Resuming gym/advice after mid back issue

Gerry

Hi, first time poster. I had started in to a local gym after many years of no gym and very little exercise besides cycling. I started with a group pt class and did a few bootcamps. I would struggle to do more than 2 sessions a week with young kids. It was a shock to the system but after a few weeks I was familiar with most of the exercises and machines. Anyways enough waffle, I put my back out, I don't think the gym was the cause more that I noticed pain while doing barbel lifts while bending over. a few days later I was in bother with the mid back.

I went to physio, got sorted and back is "normal" again. I can check with the trainers at the gym, but Id like to work out how to avoid these back issues in the future, rather than avoiding specific exercises .

I know I'll need to spend more time on mobility than strength training. But any advice from anyone who's gone through similar. Thanks

Cill94

The most common cause of back injury I see with clients is simply doing too much work too soon. Barbells are a great piece of kit but they need to be loaded intelligently. As a beginner, you really shouldn't be training close to failure on these movements.

I would personally recommend loading that back up again, but in an intelligent way.

Deadlifts, jefferson curls, back raises, good mornings etc. are all great exercises for building the general strength and mobility of your back.

Ericmorr

My unprofessional opinion is that ab work helps prevent back injuries. I've really tried to focus on some core work every session over the last few years and any of the nagging (minor) back issues I've had have all but disappeared.

Gerry

Thanks folks. think I did do too much too soon. I will look into those exercises. Had heard this about abs. I definitely found ab exercises very tough ( relatively speaking ) so quite likely weakness there.

Black Sheep

With the core training, I do think there's a relationship between developing strength in some core training movements and relieving low back issues (or avoiding them). Planks, side planks, performed well.

I'm less certain that doing a high volume of ab movements like crunches, butterfly kicks etc as you'd find in a circuit class are of benefit - particularly if they're done tired and to failure, as they usually are.

With the plank type movements I feel the benefit is that you are learning to brace hard and develop what some people have called 'super stiffness' around the spine. Although all of this stuff is contested, some experts believe that that 'super stiffness' is what will prevent further back injuries and as the muscles involve get stronger it relieves symptoms. Not sure I buy it 100% but this is a model that has worked for quite a few people (Dr Stuart McGill popularised it AFAIK).

If you brace and take care when hinging and lifting, and are careful with loading and weight progressions, as Cilian mentioned, actually continuing training should help rather than hinder you.

Gerry

Yeah, thats the thing, I had to take a pause, but I want and I think need to continue in a sustainable way. I feel like I need to build my own program and stay out of the circuit classes for now. Definitely want to prevent injuries rather than just avoid.

Cill94

https://www.boards.ie/discussion/comment/120055985#Comment_120055985

The problem with his theory is there are several studies showing that people with back pain actually have more core stiffness, probably as a protective mechanism to avoid movement at the spine.

Which would lead me to thinking training not just bracing but more importantly flexing, extending, rotating etc with sensible loads is the best approach.

People with back pain tend to have stiff, weak backs. So my take is do the opposite. Strengthen and move. Not just rigid bracing. Jefferson curls are great for this.

I would still be for including core work like planks and sit-ups, but more strengthening those muscles than for any idea of a 'protective effect'.

Flinty997

...

Black Sheep

I'm not a complete devotee of Stuart McGill, I don't know for certain that his approach is 100% right (although I'm not sure many of us have the experience he has to say what he is definitely wrong on either). BUT that being said, I think his model has relieved a lot of people's low back pain and it's hard to hurt yourself with.

He does advocate for hip and thoracic spine mobility work without loading.

Then he has his suite of movements that he believes teach proper core stability / bracing of the spine under load... These are the strength movements requiring anti flexion and anti rotation like we're talking about, mainly plank variations.

But in his approach there's always meant to be a progression and a return to sport. McGill's advanced progressions (We're talking weeks / months here, not 'advanced' in terms of years) are one handed deadlifts, one sided farmer's walks and advanced planks where there's movement or instability, and one handed plank variations. At that stage he'll already have people having reintroduced pull-ups, kettlebell swings and squat and deadlift variations. I remember when I first read his work - it was Ultimate Upper Back Fitness and Performance, around 2005, which was more of a book intended for clinicians - I was surprised how much his programming looked like conventional S&C once you were past the early phases.

I found his approach less risk-averse than the likes of Mike Boyle. McGill might prefer a front squat to a low bar back squat, but he's not saying no heavy bilateral squats ever again.

When it comes to Jefferson curls, like rounded back deadlifts I think it depends who's doing them, how intelligently they load, and what their goal is. I can see how they allow for people to try to get truly segmented spinal movement in a way that a quadruped spinal flexion movement like cat camel doesn't, although debatable whether that's a good thing if you're in the McGill camp.

Stefi Cohen's book "Back in Motion" is on my shelf but I haven't read all of it. She very much based her back rehab on Stuart McGill's work at the outset but the book is a really interesting counterpoint, it's 60% him, 40% her then pushing back against his approach. She's less conservative than him, but still no Jefferson curls in the rehab program.

Cill94

https://www.boards.ie/discussion/comment/120058529#Comment_120058529

I think McGill's stuff can certainly help, particularly if someone is in the very early stages of significant back pain where any movement is flaring things up. I do think the message around what the back can handle is very pessimistic and fear inducing for many.

I can say just from personal experience that I have basically all my clients do jefferson curls and loaded flexion with no issues, most of them saying it relieves any back stiffness/pain. Of course this is done with smart loads they can handle, always with several reps in the tank.

I don't think we have any reason to believe the back is different to any other area of the body. It adapts positively if it's loaded well. It gets hurt if we do too much. It just happens to a very debilitating area to hurt so psychologically it's a hard injury to get past.

McGill's research is primarily based off in vitro spines of dead animals. The studies bring these spines through thousands of flexion/extension cycles per day, with no ability for the spine to adapt (given it's.. dead). Eventually a herniation occurs and that's meant to be proof that loaded movement of the spine is bad.. Fair to say the research in this area is poor and not something we can make strong claims from.

I just don't see how it's all that applicable to a living human who realistically will only do a few dozen challenging reps on the lower back per week, and has living tissue that can regenerate and strengthen. We could basically do the McGill approach with any in vitro joint/tissue and it would eventually break. If a dead ankle snaps after 20,000 cycles, does that mean we shouldn't walk, run, do calf raises etc?

Some more detailed critique of this research here from Greg Lehman, who I know Stefi Cohen is a big fan of https://www.greglehman.ca/blog/2018/4/2/reconciling-spinal-flexion-and-pain-we-are-all-doomed-to-failure-but-perhaps-it-doesnt-matter

Black Sheep

Yes, I've heard / read the pig spines argument and thought "surely McGill should be given a bit more credit", I just don't see him as likely to be oblivious to such a big hole in his work.

He says cadaver studies were only part of his research, and in fairness if you look at his written output then even going back to the Ultimate Back Fitness and Performance book a lot of the studies mentioned relate to live athletes. Pavel Tsatsouline in one instance, in a kettlebell swing study.

His somewhat irritated response to questions about pig spine studies and other topics is here: Microsoft Word - Spine flexion myths truths and issues (backfitpro.com)

In general while I agree that the human body is durable, adaptable and has a capability to heal (even the spine) I also don't see a difficulty in applying learning that is a little more nuanced if we have it. I mean, adaptation in the muscles around the spine I can see happening, and movement patterns improving... But disc makeup or the shape / diameter of disc someone has is likely to be more fixed I would think.

Although sometimes McGill is sometimes accused of encouraging catastrophising I would say again there are probably worse offenders, maybe some of them citing his work without reading it in detail. In the very first chapter of McGill's book he lays out as a starting point that serious back pain is not a life sentence, and that it can be addressed conservatively through training. I've always thought his tone is pretty positive.

It's good that your clients report feeling less pain, although - genuine questions - (1) how do you know it's the Jefferson curls and not a benefit they are accruing from some or all of the other training they're likely doing from you? And (2) have you considered there might be a bit of a placebo going on in terms of the pain level they're reporting, because people obviously report great relief from back pain having done everything from static stretching to yoga to pilates to chiropractic visits and so on.

Cill94

https://www.boards.ie/discussion/comment/120061015#Comment_120061015

McGill published some great research, I just think it's been misapplied. His research showed us the exact mechanism behind how things like a disc herniation happens, which is in loaded flexion. However to me it's like discovering that biceps tear when we're in loaded supination, and then saying that we shouldn't do things like chin-ups, curls, etc. The dosage of the load is what makes the poison, not the movement itself, y'know? Ultimately he's an expert in spine biomechanics, not pain, injury or rehab. There are far more facets to that than just biomechanics.

The adaptability of the disc is definitely at the heart of debates on this topic. A few things highlighted by the likes of Lehman, Peter O'Sullivan, Adam Meakins etc that I find very compelling is that whether the disc adapts or not is kind of pointless. Relevant studies are discussed in that article I linked I think but the main points are that:

1. There is actually some evidence to suggest discs can adapt to loading. It's not a lot but it's still better than just assuming they are fragile.
2. If flexion is a major risk factor for disc damage, we can't actually control it much at all. Even neutral looking squats and deads are actually already at about ≥70% of our max flexion capacity. What's a more interesting question is if end range flexion has an effect on risk, as that is controllable.
3. Disc degeneration seems to be determined more by genetics and the ageing process than what we do with our bodies. One large scale twin study comes to mind where the level of disc degeneration was not affected by how active the twins were. (somewhat contradicts point 1, but then again, the 'active twins' probably weren't doing much resistance training)
4. Even if flexion was a major risk factor and we could wear out our discs from training certain ways, it's really poorly correlated with pain. There are more people with no pain and degeneration than there are those with lots of pain and degeneration.

It's good that your clients report feeling less pain, although - genuine questions - (1) how do you know it's the Jefferson curls and not a benefit they are accruing from some or all of the other training they're likely doing from you? And (2) have you considered there might be a bit of a placebo going on in terms of the pain level they're reporting, because people obviously report great relief from back pain having done everything from static stretching to yoga to pilates to chiropractic visits and so on.

This is a great point and you're 100% right, it may well be a placebo. No different to someone lying on a foam roller for a few minutes and feeling better (much as it kills me to say that 😂) ... BUT one thing that you cannot placebo is getting stronger, and nobody can deny the link between injury and physical preparation. So I am at least very confident that my clients will be well prepared for picking up a couch, box, child etc. in a flexed position, far better than if they went to a chiro every week. The pain relief they report is just an added bonus.

His somewhat irritated response to questions about pig spine studies and other topics is here: Microsoft Word - Spine flexion myths truths and issues (backfitpro.com)

I'll certainly give this a read. I'm sure his views are somewhat misrepresented by many of his followers and tbh I take more issue with the general mainstream 'safe/unsafe' movement concepts that proliferate in the industry than I do with McGill personally. He's just a science guy they can point to to support their biases.

Black Sheep

Great points, I must read some of his critics in more detail.

I was going to say that I was trying to figure out exactly what he was saying about his interactions with BJJ athletes in the document I linked to.

BJJ is one sport where people are constantly in compressed positions where their low backs and necks are rounded. The spine is flexed under load AND there can be rotational forces. I know someone might say that can arise in any sport or everyday life, but I think the situations are more common in BJJ. Obviously there is a significant amount of people leaving the sport because of back and neck pain.

Curious what McGill did with them.

In the BJJ community there are a lot of people who believe the answer to this problem of back and neck pain is yoga or mobility work. I am in a funny position because even though I'm yoga for BJJ certified I always say the reason I've had zero disc issues on the mats for 10+ years at this stage is all down to heavy compound lifts and direct neck training. I said that at a yoga for BJJ instructor weekend and it was as if I'd done a very loud fart.

Cill94

https://www.boards.ie/discussion/comment/120062060#Comment_120062060

Tbh I’m not surprised back injuries are so common in BJJ, because that is an area that’s loaded a lot. Much like how knee injuries are the most common with runners and shoulder injuries with pitchers.

My take would basically be what you’ve alluded to there, which is that you minimised your injury risk by making your back and neck extra resilient to those positions with proper S&C, something most martial arts seem to be allergic to 😂