Does Your Back Hurt? Part 3
Finally the finishing touches to my back pain series. This was prompted by the epidemic of back issues that have been posted all over my social media lately. It seems that this winter many people have decided to “throw out” their backs. And this is something that is completely avoidable. The problem lies in that you’ve already likely done it to yourself. Now we have to make sure that it doesn’t happen again.
In July I wrote two articles on back pain. The first one which you can find here was about identifying what and why back pain typically occurs. The second one, which you can find here was about movements you can use when you’re feeling stiff or sore to help provide relief for general stiffness and soreness.
This part is about the exercises. Now, most therapists and trainers would identify that you need “more core strength”. What does that actually mean? Many people will think that yoga, pilates or even just simple crunches will do the trick. As I said in Part Two, the “core” is a very complex thing and can’t be isolated into one or two muscles. You have to strengthen the entire complex, and this stretches from the pelvis all the way up to the shoulders and even down into the legs.
So how do you begin? Well, a good place to start is by working on movements that you have to perform daily anyway.
My number one exercise to develop and improve back strength and resolve symptoms of back pain: The Deadlift.
In fact, if you were only allowed to do one exercise for the rest of your life, this would probably be my first recommendation.
Pretty simple, right? Picking something up and putting it down. This is not actually true. There is a lot of proper technique and intention behind this movement and I strongly suggest you have a competent coach (not your “brother-in-law who lifts”) teach you the movement and all of its’ parts. It includes the ability to squat, hip hinge and also keep your spine engaged throughout the movement, all individual components that you need to be aware of.
The good thing about this exercise is that it can be regressed so that my 103 year gold Grammie can do it, or progressed to an Olympic lifting level. It is very versatile and hits most of the muscles in your body in a very good way. One of my goals with any of my clients (even those with compromised backs) is a good solid deadlift.
My second choice for back strength actually involves the hips more than anything. Strong hips (and you can feel free to think “glutes” here) are essential for spinal integrity. Therefore my number two is: Hip Thrusters.
Now, this can be an uncomfortable position for many so I typically suggest starting this movement on the floor, then progressing to a Swiss Ball for mild loads, then a bench or modified floor position for heavier ones. You also need to make sure that your legs are in the proper position and you can actually hinge at the hips before you can do this properly. Again, please consult a professional coach to help give you the right technique.
Easy regression is an isometric hold in the up position (on the floor or a mat) for 15-20 seconds to start. Focus on pushing through the heels and pretending you’re holding a pencil between your butt cheeks and not letting it go.
Now, we also need a movement that takes place in the frontal plane – which means up and down if you’re standing up. This makes sure that the spine is being trained with forces that it will experience frequently. One way that people frequently hurt their backs is by extending a load over their heads they have no business lifting.
Most people also have very little upper body strength in relation to their lower body or vice versa. Men are horrible at this because they want to have a big upper body and never make their legs strong so their poor spine is like a pipe cleaner balanced with a big rock on top of it – and easily collapsed.
Therefore my next exercise for proper back health is very simple: The Pull-Up.
I realize that most people can’t do one full pull-up properly. Therefore I’ve given you two pictures that show easy ways to do these assisted in a gym or at home. If you need more ideas feel free to email me or google it and you’ll find a few more. I have at home clients do this with a bed sheet and a door frame sitting on the ground.
This movement not only is great for loading your spine in a frontal plane, it also hits those often neglected upper body pulling muscles that don’t get a lot of use. I encourage all of my clients to get to the stage where they can do pull-ups without much assistance. There are also a variety of choices in terms of grips and adjustments to enhance the strength in your shoulders without wrecking them. Please be careful and progress things appropriately.
Oh, and yes there is some debate over whether this is a frontal or sagittal plane movement. I believe it is a frontal plane movement. If you want to debate it, feel free to call me out.
There is a long list of complimentary exercises that I would add to this list. Some of them include:
- Overhead Pressing
- Romanian Deadlifts
- Back Extensions and Reverse Back Extensions
- Loaded Planking with movement
- Lateral Side Flexion
- Loaded Trunk Rotation
- Split Squats
And the list can go on. However, if you want to get started on the path to good spinal strength, these three are your first and best bet towards good spinal strength.
You might also notice that none of these first three exercises are traditional “core” exercises. However, all of them load your spine quite nicely and give you the benefit of adding strength in a bunch of other places as well. This is essential for total body health.
All of these exercises can be progressed and regressed by a competent coach. Always remember that exercise is tailored to the individual, and a good coach will adjust your program based on need and result (and goal).
I’m planning on putting together a proper E-Book on Back Strength coming soon. If you would like a free copy, feel free to subscribe to my site by adding yourself to the list at the side, or follow me on Twitter at @strengthottawa, Instagram at @strengthrehabottawa and on Facebook at Strength Rehabilitation Institute of Ottawa. I’m also always interested in your thoughts and feedback, so feel free to Share this as well on any social media.
Take care of your backs!
Case Study: Randi S
This is another success story I’d like to share with my readers and anyone interested in what I do. This case really illustrates the gradual use of resistance to create tension and hold positions for spinal issues and how they can be improved.
Randi came to me through a referral from one of my local MAT practitioners. Often when these people are receiving treatment they require someone who has my skills to help increase their strength once their body is able to fire muscles properly again. Having this combination is a really great way to enhance your gains in strength and allow your body to develop at a much more rapid pace. By the way, I highly recommend MAT to anyone looking to improve their physical self, you can find more about it HERE.
When I first assessed Randi it was a challenge. In a nutshell, everything we tried caused pain in her back, localized mostly around the right SI joint area which was indicated as the main issue. This had been going on for almost eight years and caused her to give up a lot of things she enjoyed doing, like hiking, cycling and even caused her problems while walking her dog. She had trouble with simply standing in proper posture, which put pressure in areas that her back “didn’t like”. This became a frequent gauge of her pain levels during our first few sessions.
Doing what I do, I will at first admit that I miscalculated and didn’t realize how much Randi’s back would react to my initial movement pattern assignment. After our first session she was okay, but after the next couple her back was sore for four days to the point where she couldn’t do normal everyday activities. This is after doing much movements as simple hip flexion, mild bracing, some basic extension (ie hip hinging) and trying to integrate her hips with her shoulder girdle. I was surprised, but glad that Randi (after she recovered) allowed me to try again.
The lesson here for both you and myself, is that you can reduce any level of force to an appropriate one for any person. So what did I reduce to? Randi started out most of her subsequent sessions with postural holds (bracing in a standing position), walking in proper alignment, and then going through various drills and movements unloaded in order to teach her body to facilitate coordination without any load. Loads were added eventually, but using angles of her body and longer ranges of motion, not weights. This Is a very broad description, but it worked. Before long, Randi’s body was to the point where she could endure long car rides, do sustained long activities she enjoyed like cooking and was able to think about buying a bicycle for her main goal.
Randi’s main goal was to be able to bike 26 kilometers for her trip to the Canadian Rockies, something she had wanted to do for a long time. The first step was to get her back on a bike again. She lasted for only 45 seconds the first time we put her on one. Then, through gradual application and increasing of mileage not only did we get her back onto a real bicycle (after finding one her body could tolerate) but we got her to the point where she could bike for over an hour (with breaks) and while her back was tired, she was able to recover quickly and function normally afterwards. Progressions were done weekly and she was also given specific technique rules and ways she could approach what she was doing on the bike to take tension off of her back. With some movements, it is a matter of reteaching the body how to move.
One interesting weekend Randi pushed herself a bit too hard, not realizing that a 15km route (which was prescribed) was actually a 20km route with hills. Her back reacted accordingly, but the great thing was that she recovered fairly quickly. Recovery time is always a great marker for performance improvement. Normally what would have done her in for a week had her sore for a couple of days, which is fairly normal when you’re doing something you haven’t done in eight years.
I’m happy to say that Randi has made incredible progress. Not only did she successfully ride the trail in the Rockies, she is now dead lifting up to 50 pounds, performing movements like lunges and pulldowns and planks, and is able to recover from workouts quickly. Her MAT therapist has seen a significant change in the way her muscles hold onto position. This is all in a period of about six months.
Once of the best parts of my job is helping people like Randi and sharing in the results. Here’s a picture she sent me of her on the bike out in the Rockies accomplishing her goal:
Randi’s goals have moved away from reducing pain and into more typical goals like weight loss and strength gain, which is fantastic. Everyone has to start somewhere, and the great benefit that I tell my clients is that if you can teach your body to tolerate forces, then it will always improve. If you have any specific questions about my work with Randi (or anyone else) feel free to contact me through this site or at firstname.lastname@example.org. I’m always willing to help if I can.
How To Set Your Year Up Right
On my recent podcast with Dan T and Canadian Minds on Health I spoke about resolutions, and how 88% of people fail at them. There are some simple strategies you can use in order to be more successful in your fitness and nutrition life this year, however. This article is all about the big things that you can change and some strategies that you can use in order to get your year off to a good start and keep it that way – until NEXT Christmas.
#1: Think Long Term
When we set goals the problem is that we don’t think about things in a long term sense most of the time. We want immediate gratification like everything else in society today. The problem with that is not only are you not really setting a well defined goal, it isn’t long enough to have lasting impact if it is only in place for a few weeks.
All of my athletes have their yearly goals typically planned by February, and successful fitness people do this all of the time as well. It allows you to then break up the year into smaller chunks and makes it more manageable. You can then set short term goals to move towards, and then even shorter ones. In athletic vernacular this is called periodization, but for the average person it just means that you always know what you’re going to be working on from start to finish in 2015.
You also need to factor in changes to things like weather, vacations, any major family events and think ahead to manage these things. If you set it up long term then you’re much more likely to succeed.
#2: Make Small Changes, Not Big Ones
Big changes like trying to work out five times a week and completely overhaul your diet also just sets you up for failure – because it isn’t realistic. Lots of people think they need to throw out everything in their pantry and suddenly find an extra 5 hours a week to spend at the gym, which isn’t totally necessary.
If you’re going to cut something out of your diet – make it one thing. And that thing should be fairly easy to do. An example would be processed sugar – easy to cut out and easy to maintain once you get over the withdrawl and taste of your coffee. Another good one might be a processed carb like pasta. Tell yourself no pasta for 30 days, then after 30 days pick something else and remove that too – by the end of 6 months you can remove pretty much everything major that might cause a problem.
When it comes to exercise, start simple. 20 minutes is my general recommendation. Whether it be walking, cycling, weightlifting (which would be my number one choice), yoga at home in front of YouTube, set your timer for 20 minutes – you can even get away with doing one exercise if it is the right one (see my article on deadlifts for this). Will this turn you into an Adonis overnight? No. But it will start a good pattern. Find that 20 minutes isn’t a problem? Bump it to 30 – then 40 if you can or add another day if your time allows.
#3: Find Something You Really Want To Do
We are all motivated by different things, but for many people at this time of year it comes down to vanity and looking better. In my opinion as I always say, health first – looks second.
So what’s a good example? I want to run a 10k in the spring. I want to fit into my dress for that upcoming wedding. I want to climb a mountain in the fall. I want to rock that bathing suit at the resort I go to next year.
Or how about I want to get off my medication? I want to stop thinking that I’m awful looking every time I look in the mirror? I want to be a positive example for my kids? I’m single and I really want to have sex with someone? These are more emotionally motivated but you get my point.
Bottom line is if you don’t really want to do it you’re not likely to – so find out what that thing is, make it stick for a long period of time and set the goal for the long term.
#4: Put Together a Team
This can be your family, friends, or experts in the field like myself or Dan – or even starting to blog online and getting support through that. Ongoing support is vital towards success in any stage of the game.
Women are 20% more likely to achieve a goal if they tell their friends about it – so do that. Guys prefer to do things solo generally but they like to learn, so hire a good trainer and sit down with a dietician and go over everything, with a way set up for support and constant feedback. Some of my clients are completely virtual (I’ve never met them in person), but we correspond through email and I track them online. Dan meets with people via Skype and with modern technology there is no excuse for not reaching out and finding someone you can trust with your goals.
Are you a group person? Join a meetup workout group or a running group or a sports team locally if you can manage the time. Not into groups? There are tons of tracking apps and anonymous ways to support yourself with whatever physical thing you are doing.
Family is typically really important for these things – my wife and I trade off care of our daughter and you can too. We also plan ahead for meals and make sure that even if things go off a bit they come back quickly. But even telling your family about what you want to do can be enough for them to support you at meals and with your activity outside of the home.
So before you set a resolution, take the time to plan ahead and set things up properly. If you need help with anything feel free to contact or email me. Good luck and before you know it, 2016 will be here, and a whole new you as well!