to many recipe approaches, when you have a diagnosis that is specific, it does not dictate what the treatment must be. That involves a bit more understanding that will follow. For today, let’s just get our language clear and precise. I will give you a case in point later.

Here are the accepted terms you may see on a report describing the state of the disc:

• Normal – Okay, it is normal
• Congenital – Condition present at birth
• Developmental variation – Due to abnormal growth of the spine (e.g. scoliosis)
• Degenerative – A progressive impairment that can include desiccation, fibrosis, disc space narrowing, osteophytes
• Traumatic – Due to trauma

So let us look at a disc. Yes, another original drawing by me. This perspective is looking down upon a disc/vertebral section. A disc has two components you need to understand at this point. Further anatomy may be used in other articles where necessary, but today I am instructing about common disc injury terminology:

• Nucleus – in the center
• Anulus – series of rings that contain the nucleus in the middle.

What are the injuries common to a disc? Well, here we get onto more specific terminology.

• Anular tear or anular fissure – These are separations of the fibers that surround the inner part of the disc.
• Herniation – A localized displacement of disc material beyond the limits of the normal disc space. The material displaced may also be mentioned – it may be nucleus, cartilage, bone, or anular material. Herniations are subcategorized as focal, broad-based, symmetrical, or asymmetrical.
• Protrusion – A form of herniation defined by the distance it has displaced.
• Extrusion – A form of herniation greater than protrusion.
• Sequestration – Where the disc material has separated from the disc.
• Migration – Defines the movement of the disc material and its direction.
• Bulge – By definition this is not a herniation. It describes a generalized extension of the disc material beyond the normal disc definition. Bulging is often a normal situation requiring no treatment.

Here are some examples to help clarify the above terms. Figures 2-4 give you an idea of what I have defined. I have simply taken the disc shape and shown you how the various situations look on a CT or MRI scan. I could draw a few more but this should do for a start. (Commission art is upon request.)

So how many people do you know, or have met, who seem to consider a disc bulge as some sort of life sentence without parole? You may not have known it, but some disc bulges are absolutely normal and do not require any treatment. In fact, the person will have never felt pain or experienced impeded movement. Yet, tell someone they have disc bulge and watch how fast they press the panic button. At this time, just become more familiar with the terms and comfortable with their use.

You should also become far more critical of articles written by people telling you how to treat a disc bulge or low back pain. Also there are a lot of articles published about non-specific low back pain. This to me is a term used for academic laziness. Besides radiological terminology, there is also symptomatic terminology. Any article about non-specific low back pain to me indicates the researchers were not experienced in clinical spinal rehabilitation and were unsure about how to define low back problems.

So now you know the names of the most common radiological terms for disc investigations. Now, for the bad news – a lot of doctors do not use the terminology correctly themselves. You might get an MRI scan that a radiologist will term incorrectly. Sorry, not my fault. It is up to you to be interested and to ask questions if you have a scan or are training a client with scans. Ask to look at them. It does not mean you will understand them, but the more familiar you become with them the better you will grow as a professional over the years.

So grasshopper, want to try and take that pebble from my hand yet?

The Dark Side

A “doctor” I once worked with told me he ordered MRI scans for every patient. He said the more precise the investigations you ordered the more chance you would find something wrong with the patient. That was why he did it. He knew the patient didn’t understand the amount of false positive results you can get on an MRI, but he always knew he could find something. He would make disc space narrowing appear to be a terminal condition to a frightened patient. Then he would tell the patient to bring in the husband or wife so he could explain how serious it was to the spouse as well. These people exist, they prey on you being uninformed.

References:

1. Fardon and Milette SPINE 26(5) E93-E113. Nomenclature and classification of lumbar disc pathology.

Photo courtesy of Shutterstock.

Drawings courtesy of Andrew Lock.

The post The Rabbit Hole of Back Pain: What Your Doctor Doesn’t Want You to Know appeared first on Breaking Muscle.

I have studied and treated human beings for a couple of decades. I’ve spent long days and nights in university libraries, late nights in the dissection rooms with cadavers for company, and have amassed a professional career of treating people in pain. I’m good at this and now I’m trying to educate a whole new breed of fitness professionals to become good at fitness rehabilitation. So, let me shine a light for you in the darkness of the back pain night.

Disc “Bulges” Are Not Forever

Disc bulges and injuries can go away without surgery. Even really big disc injuries like the one pictured. Below is a before and after MRI of a patient of mine, who had a huge injury. Look at the after photo and you can see what the spinal canal should look like, then the before and you can see this is a big one. It looks like someone sneezed on his MRI, there is that much junk in the spinal canal. Three months from that MRI to total freedom from disc injury is what he achieved.

After an Injury Training Should Be Expected to Return to Normal

I’ve had quite a few patients with disc injuries this big and thousands with lesser size injuries, and I’m close to a 100% success rate in getting them back to whatever they wanted to do. In the case of the guy in the before and after scans, he was back into the gym doing calf raises with 1,000lbs within six months. This was after he got back the control of his calf muscle due to the nerve injury concurrent to the disc injury.

No, I did not tell him to do those calf raises. It is just what he wanted to do, and I had no problem with his personal choice. I just showed him the tools to achieve his goals as the disc resolved. This is the greatest skill in low back injury treatment – getting the patient back to 100% of pre-injury function. It takes specific exercise application, including strength exercise both for hypertrophy and skill.

Once the Injury Is Healed, You Do Not Need Ongoing Treatment

Don’t let anyone tell you a disc injury is for life. I’ve got files full of MRI evidence of disc injuries being healed, and they don’t need monthly “adjustments” to keep them “in line” either. These people may naturally incur other injuries in the course of their pursuits, but once I solve a disc injury I expect it to stay that way, as long as the patient keeps doing the work I prescribe (forever), then they can go ahead and pursue the dreams and goals they had interrupted.

The specific exercises I prescribe will vary with each patient and are related to each personal history, presentation, lifestyle, and occupation. So I can’t give you a cookie-cutter treatment protocol for everyone today, but I just wish to show you that even big problems can be solved. It’s just a matter of finding the right answer and not giving up.

Here below is an example of the disc in the healing process. The balloon-like bulge is being healed and will return to normal. The process is a bit too complex to describe fully in this brief article, but when I teach courses on low back rehabilitation, I go through this process in detail.

Left: before; Right: after.

Pain Can Come From an Uninjured, Normal Scanned Disc

You do not need to have a disc bulge, rupture, or herniation to have pain from your disc. Sure, the injuries you see on an MRI like above, can be correlated to the symptoms, but experiencing pain that is from a disc and yet having the disc appear perfect on an MRI is certainly a more common clinical picture.¹

You Can Have Pain Without Injury

Not as strange as it first sounds. Most often these pains relate to stretch receptors in the ligamentous tissues being stimulated. I have found these problems the easiest to solve, as it usually involves an examination of the person’s lifestyle and daily postures to provide a solution. Funny enough, these are often the people who come to me after seeing everyone else. The ones that doctors put up their x-rays and scans and can’t find the problem, yet all the while the patient is sitting there slumped on a stool.

You will find this in many areas of health and fitness, where a client bounces from trainer to trainer or doctor to doctor in despair of finding a solution. There are some classic questions and tests you can learn that will help you sort these people out swiftly, and the solution is usually a significant alteration in the patient’s ergonomic comfort zone, or stopping them from doing an exercise that someone else gave them that is perpetuating the problem, not solving it.

Healing a Person Can Be as Simple as Stopping the Wrong Exercise

An example of what I just mentioned is pulling your knees to your chest, in the case of posterior disc injury. This classic exercise prescribed in low back pain is from the famous Williams flexion exercises for back pain, these exercises are still prescribed today and are almost as universally wrongly applied as the day they were first published in 1965.² The concept that spinal flexion exercise is a universal cure for low back pain even flies in the face of 2,400 years of evidence to the contrary that can be traced back to Hippocrates in 400 BC who recommended pressing sharply on the lumbar kyphosis of a patient with low back pain.3

Pain Is Not Expected to Be Proportional to the Injury

Knowing low back pain can be present without tissue injury, then it can obviously exist when there is actual damage. But there is no rule that says the pain is proportional to the injury size. Pain is a construct of your mind; biological injury is damage to living tissue. (This is another article in itself.) Simply remember the pain is rarely proportional to the injury. Some of the people I have met in the greatest amount of pain, often in the hospital unable to move from the bed, had little if any demonstrable injury on their scans. And all the biggest disc injuries I have treated were in people who were able to walk through my front door (even if they were dragging their leg).

Biological Healing Time Is Universal

The biology of healing an injury is universal to human tissue. (A good summary is Evans P. “The Healing Process at Cellular Level: A Review” Physiotherapy, August 1960 vol 66, no. 8.) In back pain, the statistics of injury resolution are approximately 86% of people are feeling better at four weeks post injury and 92% are better at eight weeks, regardless of the treatment.⁵ This is a good ballpark figure to go by, as I’ve read a heap of studies on back pain resolution and those numbers correlate to clinical practice observations.

The word better I think is worthy of discussion, because better does not necessarily mean resolved, does it? I aim for back pain resolution, not just better. Remember there is no such thing as a fast healer. There are normal healers or slow healers only (drug assistance not considered). So, you can be out of pain quickly, but remember pain is not injury. Pain is your conscious construction of various inputs, it does not directly relate to healing. It relates to removing the painful inputs to the brain, which may involve healing, but also may not.

I usually have people out of pain fast, but temper their enthusiasm by teaching them to respect the biological healing parameters. Once you remove or reduce the pain, then your client is going to be able to pursue the active components of the rehabilitation exercise to the optimum prescription.

Treat Each Personal as an Individual – They Are Not Recipes!

The key to full success in treating low back injury, once you have a handle on the cause of the problem, is to understand that each person is different, not different in basic biology, but psychology. This is why in the health and fitness profession, the successful trainers are those who understand each client’s different needs. In the treatment of injury, it’s the same. We have the universal principles of biology, biomechanics, and physics to apply, but we also need an element of understanding human behavior, because this influences the patient’s successful transition for injury to sporting return.

Injuries Can Be Totally Healed and Not Require Ongoing Treatment

Okay, so you now know even big disc injuries are not to be feared. They can be healed totally without lasting deficit. It then requires the perfect combination of passive, active, and neural rehabilitation strengthening exercises and progressions to take the patient back to optimum recovery and return to excellence of performance. (None of which, by the way, requires you to pull your damn belly button in!)

References:

1. Bogduk N. 1989, “Pathology of Lumbar Disc Pain” AAMM Vol 5 No.1.

2. Williams P.C. The Lumbosacral Spine, Emphasizing Conservative Management. New York, Blakiston Division, McGraw-Hill, 1965

3. Schiotz E, Cyriax J. Manipulation: Past and Present. London Heinemann and Son. 1975

4. Evans P. “The Healing Process at Cellular Level: A Review” Physiotherapy, August 1960 vol 66, no. 8

5. The McKenzie Institute Australia, Part A. The Lumbar Spine. Course notes

Photos 1&2 courtesy of Andrew Lock.

Photo 3 courtesy of Shutterstock.

The post Myths About Disc Bulges: They Are Not Forever – But Training Is appeared first on Breaking Muscle.

We have also added a recent updated set of poses: 5 Yoga Exercises for a Healthy Low Back. Check both articles out for a comprehensive approach to using yoga for back pain.

If you look at a typical weekday of an average American who works a nine-to-five job, it is easy to see why lower back pain is an issue.

A Marathon of Sitting Leads to Low Back Pain

Upon awakening, one may sit to have coffee or breakfast before sitting to drive to work. When arriving at work the corporate employee will often sit at a desk or in meetings until lunch. Lunch involves more sitting, before sitting at the desk to finish the workday. Then of course there is the commute home and another sit-down meal.

Exhausted from a long day of sitting at the office one may choose to sit on the sofa to watch television to unwind. If we look at it from an anatomical standpoint we realize the hamstring muscles and the iliopsoas muscles are shortened from the many hours of sitting and this causes strain on the lower back.

But I’m an Athlete, and My Back Still Hurts

Athletes on the other hand are not sedentary, so why the lower back pain? Any weight-bearing sport or exercise that involves running, jumping, or rapid dynamic movements produces tension on the lower back. When these activities are repeated over time without properly stretching and releasing these tight muscles overuse injuries may occur.

For the sedentary nine-to-five worker exercise is key for relieving lower back pain as well as reducing the risk of heart disease and diabetes. However, I’m assuming you are not in that category. If you are, then add some cardiovascular exercises along with the lower back stretches suggested below.

If you have a slipped disc in the lower back or sciatica, please avoid all deep forward bends as these can make your condition worse.

Lower Back Pain Relief Yoga Sequences

For lower back relief please do the following poses daily or at least after your workout. Breathe deeply in and out of the nose while doing these poses.

Lower Back Pain Relief Yoga Sequence #1: Supine Hamstring Stretch

Lying on your back, bend your right knee into your chest and place a strap or rolled-up towel around the ball of your foot. Straighten your leg toward the ceiling. Press out through both heels. If the lower back feels strained, bend the left knee and place the foot on the ground. Hold for 3-5 minutes and then switch to the left let for 3-5 minutes.

Lower Back Pain Relief Yoga Sequence #2: Two-Knee Twist

Lying on your back, bend your knees into your chest and bring your arms out at a T. As you exhale lower your knees to ground on the right. Keep both shoulders pressing down firmly. If the left shoulder lifts, lower your knees further away from the right arm. Hold for 1-2 minutes each side

Lower Back Pain Relief Yoga Sequence #3: Sphinx

Lying on your stomach, prop yourself up on your forearms. Align your elbows directly under your shoulders. Press firmly through your palms and the tops of your feet. Press your pubic bone forward. You will feel sensations in your lower back, but breathe through it. You are allowing blood flow into the lower back for healing. Hold for 1-3 minutes.

Lower Back Pain Relief Yoga Sequence #4A: Pigeon

From all-fours, bring your right knee behind your right wrist with your lower leg at a diagonal toward your left hip. Square off your hips toward the ground. Bend forward. Widen the elbows and place one hand on top of the other as a pillow for your forehead. Hold 2-3 minutes and then switch to the left side for 2-3 minutes.

If pigeon pose bothers your knees, then do Thread the Needle.

Lower Back Pain Relief Yoga Sequence #4B: Thread the Needle

Lying on your back, bend both knees with the feet flat on the ground. Bend the right knee like a figure four, with the outer left ankle to the right thigh. Lift the left foot into the air, bringing the left calf parallel to the ground. Thread your right hand between the opening of the legs and interlace your hands behind your left thigh. Hold 2-3 minutes and then repeat on the other side.

Lower Back Pain Relief Yoga Sequence #5: Legs Up the Wall

Scoot your buttocks all the way into the wall and swing your feet up the wall. This pose is excellent for relaxing the muscles of the lower back and drains stagnant fluid from the feet and ankles. Do this pose after a challenging workout and always after traveling by plane. Hold for 5-10 minutes.

Photo courtesy of Shutterstock.

Check out these articles for more on back pain causes and relief:

• An Effective Stretch for Tight Hips or Low Back Pain (Video) *Reader Favorite
• The Best Back Workouts
• How to Return to Training After a Low Back Injury
• Find Out What’s New Today on Breaking Muscle

The post Heal Your Lower Back Pain With These 5 Yoga Poses appeared first on Breaking Muscle.

Once you’ve done that, then let’s get into returning to the gym after a low back (aka lumbar spine) injury. Before you go any further, read the article I wrote a while back in regards to the most common injuries I see in my practice – shoulder and lumbar spine injuries – that may be of some help to you especially if the problem is still present.

When I give my patients the green light to resume their regular exercise routine, we proceed with caution. Before any running, jumping, or lifting, the person must have a perfect air squat. Their pelvis must not shift to one side. Their knees must track out while feet stay firmly on the ground about hip-width apart. The axial skeleton must stay upright, active, and with no collapse of the lumbar spine (“butt-winking”). Ten perfect squats a day along with core activations and individual specific mobility are the only things I allow during the first week of recovery from a low back injury.

When the first week of activity has been completed and there is no discomfort, then we move on. During the second phase, I allow running, rowing, swimming, air squats, strict pullups, hollow holds, and perfect pushups. Yes, there will be muscle soreness from the de-conditioning that has occurred due to the injury, but if any of those things, aggravate the low back, then I encourage my patients to seek coaching for specialties such as running or gymnastics to learn the correct biomechanics.

Once the patient has mastered the second phase of bodyweight movement and metabolic conditioning with no pain, then we start to add a little weight in the squat. This means only the bar and only a front squat. Front squats have numerous benefits, but the greatest of all is that this particular squat creates a super strong core. A strong core is a solid foundation to any movement.

As you can see, there are a number of movements the athlete (you) can now do: running, rowing, front squats, hollow holds, pushups, and pull-ups. This is a great foundation to get back into your regular exercise program. If all is progressing nicely, start to add things back in. Do one thing a day and wait to see how your body responds the next day. Only introduce one new movement at a time.

There are a few movements that you need to approach with extreme caution when recovering from a back injury:

• Putting any weight overhead requires an extremely stable and active midline. This means having a solid hollow position. Dusty Hyland teaches this position very well. Do not take this movement too lightly.
• Deadlifts are great for strengthening your posterior chain, but these have to be done correctly. Use light weights and focus on the biomechanics of the movement.
• Back squats put a lot of stress on the posterior chain. For people who have had a disc issue, I advise waiting nine to twelve months of pain free exercise before going heavy on back squats.

Injuries can be a blessing in disguise. Continue to work with your chiropractor or physical therapist as your progress. Set the intention for correct biomechanics and you will be a stronger, more efficient athlete in the long run.

Photos courtesy of Shutterstock.

The post How to Return to Training After a Low Back Injury appeared first on Breaking Muscle.

6 Steps to Heal Your Low Back Injury (Traver Boehm)

So you’ve done it, you pulled too hard with a rounded back on that last deadlift, or waited one second too long before tapping. You’re a CrossFitter or BJJ with a hurt low back. Now what?

Why You Lift With Your Legs, Not Your Back (Willow Ryan)

You’ve heard it a million times before. Lift with your legs, not your back. But what does that mean? Let’s have an anatomy lesson today and see what the science is behind this advice.

Strong Foundations: Building and Maintaining a Healthy Low Back (Katie Chasey)

A strong low back is essential for powerful and injury-free movements in sports and other activities. But how do you keep your low back strong? Here are some dynamic stretches and lifts to help you.

Low Back or Leg Injury? Stay Active With Modified Sun Salutations (Willow Ryan)

Don’t stop going to yoga just because you’re injured. Use yoga to stay active, heal your injury, and explore your body and the yoga poses in whole new ways.

Yoga Proves a Cost Effective Treatment for Back Pain (Joshua Wortman)

A program known as “Yoga for Healthy Backs” is saving people and health services a lot of money in the UK. Treatment of chronic back pain with yoga results in lower costs and fewer sick days.

Breaking Muscle Video – Chair Twist For Low Back Tension (Jon Kolaska)

This week I’m going to share with you a simple exercise I like to do to stretch my lower back. All you need is a solid chair without wheels, but with armrests.

How to Heal Shoulder and Lumbar Spine Injuries (Lindsey Mathews)

As a health practitioner, the two most common injuries I see are shoulder and low back injuries. Here is my advice for how to handle and heal from these common athletic injuries.

Dear Willow: Need Help With Low Back Pain During Meditation and Yoga (Willow Ryan)

Do you get back pain while sitting in meditation or certain yoga positions? This week Willow walks us through the reasons for this pain and how to develop a strategy to work with it.

The post Get the Low Down on Your Low Back appeared first on Breaking Muscle.