Archive Article: Back Pain and Back Strength

[Mark Rippetoe]

Back Pain and Back Strength | Mark Rippetoe

[tomskarda]

At least 75% of the pain patients I see in the clinic would either greatly benefit from, or see their symptoms entirely resolve, just from being stronger.

Out of all the patients that come in about half have dietary related problems as the root cause of their current health issue.

Between the two, diet and proper conditioning, it proves the point that the basics in life determine how everything works.

Of course, when I mention that simply getting stronger by lifting weights as the solution they look at me like I have three eyes sticking out of my forehead.

Keep fighting the good fight.

[JHG]

Nice write up!

I was discussing the case for barbell based training in another forum and proposed an argument for running LP as a means to managing back pain via an application of the Strengths-Based CBT model http://onlinelibrary.wiley.com/doi/1.../cpp.1795/epdf, where the emphasis is aimed at building and strengthening personal resilience.

So the act of continuing with a strength training program would not necessarily serve to diminish someone’s pain but instead help develop greater resilience, allowing them to better cope and persist with activities of daily life despite the pain they are experiencing.

I wonder if this is the model that Austin applies in his practice, and if so, might he direct me to further resources/papers on this topic.

[Jr_Geezer]

I can certainly see how a stronger back is a healthier and less liable to be painful back. What if you are already relatively strong (485 lb deadlift, 365 lb squat) and you hurt your back with, say, a herniated disc? What is the mechanism by which those exercises help the pain and aid in recovery?

[Mark Rippetoe]

Back Rehab: A Case Study | Mac Ward

[Jr_Geezer]

Back Rehab: A Case Study | Mac Ward

I'll read that article more carefully this weekend, but it amazes me that Mac could walk 2+ miles right after the injury. I had a far less severe injury and my leg was on fire after ten steps for the week after. I went to the gym after about a week and a half and did a few sets of 5 of very light squats and a set of ten RDLs, carefully watching technique, and felt much worse the next day. I haven't been back to the gym since then (about three weeks ago) but plan on going this weekend. I've been doing air squats, some foam rolling of my leg (which actually seemed to help) and other stretches and can now walk and stand pretty much pain free. Yeah, call me a wimp, but I've previously torn an adductor and gone through the Starr protocol so I know what working through pain means. I've also gone through the effort to get to a 485 deadlift and 365 squat (at 56 years old, 205 lbs) so I know how to push myself. This injury just feels different so I've approached it differently. Yes, we all heal, but sometimes we hurt ourselves again and this past month has not been at all pleasant and I'm not looking for a repeat. I really miss going to the gym and pushing heavy weights but I've now got a mental factor I need to overcome.

[Scaldrew]

I went to the gym after about a week and a half and did a few sets of 5 of very light squats and a set of ten RDLs, carefully watching technique, and felt much worse the next day.

When my brother slipped at work and hurt his back twisting his torso while holding a heavy container in just one hand, he stopped going to the gym for a week or two. I told him he had to move around on it or it'd get much worse. We met up in the gym and went about our business squatting, pressing, and deadlifting like nothing was out of the ordinary. I kept an eye on his form and was mostly there to determine the severity of the injury. Squats were a no-go; he couldn't squat half what he could before he got hurt. I wasn't really worried just yet as squats are usually pretty demanding on bad backs, more so than the deadlift, the stability of which confers some level of safety to the damaged goods. Presses went absolutely fine, so I figured it couldn't be a surgery-type situation.

But when we got to the deadlift, my eyes went wide. He was going through the usual motions of a hurt lifter bending over to grab hold of an object: slow, asymmetrical descent to grab the implement, painful expression on his face, heavier breathing, and all around the body language of a guy who really wanted to be anywhere else in the moment between setting up and moving the weight. He was skittish, but he got there. What really got my attention was the weird leaning he was doing all throughout the lift. I realised quickly he hurt the left side of his back as it seemed to be completely cramped up or persistently contracted throughout the deadlift motion. He was anything but straight up and after I noticed, I told him to focus on pushing with his left leg more. This seemed to hurt a great deal more, so we tried some other things, too. At this point, I'm shooting in the dark cos I have no frame of reference at all. The last thing I can try to get him to do as he's getting really pissed off is to get him to do rack pulls while standing on some bumper plates on just one leg. We tried to get him to move as symmetrically as possible with, really, only about 135lb of weight for a few sets of 3. At this point, though, with all the angles I wanted to inspect, he had pulled a lot of low intensity volume. I told him we'd call it a day and figure out our next move next time.

Now here's the spooky part. I'd call it weird, but I was more or less expecting this outcome from the beginning. The next day we arrange another session of in person coaching and settle on Wednesday (it had been Sunday the day before). I ask him "does your back still hurt?" and he just says "no". Wednesday, he was back to squatting close to his old working weights and deadlifting effortlessly symmetrically with no plates under any of his feet, again close to working weights. He didn't have to go through any more grueling workouts, workdays, or just days of horrible pain and attempts at regaining range of motion. We just came in, did what we had to do in the moment, and poof, no more pain.

My reason for posting this overly elaborate case study is that I find it weird that you would attest to the opposite effect. Especially considering you're much stronger than my brother, I'd expect you to have similar results. Then again the "leg on fire" symptom is one we didn't encounter; my brother was just in non-specific back pain throughout those few weeks. I, myself, remember feeling some troubling pains in my right leg when I fucked up my deadlift form long enough for it to matter, but that pain usually calmed down after walking around for a while. I remember stretching helping just a little bit, but nothing as much as fixing my deadlift form which removed my pain instantly, and I do mean immediately after setting the bar back down again. A form check is really the first thing I'd care to get in this situation, as technique becomes all the more important once normal function is compromised. Can we assume you've already had your form checked on squats and deadlifts?

[Jr_Geezer]

When my brother slipped at work and hurt his back twisting his torso while holding a heavy container in just one hand, he stopped going to the gym for a week or two. I told him he had to move around on it or it'd get much worse. We met up in the gym and went about our business squatting, pressing, and deadlifting like nothing was out of the ordinary. I kept an eye on his form and was mostly there to determine the severity of the injury. Squats were a no-go; he couldn't squat half what he could before he got hurt. I wasn't really worried just yet as squats are usually pretty demanding on bad backs, more so than the deadlift, the stability of which confers some level of safety to the damaged goods. Presses went absolutely fine, so I figured it couldn't be a surgery-type situation.

But when we got to the deadlift, my eyes went wide. He was going through the usual motions of a hurt lifter bending over to grab hold of an object: slow, asymmetrical descent to grab the implement, painful expression on his face, heavier breathing, and all around the body language of a guy who really wanted to be anywhere else in the moment between setting up and moving the weight. He was skittish, but he got there. What really got my attention was the weird leaning he was doing all throughout the lift. I realised quickly he hurt the left side of his back as it seemed to be completely cramped up or persistently contracted throughout the deadlift motion. He was anything but straight up and after I noticed, I told him to focus on pushing with his left leg more. This seemed to hurt a great deal more, so we tried some other things, too. At this point, I'm shooting in the dark cos I have no frame of reference at all. The last thing I can try to get him to do as he's getting really pissed off is to get him to do rack pulls while standing on some bumper plates on just one leg. We tried to get him to move as symmetrically as possible with, really, only about 135lb of weight for a few sets of 3. At this point, though, with all the angles I wanted to inspect, he had pulled a lot of low intensity volume. I told him we'd call it a day and figure out our next move next time.

Now here's the spooky part. I'd call it weird, but I was more or less expecting this outcome from the beginning. The next day we arrange another session of in person coaching and settle on Wednesday (it had been Sunday the day before). I ask him "does your back still hurt?" and he just says "no". Wednesday, he was back to squatting close to his old working weights and deadlifting effortlessly symmetrically with no plates under any of his feet, again close to working weights. He didn't have to go through any more grueling workouts, workdays, or just days of horrible pain and attempts at regaining range of motion. We just came in, did what we had to do in the moment, and poof, no more pain.

My reason for posting this overly elaborate case study is that I find it weird that you would attest to the opposite effect. Especially considering you're much stronger than my brother, I'd expect you to have similar results. Then again the "leg on fire" symptom is one we didn't encounter; my brother was just in non-specific back pain throughout those few weeks. I, myself, remember feeling some troubling pains in my right leg when I fucked up my deadlift form long enough for it to matter, but that pain usually calmed down after walking around for a while. I remember stretching helping just a little bit, but nothing as much as fixing my deadlift form which removed my pain instantly, and I do mean immediately after setting the bar back down again. A form check is really the first thing I'd care to get in this situation, as technique becomes all the more important once normal function is compromised. Can we assume you've already had your form checked on squats and deadlifts?

Thanks for the interesting case study Scaldrew. I'm certainly a believer that things heal better and faster when you use them and your brother is yet another example of that. I'm pretty sure my injury is a bit different than what your brother had, though. I was deadlifting 465 lbs, he twisted while holding a weight. My leg on fire feeling (and numbness around my kneecap) was from, I'm pretty sure, a disc pushing on a nerve. Doesn't really matter. While others who have had an injury similar to mine have gotten back to the gym quicker than I have, I think perhaps each case is a bit different and I just went back too soon (or didn't have quite the right form) and irritated rather than helped the situation. I went to the gym yesterday, did some very light (135) squats and rack pulls and a few sets of light (90) presses and bench. My back feels fine today so I'll head back to the gym tomorrow and add some weight and reps. The only pain I have now is a tightness in my right adductor. Certainly related to my adductor tear of last year but I'm not sure why it would be acting up now.

I've seen an SSC twice in the last year and submitted several squat videos for feedback so I'm reasonably comfortable with my form. As soon as I recover just a bit more, I'm scheduling another coaching session.

Now the question that remains is how far am I willing to push myself after this injury. I had a goal of a 500 lb deadlift but I really, really don't want to go through this again. I also really, really wanted that 500 lb pull. I dunno, maybe I'll work back up to 450 or so and just maintain there. Hate to settle though, when I was so close.

[Ryan Arnold]

Now the question that remains is how far am I willing to push myself after this injury. I had a goal of a 500 lb deadlift but I really, really don't want to go through this again. I also really, really wanted that 500 lb pull. I dunno, maybe I'll work back up to 450 or so and just maintain there. Hate to settle though, when I was so close.

Try not to think about this yet. Let pain be your guide and try to get a little better each week. Get to a coach when you can. You'll know when its time to think about big goals again

[Scaldrew]

I think perhaps each case is a bit different and I just went back too soon (or didn't have quite the right form) and irritated rather than helped the situation

Now the question that remains is how far am I willing to push myself after this injury. I had a goal of a 500 lb deadlift but I really, really don't want to go through this again. I also really, really wanted that 500 lb pull. I dunno, maybe I'll work back up to 450 or so and just maintain there. Hate to settle though, when I was so close.

I think the hard part in overcoming an injury is mental, not physical. All people really need to do is lift an increasingly heavier weight perfectly. Now I know I'm downplaying what is of course a very meticulous process, but you'll forgive me when I add to that the idea that people who considered themselves injured start moving differently. Whether it's bending over more slowly or walking with a limp or both, the change in daily function reflects a desire to alleviate the symptoms by not aggravating the injury. Yet doing this more than actually failing to alleviate the pain, may in fact make matters worse as you continue to make changes and lose more and more of your normal function. Counterintuitively, the point is exactly to load the entire body as if to assert that no injury is present whatsoever. But even under (or over) a bar, the injured lifter will want to move differently, again due to this fear of making things worse. Overcoming this stage is the hardest part; regaining function is a necessary consequence, it seems to me. Sadly our bodies seem to tolerate fewer errors in executing the lifts when banged up, so form does need to be absolutely perfect.

It's interesting to hear you say you're afraid of attaining a 500lb deadlift after the painful sensation you experienced. Besides corroborating what I said earlier, this seems to me to be an exceptional position to take. From my own experience, I can definitely attest to never having thought anything in any vein similar to this. I can't say I've ever heard anyone else say as much as you either. I'm afraid to say it may not be up to you anymore. Again from my own experience, so take that for what it's worth, I've found that approaching old PRs and setting new PRs actively reduced pain in troublesome areas where I'd otherwise be in pain during moments of unwanted deloading. So if "mostly pain-free" is what you're aiming for, I would advise against settling for 450. I realise I have a very limited dataset of 1 in this case, so I welcome anyone with more experience to comment on this and tell me I'm a stupid doodoohead. I'll close with an analogy for which I hope Coach Dr. Sullivan will forgive me: if barbells are big medicine, then surely no longer taking your medicine would cause old injuries to rear their painful heads as a matter of simple consequence.

Regrettably, I saw Coach Dr. Sullivan's video on eggs in which he shared very elegantly the idea that stories have to make sense. Sensical as my analogy may be, it may just be a young guy's tale. It seems like you're taking some very proactive steps to recovery, though, Mr. inAZ. I wish you nothing but good fortune on your way there.