Finding Fitness With Lower Back Pain
The number of USA emergency room visits, pain medication orders, injections, imaging studies, and surgical interventions directed at lower back pain continue to rise. I frequently meet people who report their fitness efforts have been hampered by low back pain. I have five recommendations that can help fitness clients with lower back pain have more success in the gym.
#1 Do not exercise first thing in the morning: Ergonomic experts have found that many more industrial lower back injuries happen in the morning. The theory is that the discs in the lower back imbibe or gain fluid overnight and are more likely to deform with a physical challenge. Give your lower back one or two hours of walking around time before starting an exercise session.
#2 Isometric strengthening of the spinal stabilizers: The function of your “core” muscles is to limit movement of the lumbar spine and pelvis. Stop all crunches, toes to bar, sidebends, sit ups, seated twisting, and learn how to perform bird dogs, side hovers, Pallof press, planks, and carries. Compliance with this single hint would reduce USA expenditures on lower back pain dramatically.
#3 Enhance the function of your hip flexors and gluteal muscles: Please cease all the forward spine flexion, toe touching, spine twisting activities. Greater lumbar spine range of motion is associated with more–not less, lower back pain problems. Learn how to foam roll and mobilize the hip flexors and gluteal muscles. Prolonged sitting and most popular “cardio training” deadens these muscles. Properly functioning hip flexors and gluteal muscles keep the pelvis stable and take stress off the lower back. Reawakening dormant gluteals and hip flexors is the magic that resolves long term lower back pain.
#4 Focus on single leg strength training: Ditch the front loaded hip hinges–deadlifts, cleans, snatch, and drop the loaded squats. Swear off the lower lumbar deranging leg press. Reduce spinal compression and train the legs, one at a time. Single leg training reveals the right / left side movement asymmetries that drive lower back pain. Resolving these asymmetries and sparing the spine goes a long way to abolishing back pain. You will need some guidance on exercise selection and execution- this brings me to #5.
#5 Get some help: Exercise is the most powerful medication on the planet. Nothing else comes close. Take the proper dose of appropriate training and the results will be amazing. Take the wrong dose of an inappropriate activity and the results can be devastating. This is especially true for people with a history of lower back pain. Find a qualified physical therapist to guide you through your fitness journey. One way or the other, you are going to spend time and money on your health. Proactive spending is always cheaper and more beneficial than reactive spending.
Michael S. O’Hara, PT, OCS, CSCS
Training Modifications That Help With Your Medication
Statin medications are amazingly effective at lowering blood lipids and have, undoubtedly, lengthened lives. More doctors are recommending their patients start on these drugs at younger ages. For a long time, we have known that a common side effect of cholesterol lowering statin drugs is severe muscle soreness after exercise. Recent research on animal models has demonstrated that statin medications inhibit the beneficial muscle adaptations that occur with exercise. If you are taking a statin drug, take the time to read Gretchen Reynolds’s interesting article in The New York Times, “A Fitness Downside to Statin Drugs?” Over the years, I have found certain exercise modifications help reduce the muscle soreness symptoms in physical therapy and fitness clients who are taking statins. The following recommendations may work for you.
Delayed onset muscle soreness is more pronounced with two types of training: eccentric type muscle contractions (the muscle lengthens against resistance) and deceleration activities (landing from a jump, hop, or stride). I have found that managing eccentric muscle contractions and reducing deceleration activity allows clients taking statins the ability to perform beneficial training with less discomfort.
Manage Eccentric Muscle Contractions
Eccentric contractions (the muscle lengthens against resistance) create more micro trauma to the muscle fibers, and it takes longer to recover from a bout of training that involves more eccentric repetitions. Controlled pace, bodybuilding type muscle isolation training delivers eccentric loading in an effort to stimulate a hypertrophy response in the muscle.
Performing isometric strength training (no movement of the joints) completely eliminates the eccentric portion of an exercise. Sled pulling and pushing has no eccentric component and many statin medicated fitness clients say this fairly intense fitness activity is well tolerated. A suspension trainer works well to preferentially unload the eccentric portion of a squat or lunge movement pattern. Strength training with resistance tubing creates an accommodated force curve that reduces eccentric loading of the muscles. At FFAC, we have a Surge 360 that is a concentric only device that works all directions of a push or pull with no eccentric muscle stress. A good fitness coach can find multiple ways to reduce the eccentric involvement of an exercise activity.
Impact activities produce high intensity, eccentric muscle contractions. Land from a jump off a box and your quadriceps, hamstrings, and gluteal muscles must create a quick, coordinated contraction that slows your interaction with gravity. Deceleration eccentric exercises create more muscle damage and repeated deceleration events are notorious for creating higher levels of delayed onset muscle soreness.
If you want to perform “cardio exercise,” choose the elliptical, Ski Erg, or one of the many types of bikes. If you possess the mobility, use a Concept 2 rower. Stay away from the impact of treadmill running and avoid jumping rope, jumping jacks, and any activity that involves both feet leaving the ground. Medicine ball throws can be performed with minimal impact and produce an excellent muscular and neurological training response. Avoid box jumps, Olympic lifts, and any other activity that creates an impact on your body.
Talk to Your Doctor
I have worked with many people who had a discussion with their doctor and a simple alteration of their statin medication resulted in far fewer side effects. I am always surprised by how often patients are reluctant to report their symptoms of severe muscle soreness to their physician.
So those are the hints that have come from years of my work with physical therapy patients and fitness clients. Stay off the wheel and stay healthy.
Read the NY Times article here: https://www.nytimes.com/2017/01/04/well/move/a-fitness-downside-to-statin-drugs.html
-Michael S. O’Hara, P.T., OCS, CSCS
I am often asked about my favorite “core exercise.” My response is Stir the Pot, an exercise I learned at a lecture given by spine biomechanics expert, Dr. Stuart McGill. Most people have never heard of this exercise, and I have never witnessed it performed in a commercial gym. It is a challenging drill that is worthy of your training time.
But first I need to make a disclaimer: If your training goal is to reduce the layer of fat across your abdomen and develop a six pack, the Stir the Pot exercise is far from the most beneficial exercise. The best exercise for that is the table push away. One strict repetition of the table push away, performed midway through each meal, is the only exercise that will make the six pack visible. If your training goals are to improve your posture, reduce back pain, and function more efficiently, try adding Stir the Pot to your training program.
The abdominal muscles operate as a team to reduce, not produce, spinal motion. They hold the torso upright and transmit forces from the lower to the upper extremities. You need to develop the isometric strength/endurance that enables the team of abdominal muscles to turn on, and stay on, for an extended period of time.
Stir the Pot Performance
You need a properly inflated physioball for this exercise. Place your elbows on the physioball with the shoulders directly over the elbows. Dig your toes into the floor and set the feet at least shoulder width apart. Lift up into a solid plank position—one long line from the ear to the ankles. Tighten up the gluteal muscles and the pull the shoulder blades down the back. The pelvis should not drop or rise up during the exercise—a mirror and some instruction can help with this common problem. Rotate the ball with the arms clockwise and then counter clockwise for five repetitions, each direction. Try to perform this exercise for time. Work up to sixty seconds of Stir the Pot, and as you get stronger, try elevating the feet on a bench.
-Michael O’Hara, P.T., O.C.S., C.S.C.S.
Testing Fitness Readiness
Isometric Spinal Extension Strength Test
A big problem in the fitness industry is that there are no standardized performance evaluations that participants must achieve in order to begin or progress in an exercise activity. Anyone, no matter how deconditioned, posturally flawed, and orthopedically challenged can walk into the gym and get a workout. As a strength and conditioning coach, the present “free for all” system is a challenge that at times can be very frustrating. As a physical therapist treating orthopedic injuries on a daily basis, the present system keeps me busy. Performance tests and movement assessments identify asymmetries, strength deficits, and potential pain problems. A good coach uses assessments to determine the appropriate exercise prescription for their client. I will be posting some basic user-friendly performance assessment tests that should be a part of all fitness programs. If you pass the tests, congratulations and keep up the good work. If you did poorly on the tests, you need to get to work on improving your performance.
Isometric Spinal Extension Strength Test
The muscles around your spine and pelvic girdle are designed to reduce and not create motion. They are isometric muscles that brace the torso and pelvis to create the pillar strength you need to carry in firewood, lift the wheelbarrow, or push the lawn mower. The Isometric Spinal Extension Strength Test is an assessment of the component of core stability that isometrically resists spinal flexion. This test is used in industrial medicine to assess a worker’s ability to return to material handling tasks. In my evaluation of fitness clients, it is often the stability test with the most significant deficits.
You need a Roman Chair or Glute-Ham Developer Bench to perform this test. The support pad of the bench should be on the front of the thigh just set below the pelvis. Position your body so that the ankles, knee, hips, and lumbar spine are in one long line that is parallel to the floor. Cross the arms across the chest and hold a solid, floor parallel position as long as you are able. Pain with the test is a fail and you need to be evaluated to find out why the test is painful. Less than thirty seconds is a poor grade. You need to improve your performance, and in the meantime, avoid activities that require you to resist spinal flexion-resisted squats, deadlifts, kettlebell swings, and bent over rows. Thirty to sixty seconds is a fair grade and clears you for most resistance training. Athletes and those involved in occupations that require lifting and carrying need the isometric strength that permits a sixty-second hold.
Michael S. O’Hara, P.T., OCS, CSCS