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The Back Pain Episode | Starting Strength Radio #9

Mark Rippetoe | June 21, 2019

https://youtu.be/qGLe1OR_n88 | Convert video-to-text with Sonix

Mark Rippetoe:
You know why I lean on things? Because my fucking back hurts all the time.

Mark Wulfe:
From the global headquarters of The Aasgaard Company in beautiful, downtown Wichita Falls, Texas... From the finest mind in the modern fitness industry... the one true voice of the strength and conditioning profession... The most important podcast on the internet... Ladies and gentlemen! Starting Strength Radio.

Mark Rippetoe:
Welcome back to Starting Strength Fadio. Thank you Mark Wulfe for that wonderful introduction. And we are here in the beautiful, expansive, highly decorative, garishly opulent studios of The Aasgaard Company here in beautiful, downtown Wichita Falls. And in fact we're just right across the street from Wichita Falls Athletic Club, the greatest gym in the world. And we have a... In fact, Garm is over there right now. Have to figure out a way to get our Garm dog on the on the podcast one of these days.

See if we had him in here running around he could jump up here and he'd be sitting there looking around for five, six seconds and then he'd get bored and go somewhere else. I think we ought to try to have him in sometime. He would do that. He'd knock over everything in here because he just doesn't understand some things. But he's he's a good boy though. He's a very good boy.

So anyway what are we going to talk today about back pain and... But first I want to talk about a couple of pertinent topics here. Our seminar schedule - let's go over that real quick. By the time this airs we'll already have been done with the June 7th through 9th seminar Wichita Falls. We're in July the 26-28 we're in Woodmere, New York on Long Island at Inna Koppel's wonderful little gym up there.

We like going up there to visit Inna primarily because the pizza is good and sometimes she brings her dogs in. She brings Elliot and Iggy dog - the Iggosaurus. Little Italian greyhound, little eight pound creature about like this who's just bug eyes, evil, jumps up in the air, steals food out of your hands and stuff. You know why he does that? Because he hadn't been killed yet. That's why. But I think we're killing when we're up there. Just plan the event. Kill Iggy. And then Roland-dog who walks around on his hind legs. He's kind of a funny little creature. All four... all three of those little dog she's got are just like... interesting little animals. Right. So that's one of the reasons we like to go up there.

And then we will be in Los Angeles in August. August 16 to 18 in Los Angeles. I've gotta go. I'll be in Los Angeles. I know. Shut up! I don't hear about it. I'm not going to Orange County. I don't think. Gulf shrimp, you know, might get me to go. I don't know. Artillery would be more likely to be the hook. That's 16-18 August.

And then we're... this will be a good trip. Boston, we'll be in Boston September 27 through 29th. And that's always an interesting place to go. That part of that part of the year ought to be nice colorful up there. Leaves changing up there in September. Pretty trip. Food in Boston's good. Place called the Public House I remember in Cambridge, if it's still there we'll have to go there. That was an interesting Sunday night place to go.

So all that's coming up. And if you've not been to a seminar you need to make your plans. We're always proud to bring our educational products to you and this should be an opportunity for you to save some mileage if you're up in the Northeast, up in Boston.

Now Stan Efferding is saying nice things about our pressing technique online and we just want to make you guys aware of the fact that Efferding's food company, the Vertical Diet people, sell an excellent product. It ships on Monday or Tuesday of the week. It consists of a pre-prepared meals that are frozen. They ship in Styrofoam containers. I order 20 at a time. And the end up being about 10 or 11 bucks apiece and they're excellent. And if you don't have time to to leave to eat you warm up in the microwave. They're fabulous. Beef, rice, potatoes, just good staple stuff. The've got a rather large menu. Got some breakfast items. Got some fermented oatmeal for breakfast which is good. It's better than you think it'd be. Excellent stuff.

Since since Stan is being nice to us, I want you guys to do business with him. Just look him up online. It's called the Vertical Diet. Look up Stan Efferding online and you'll see a link to the to the order page. And go do business with Stan. Good man.

We just got back from this past weekend. Of course, there'll be a delay since we're taping today. We just got back a couple of days ago from the grand opening of Starting Strength Austin and the place looks good. The place looks great. It's a... it's a nice big facility. You knew you'd be deceived about the fact that it's only sixteen hundred square feet. There's plenty of room. The trade dress looks excellent. The art's on the walls. Our trademark furniture is in the lobby. All of our equipment is set up.

The whole thing is just... it just turned out way better than I thought it would. It's just an excellent little gym. And it's there on West Anderson Lane in North Austin. And those of you that are in the area need to swing by and check it out.

There is continued activity continued inquiries about other people buying franchises. The list of gyms is up on the website at startingstrengthgyms.com And startingstrengthgyms.com is the list with the expected opening dates. Nine gyms are in the works right now and you'll need to make your plans if you live in one of these cities - Houston, Austin, Dallas, Denver, Boston are all accounted for right now.

And we've had inquiries from New York, several other places around the country - Chicago, for example. And you know continuing the the process of getting these things up and running. So those of you who are interested check out the webstie at startingstrengthgyms.com.

Now, let's get to today's topic back pain. OK. Back pain is one of these things that we hear about all the time. We hear about to... hear about back pain on the website. People ask us about it every day. There are inquiries about what to do about back pain on the website. Is it okay to deadlift and squat with back pain, so forth and so on.

All right. Bottom line. All humans have back pain. There are no exceptions. If you are 50, you've had back pain. It may or may not have been associated with anything you were doing. You've just had back pain. One morning you woke up and your back hurts. This is just you know... Look. Join the club. This is the common, human experience. Humans have back pain.

The reason humans have back pain is rather interesting. It's because of the structure of the back. The human back is an interesting column of vertical, more or less, column of bones that are separated by fibrocartilagenous discs, the intervertebral discs. And those discs separate the bones and allow for wiggly movement to take place. They allow you to perform a sit up in back flexion. They allow you to perform movement in back extension. They allow for some side to side movement.

But the problem is your vertical back, your bipedal back, was not designed originally for this function that we took it upon ourselves to give it several million years ago. Up to... oh prior to four million years ago this particular branch of the primate family tree was not bipedal. We're not we were not upright all day like we are now.

Several things changed when we decided to stand up and walk around. Our knee and hip geometry changed quite a bit. The geometry of the foot went through an extreme period of modification and our feet are unlike those of many of other primates. As a result of this bipedalism adaptation we undertook.

But in addition to all of that stuff, all of the stuff above the pelvis also changed the human back is, in an upright position, loaded in compression, but our ancestral spine was quadrupedal spine and it was supported front and back by our forelegs and hind legs. And the primary function of the entire vertebral disks was not load bearing. It was not a compressively loaded system as it is in an upright creature.

It was essentially loaded in moment and the moment force it was loaded with was that of its own load suspended from below the spine, the gut load, that was on the back was the only load the spine was.. was in. The intervertebral discs in this configuration presented themselves as separators of the vertebral bodies and they facilitated flexion laterally from side to side.

Like when your dog licks his butt OK. Like when your horse reaches around and tries to bite a fly who's chewing on his ass. This lateral flexion side to side that a quadrupedal spine presents was the only thing that the intervertebral discs had to do. They weren't constantly loaded all day long in compression. Ours are.

Now, as a result of this change in function several million years ago, our spines have taken on a new role and it is a role for which they're not designed very well. As a result of that I have seen estimates that everyone over the age of 35 and certainly every human being on Earth over the age of 40 has what could be described as degenerative changes in the spine.

This involves bony overgrowth, spurring, osteophytess, this sort of thing. Thinning of the intervertebral discs. Some herniation of the intervertebral discs are usually unavoidable and are not really a terrible problem unless they go the wrong direction and mash on the central canal and the spinal cord, producing neurological problems.

The vast majority of back injuries and back pain are local back pain. They are not associated with radiculopathy down the legs. They're not associated with loss of function that a true, profound neurological deficit would cause. If your intervertebral discs herniate, they could herniated in the wrong direction and press on the spine and cause problems not only down the legs, but with with functions associated with where those nerves come out of the spinal column and could be associated with gastric problems and numbness in the abdomen, lower abdomen, loss of control of the urinary functions, bladder functions, doo doo functions. This sort of thing. These kind of abdominal problems are real severe, right, but they are a tiny minority of the types of back problems that most humans encounter as a normal course of their existence.

Once again: everybody north of 35 or 40 has diagnosable, degenerative, spinal changes. In other words if you go to the doctor - for some bizarre reason - you're not symptomatic. You don't have any back pain. You don't have anything wrong at all. You go to the doctor and you just want to see what your back looks like and you somehow talk him into ordering a lumbar MRI or thoracic MRI. You are going to present with degenerative changes in your spine. There will be a thin disc. There will be some spurring. There will be other changes that are diagnosable to an orthopedic surgeon who specializes in backs or a neurosurgeon, that indicate that your spine is older. It is normal for a spine to degenerate with age. And by normal, I don't mean it's good. I just mean that that's what happens to everybody.

Now remember, you have gone to the doctor without any symptoms. Your back doesn't hurt, OK. Without any symptoms, without any back pain, you wouldn't have really a reason to go to the doctor nonetheless you would present, upon study, with degenerative changes.

Now let's say you go to the doctor and you do have back pain. Guess what happens. You present with degenerative spinal changes just like the guy who was asymptomatic did.

Now this presents a serious problem doesn't it? If everybody that goes to the doctor shows degenerative changes in spine, then people with back pain are going to show degenerative changes in the spine. But people without pain are also going to show degenerative changes in the spine. And what this means is - now think with me very carefully here - if you go to the doctor and you've got degenerative changes in your spine and he MRIs you and he shows you these degenerative changes in the spine that are also present in somebody without back pain this may very well mean that the degenerative changes that he shows you are not the cause of your symptoms. Because just as many people without symptoms have the same signs upon MRI diagnosis.

And this presents an interesting situation doesn't it? I remember a long time ago back when I was in the horse business there was a famous study done at... I believe and don't count me, you know, hold me to this I'm terribly bad about remembering the picky specific details of just virtually everything, but the study was done I believe Georgia A & M. and they x-rayed the feet of about a thousand horses. They did navicular disease studies on a thousand horses. And navicular disease in a horse is the same level of problem that back pain is in humans. Lots and lots of horses are lame. Lots and lots of horses are so lame that they have to be put down. Now fortunately we don't put people down for having back pain. Although it's not a bad idea. And it's something that... you know we probably need to have that conversation, to quote Kamala Harris.

And the studies that were done on on horses at the time were very interesting. They just took a plain film x-ray of the horse's feet. Think it was front foot. Front feet are the most common sites of lameness in horses and navicular disease is - if you're familiar with the horse's distal appendage - the horse basically walks on his middle finger and the coffin bone, which is the final digit that he's standing on, is the same bone in him as this middle... this last distal phalanx is here in you. And the column of bones goes up to his fetlock, but he's standing on the coffin bone. And the navicular bone is the one that articulates with the coffin bone. And if there are bony changes in that joint it is thought that that predisposes the horse the lameness. If he injures that, if he fractures it, it can be very bad. tThe lame horse is not much good to anybody, not even to himself. Because if he can't get around, he can't graze, he can't be useful. So we typically don't indulge ourselves in the luxury of lame horses and they go away.

Now the interesting part about this study was that it had been theorized for for many years that positive x-ray for navicular disease was not necessarily an indication of the presence of the conditions that predispose to lameness. So this study undertook to x-ray a whole bunch of horses' feet. And the interesting thing was that when they got through x-raying the feet of a thousand horses or so. They they found that there was no correlation between a positive diagnosis of navicular disease on x-ray and symptoms of lameness.

A horse with symptoms of lameness was just as likely to x-ray positive for navicular disease as he was to x-ray a negative for the navicular disease. And a horse without lameness was just as likely to x-ray positive or negative for navicular disease.

Now this is interesting isn't it. Just because there are bony changes in a joint does not necessarily mean that the bony changes present a problem for the animal possessing the changes.

And humans are the same exact way. If you go in with back pain and you go to the chiropractor and the chiropractor takes a plain film x-ray it says L4-L5 sure does look like a mess. And you say to your chiropractor, "Well will would you please order me an MRI and let's look at this further." And in the states where a chiropractor can in fact order an MRI - and there are some states where you can do that - he sends you in for the MRI. And the MRI study shows that in fact you have profound degenerative changes at L4-L5.

What I'm telling you is that the degenerative changes that you see on that study at L4-L5 may not represent the cause of the back pain. Because there - right next door to you - there's another guy with the same profound changes at L4-L5 that is fine. That does not have any back pain at all. And this is just, I know this is weird, but think about the problem here. Okay. You've got chronic back pain. You show up with degenerative changes at L4-L5. Guy says "Man looks like you need back surgery." Maybe you don't. Maybe you don't need back surgery. Maybe you don't want back surgery.

Maybe what you want are deadlift and squats. Because it has been our experience that for chronic back pain the vast majority of the time a guy with chronic back pain comes in the gym, listens to his buddies that have experienced this phenomena. He comes in the gym. He deadlifts and he squats. And we show him how to do it correctly and all the mechanics are correct and he loads his back. Even though it hurts, he loads his back. And he does this for three weeks -nine workouts. And his back pain goes away. We see it all the time. You see.

How many had you looked at. How many cases of this did you find? 24, 25, 26 cases of people on our board that have reported that they started training with weights and their back pain went away. And I can tell you that there are thousands and thousands of people across the country that have had this same experience.

Now here's the other side of this coin, all right. Say you have back surgery. Say the neurosurgeon talks you into a back surgery because you've got degenerative changes in your L4-L5. Just looks like a nightmare and we've got to go in there and clean this up.

Back surgery is an interesting thing. OK. Back surgery... the results are back surgery are divided into roughly thirds. All right. One third of the time back surgery is successful, meaning that it relieves the symptoms for which the surgery was performed. Okay. One third of the time it does not relieve the symptoms for which it was performed. And one third of the time it makes the back pain worse. In other words, two thirds of the time back surgery is not successful.

Now I'm talking about back surgery. I'm not talking about a cervical spinal surgery. I've had a fusion at C6-C7 myself back in 1999 20 years ago and I've been fine ever since. I woke up completely out of the very, very, very, bad pain that I was in before they anesthetized me that morning at six thirty. I woke up and I was out of pain.

My arm - the first thing I did I remember very clearly - I looked down at my left arm and I said, "The pain's gone." Then I went back to sleep there in the recovery room. So I had a good outcome from that, but I know lots and lots of people who have not had a good outcome from lumbar spinal surgery. The cervical spine is not under near the load that the low back is and it is not as structurally a precarious a situation as is your lumbar spine.

You go in there and start monkeying around with the lumbar spine taking things out, putting things in, things may not turn out the way you want them to turn out. Often they don't. More often than not, they don't. And there will be people respond to this with "Hey my back surgery went just fine." And to that I would say, "Good, I'm happy for you, but lots of people's it doesn't." Right. You have to be very careful about back surgery.

Friend of mine, over here at the gym, older guy, had some central canal stenosis cleared out. Didn't really alter anything structurally about about disc morphology or or replace a disk or you know, hardware, fusion, nothing like that. Just said some central central stenosis cleared out and he was fine. Back squatting in two weeks.

I wouldn't hesitate to have that done myself in... and I probably I have some symptoms of some central canals stenosis myself and I probably will eventually end up having had that done. But that's not what I'm talking about. I'm talking about having a go in and replace the disk with some kind of hardware and various other things they use to remedy these perceived degenerative changes in the low back.

If you can stand it. Don't don't do that. All right it's... it's if you can stand it and I understand that there are times when your back hurts so fucking bad that you don't care. You got to try something and you let him cut on you.

I understand that completely. I understand how the pain I was in before I had my my neck fixed. And I understand that you may well be motivated to just try something. But let me point out that if... if you have that done and it doesn't work that you may be in a seriously bad situation that... I mean, I know there been people that have killed themselves because this kind of chronic pain. Because you just can't stand it anymore. I understand.

Just be aware of the fact that degenerative changes in the spine are normal. And being normal they may or may not be associated with the symptoms that you are having in back pain. Okay. It varies in severity. I've got some degree of back pain all the time.

I've done lots and lots of stupid things in my life that didn't have anything to do with the barbell. And as a result I've been injured pretty badly many times and my back hurts pretty much all the time. All this "Rip leans on things" shit. You know why I lean on things? Because my fucking back hurts all the time. If I get some of the weight off of it. it helps. And so there's a cottage industry been formed about Rip leaning on things.

He's leaning on things 'cause he's 'cause he's in pain and it helps it a little bit to lean on things, all right.

But, you know, depending on who you are your back pain may or may not be severe enough to warrant any attention at all. I just ask you to think about something here. Nobody said you weren't going to be in pain. All right. The older we get, the more likely you are to have accumulated enough injuries to where things hurt. OK. There aren't any guarantees here. Sometimes things are just going to hurt. They hurt all over. Sometimes I hurt worse than others. And you can either learn to ignore that or you can't. OK. Some people can ignore it better than others.

My personal - and I'm a get a bunch of shitty comments about what I'm about to say about fibromyalgia here - I think fibromyalgia which is not a diagnosis it's a description of symptoms, is basically attributable to a hyperawareness of pain sensation. I'm good at ignoring it. Other people are not. And if you are constantly focusing on the fact that something hurts then that that's not good for your psychological health. Interestingly enough, lifting weights helps you with that because it teaches you that just because something is hurting doesn't mean that you can't deal with it.

Lifting weights teaches you that just because your back hurts doesn't mean that you're back can't do a heavy deadlift. It can do a heavy deadlift. Pain is just... pain is as much probably a psychological thing as it is a physiological thing. And depending on how receptive you are to the input, you know the pain will affect you at different levels.

Kinda like tinnitus, you know, those of you that have tinnitus. I've got it right now if I think about it. It's a little hiss that's always in the background. Right. Some people can't stop focusing on that. I don't pay any attention to it. I have it all the time and it does not affect me because I don't pay any attention to it. And I've... had I been conscious of it and aware of it all the time. Some people just can't get to sleep at night without some kind of white noise to cover up the tinnitus. I just don't think about it. I just go to sleep. It doesn't bother me at all. But if I stop and think and get real quiet I can hear it.

But... pain's the same way. If you dwell on your pain all the time then it it's it's going to be a bigger problem than if you learn that you don't have to think about it all the time. Because for some people pain is constant. Pain you always are hurting somewhere. I'm always hurting someplace every day all day long whether it's my back, my shoulders, my knees, my feet something is always hurting. I haven't been completely pain free since... last night after that second martini.

Alcohol is good for this okay. You know I have to have be honest with you. Alcohol is way better for pain than Naprosyn. And in fact for me I do not respond at all to opiate analgesics.

I've had... You know when I'd remember back in 1994 when I had my knee operated on - had a motorcycle wreck and my knee operated on. Now that was bad. That was real bad. I remember being in a convulsion from the pain in the hospital. My parents are down at the foot of the bed and it was hurting real, real bad. And it kept getting worse and kept getting worse and I finally just started [shaking] jaw locked up and couldn't talk and was just shaking in the bed. It hurt so goddamn bad. So all the you're all you people that say you're pain is a nine. When you stand there talking to me with a straight face, "Oh it's a nine." No, it's not. No it's not a nine.

People are real bad itself reporting pain. This thing with the full blown convulsion and momma went got the nurse and she came in and gave me a shot of IM ketorolac. Rolled me over on my belly and put a cc of ketorolac in my ass. And in about 45 seconds everything was pretty much fine. That's some amazing stuff. It's not an opiate, you know. [off-camera: How old were you?] That was when I was 40, I guess. Yes I was 40 and...

[off-camera: mumbling question] Toradol. IM Toradol. IM Toradol is excellent stuff. For some things it works it works better than an opiate. In some situations like that it works. It's amazing stuff. It really is but it's hard on your kidneys so they don't want... They don't want to give it to you a lot. I keep some IM Toradol out at the house just for emergency purposes. I've got a little supply of that ratholed out there. But that stuff is that stuff's amazing. But as far as treatment of pain I guess a lot of those is the alcoholism have probably been the result of chronic pain, don't you? Yeah I think that's probably likely. You know because it does do wonders for distracting the brain away from chronic pain.

So pain is an interesting is an interesting phenomenon. It's... it's not always - even severe pain - is not always a reason to go to a surgeon. Ok just try to keep this in mind. I understand that when it gets real, real bad and you get desperate you're gonna do anything you need to do. And I'm not telling you to develop a bourbon habit. OK. But just be aware of the fact it may not get any better once you wake up. OK. Once you come to grips with that, make your decision.

Now, if you've got back pain what are some of the things that you should not probably do. Well, the first thing I would not do anymore is sit-ups. Sit-ups and back extensions. I would not do those anymore.

Now, remember you have degenerative changes in your spine. If you're 40, you have degenerative changes in your spine. And what does that look like? Well, it looks like little pieces of bone growing where they're not supposed to be growing. It looks like discs in a vertebral disk that are thinner than they were when you were 20. All right. A nice, big, fat disc with an intact pulp core is an excellent thing. It's flexible, it wiggles around just fine, but once you get older and the inexorable changes in your discs lead to the cord drying up you've got a fibrous pad between these two bones that is no longer nearly as flexible. It's no longer as fat. It does not allow for as much motion as it once did. And this means that wiggling your spine around either in active flexion from the front using the abs, active extension from the posterior using the spinal erectors is no longer nearly as good an idea as it was when you were young.

And as a general rule, I will tell people that once you have your first episode of back pain - of debilitating back pain - your ab work and your low back work need to come from those muscles' normal function of stabilizing the spine. In other words, your abs and your back muscles the "core."

That I... was I disgusting enough when I said... the muscles of "the core" need to be trained with the squat and the deadlift because squats and deadlifts use those muscles in their functional capacity to maintain isometric contraction. They are loaded. When you do a 500 pound deadlift your back muscles and your abs are under a load. Nothing is relaxed in a 500 pound deadlift. Sit-ups and back extensions are not the only way to strengthen the muscles that stabilize the spine.

Now think through this with me: If you've got back pain and you have degenerative changes in your spine the way you do if you're 50 years old, I don't care what the chiropractor tells you: Don't do sit ups anymore. Quit wiggling your spine around. Get your spinal stability work from stabilizing the spine like you do when you squat and deadlift and press. Okay?

Don't injure your spine by mashing the little pointy bones into the intervertebral disks. Don't aggravate things with motion that does not help anything.

Okay, so that's my first advice I give somebody that first comes down with that bad bout of back pain. And look I didn't take this advice myself. And I promise you you'll hurt yourself. I have produced - the last time I did this - I laid down and did a whole bunch of situps to show a guy how good of situps I could do without without having done any situps in training. That I could still do a set of 10 situps with 35 pounds on my chest. And I did the 10 situps and I got up off the bench and my back was tweaked.

Really, that's what I did and I thought, "Oh shit! Here some kind of direct evidence for this." And then you know what I did? I squatted. Squatted 315 for a set of 10, back was fine. May have still tweaked, but it wasn't any worse. In other words, I hurt it doing situps and I didn't hurt it once it was already hurt doing squats. Now think very carefully about this. I had a belt on and I was very careful to not wiggle my back around as I always am when I squat.

So... Get out of the... Get past the notion that you have to do situps and back extensions in order to strengthen your spine. What strengthens the spine more? Situps or 500 pound deadlifts? What strengthens the abs more? Situps or 500 pound deadlift? Okay. No. Just, you know, put that aside. OK.

But also be aware of the fact that when you tweak your back you have to train through it. Doing nothing is a bad idea. Very few injuries - and this is, I know, this is horrible to hear - very few injuries respond to rest. Very few injuries respond to rest. If you have a fracture and you have a bony fracture, you must not load it to the extent that it keeps moving the fracture plane around because then it can't heal, obviously. But here's something that's not quite as obvious. That injury must be loaded at some level because the osteoblasts on either side of the fracture plane know there's a fracture in between them because of the movement. The movement is the signalling mechanism that tells the osteoblasts to heal the fracture because in the absence of a fracture there aren't any movements going on between these two groups of cells. The movement is the signalling mechanism that causes the cells to heal the bone fracture.

And here's how you know this. What are the fastest healing bones when fractured in the human body? Anybody want to take a guess? Your ribs. Your ribs heal the fastest. Broken ribs take three weeks, right. A broken femur takes quite a bit longer than that doesn't it? But if you completely immobilize a broken femur it will not heal. It has to be loaded at some level. Keep this in mind when people are telling you about rehabbing a fracture. There must be some load to cause some degree of movement across the flat fracture plane so that the healing mechanism knows it needs to proceed.

Back injuries, however, are not typically fractures. The most common back injuries - back tweaks - are interesting in that their etiology is... I'm not sure I completely understand this, but I do know one thing: I do know that when you go into the doctor, when you do when you are so foolish as to hurt your back, tweak your back, and go to the doctor about it and he tells you you've pulled back muscle that ninety-nine percent of the time he is wrong. You haven't pulled back muscle.

What muscles pull? Well, those of you that have torn a hamstring know that hamstrings pull. Those of you who have torn a quadricep - have have had an actual muscle tear in quadriceps - and I mean a tear where there's a bruise. Those of you that are torn the lats. That happens from time to time. Triceps tear. Biceps pull from time to time. All of those muscles have one thing in common: they actively function in concentric and eccentric contraction. They get longer and shorter.

What do your back muscles do? They are isometric muscles and they don't move around. They don't change length a lot. A hamstring tears when it is overpowered eccentrically or concentrically. When you subject it to a dynamic stress that it cannot compensate for and it tears. It's an actual tear like a cut on the skin. It's a tear. It bleeds. It's a wound. All right.

That's what's always interesting to me... What is the first thing people want to do when they have a when I have a hamstring tear? They want to massage on it. Right. Well when you cut your arm do you massage on that? No, that's obviously... that's obviously kind of a bad idea. Yeah. Do you stretch it? Do you stretch it? You have a cut on your arm. Do you stretch it apart make it nice and wide? No, because that's dumb. Right?

It's just dumb to stretch a muscle belly tear. Don't stretch it. It's it's not hurt because it's not flexible enough. It's hurt because it got exceeded in terms of its dynamic loading capacity. You hurt it. You tore it. If you stretch it, guess what you're doing? You're tearing it some more. Don't do that.

Resist the temptation to be dumb every time you get the opportunity. Don't be dumb. All right.

Those things need to be iced. And in about three days they need to be back in contraction. They need to be worked through just like all other injuries. A torn muscle belly needs to be worked so that when it remodels it will remodel back to its good old contracttile self.

A back injury is the same way. Back injuries need to be worked through. I realize when you first have a back tweak you can't move very well. OK. That lasts about 36 hours. All right. And then after about 36 hours you need to get your ass back under the bar and do something. Load it. Move it around. Keep it still, but move the back through angle.

You don't necessarily... you don't need, I mean, not necessarily. You don't need to extend and flex the back when it's injured, but you do need to subject it to varying amounts of moment load by going through the range of motion from the hips with a rigid back. Loaded. The muscles that control the area of the injury are then placed in a load and they pump blood through the area and there's just something about lactate that seems to heal things and that's why we like higher reps for rehabbing an acute injury. You pump a bunch of blood through there, you generate some lactate. Presence of the lactate - I don't have a mechanism for this, but it does seem to have some kind of a corrective effect on all types of injuries. So keep that in mind. You have to train. You have to train through these injuries.

Now, if you know that you are predisposed to back injuries - and lots and lots of us are, we get them all the time. Humans all get back injuries, but some of us get them more frequently than others. What do you think the best approach to this is?

Is the best approach to repetitive back injuries to just sit down and take it easy? Or is it to get back stronger?

Well, we've just observed that all humans have degenerative changes in the spine. That's a normal part of being a human. It's a normal part of being a biped at the age of 40, 50, 60, 70. Right. Do you think it would be better to have a bad back be weak or a bad back be strong? Let that sink in just a minute.

Lots and lots of people that suffer from periodic, acute back pain have found that their chronic back pain goes away when they train the squat and the deadlift. When they load the thing correctly, when they keep the intervertebral relationships in good, tight, isometric control and then lift heavier and heavier weights, thus producing a greater amount of isometric strength with which to hold the spine still.

A stronger back is chronically, a less painful back. What we typically find is that if you train correctly, your periods of acute back pain are going to go away too, or at least become less frequent. Low back pain is an, is an interesting thing. It is the mechanism by which the thing hurts is not terribly well understood. It could be a tweak to a ligament in one of the intervertebral processes. Could be a tiny little, teeny little muscle belly tear down at the intervertebral level. Certainly not a wholesale strain of the of the longissimus dorsi, the spinal erector muscle belly the doctors seemed to think it is. It is a little isolated injury in between. Could be an inflamed facet joint. There's no... I don't know. All right. I don't know and I don't know that anybody else knows either. It could be a combination of all of these factors.

But if we're... if we're going to experience back pain and we are - we're humans, we're going to experience back pain - I promise you that you will experience back.. your experience with back pain will be more productive if your back is strong.

Now we've... a strong back, as we've observed, is in a better position to hold the intervertebral relationships constant so the injury doesn't take place in to begin with, but everybody's going to have a tweaked back. And if your back is strong you are going to be more able and more likely to go ahead and work it and train it and deadlift and squat on it, so that it gets better faster than you would if you you're not capable of squatting and then lifting. This is a this is an overlooked mechanism of why you want your back strong.

We know that backs respond to work when they're hurt. You're more likely to be able to do the work and you're more likely to be willing to do the work if you have a work history with the squat and the deadlift.

Now sometimes back injuries are more serious and they need to be addressed. All right. If you hurt your back and it's a it's a dynamic injury suffered in a car wreck, you may have a bad problem. You may have a bad problem. You may have a spondylolithesis where the the posterior structures on one vertebra are separated from that vertebral body and the thing can slip forward. This is a potentially very, very bad injury especially if it occurred in a dynamic loading situation. That injury is often a congenital malformation of the spine. But if you've got a... If you've got a spondylolithesis as a result of a back injury that's a bad deal that's going to need to be addressed.

It probably could very well be that it needs to be stabilized, although I know some lifters with a grade 3 spondylolithesis that are dead lifting over 400 pounds. My friend Ellen Stein has got a grade three and she's a hell of a lifter at the age of 66 and she's she's real strong with a grade 3 spondylolithesis. In other words everything that you can train needs to be trained.

If you've got radiculopathy down a leg, it could be something that's not particularly bad like sciatica. Sciatica is not really a back pain problem. Sciatica is typically caused by entrapment of the sciatic nerve in the pelvis by the piriformis and that can usually be resolved with a vicious, deep, horrible, sadistic massage of that area of your glute that exposes itself to your elbow when you mash on the piriformis.

So sciatica is not really an indication, but if you've got loss of bowel control, your peeing yourself. You know this sort of thing. You got numb spots all up and down your legs, a whole leg is numb, a foot is numb - this is a neurological problem with your back and it's it needs to be investigated. But again as I mentioned much earlier in the show these are a tiny minority of the back pain situations that we find ourselves in as humans.

Just this past weekend I had some experience working with a guy that had Harrington rods in his back. He's one of these guys that had bad scoliosis. It was causing a problem and they installed essentially hardware all the way from his thoracic spine down to his sacrum. And in fact installed braces across to his ilium. In other words, he doesn't have any back movement anymore. But what we did with him was we put him in the rack and had him do a rack pull. And had him load the spine and contract the spine to the extent that he could under a moment load as he came from one angle up to erect.

We did three sets of five with the empty bar and he didn't have any problems with that. My recommendation for him was to go up five pounds a workout and do three sets five and let's see how strong we can get him. His back will respond just like your back will. It'll get stronger if he's loaded carefully and correctly throug this range of motion.

So, boys and girls, let's just keep a couple of things in mind. All right. If you are fortunate enough to not be dead by the time you're 35 or 40 years old, you're going to have back pain. Sorry. Can't do anything about it. It's the truth. Humans... the universal human experience is back pain. All right. Nothing you can do about that except to reduce the possibility that that back pain will be chronic, persistent, more acute, or result in neurologic problems by getting your back as strong as you can get it.

Now you get your back strong with squats, deadlifts, and presses not with situps and back extensions because situps and back extensions do not load the spine enough to produce the strength adaptations that the big barbell movements will produce. If you want a strong back you have to get your deadlift and your squat up. And there's no way around that.

And if you decide that you don't like to lift weights then I suggest that you develop a good relationship with your drug dealer because you're going to have to treat these symptoms some other way because you will have these symptoms. I hate to be that way about it, but goddamn it. You know, laziness is... there's a price for that especially if you're back's bothering you.

Thanks for joining us on the podcast today. Starting Strength Radio comes to you every Friday. And if you'd like to hear a topic discussed please don't phone it in. We don't want to talk to you on the phones. Send it in through our SpeakUp link on the website. I'll post a link to this podcast on my Q and A if you'd like to discuss it. Post your thoughts in that thread and we'll deal with them as they come in. Appreciate your attention.

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Dealing with back pain is a part of the human experience. Rip Goes in-depth on why that is and how to deal with it.

00:00 Starting Strength Updates
08:12 Back Pain - The Human Condition
15:23 Back Pain vs Diagnostic Imaging
38:02 Things to avoid if you have back pain and what to do instead
43:23 Training through back pain
50:34 Predisposed to back injuries? What to do?
54:52 Serious back injuries

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