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Brian Hand
10-12-2004, 12:12 PM
There have been a lot of threads about back pain lately. Dave Werner has made the point that ultimately you have to strengthen your lower back if you want to resolve your back problems. I agree one hundred percent. I'd like to discuss some of the specifics of that process. I am hoping that we might make the process faster, safer, and less painful. In a perfect world we wouldn't have to think about these things, doctors and therapists would do all the thinking for us. Of course in a perfect world there wouldn't be any backaches would there?

Let me start by throwing out some ideas that I have picked up that make sense to me.

1 - Let pain be your guide.
Don't tough out a lot of disc pain. Find exercises you can do reasonably pain free if the "big guns" - kettlebells, deadlifts, etc. - can't be done pain free. Personally I wouldn't try deadlifting until I could do 20 bodyweight back extentions, and I wouldn't start doing back extentions until I could breeze through 20 reverse hypers without weight on a ball. If the Reverse Hyper machine is available, I'd always use it.

2-Flexibility is a prerequisite for strength training.
If you don't have adequate flexibility to use proper biomechanics, then you can't do deadlifts, or you must do them through a limited range of motion. Hamstrings are probably the number one culprit, followed by hip flexors. Flexibility should also be even from left to right, imbalances in flexibility cause big problems.

3-Weak abdominals fail to support the back.
Movements that train the transverse abdominus to flatten the abdomen and support the spine seem more important than things that strengthen the rectus abdominus. Not that the rectus and obliques aren't important, they're really important, just don't confuse a six pack with a strong core. The muscles you don't see do more than the ones you do. Using a belt is going to totally screw up your core and prevent it from learning to support your back correctly.

Looking forward to any and all comments...

David Werner
10-12-2004, 03:00 PM
Brian

Nice points. I believe that hip flexor tightness is a bigger issue than is commonly realized.

To elaborate on the abdominal support; Creating and maintaining high pressure in the abdominal cavity while loading the spine is critical. Without proper abdominal pressure, the spine and it's surounding musculature receive excessive loads. When a persons torso is required to suport a load, pressurizing the abdomen spreads the load - in effect forming a "torsion box" out of your midsection.

This is a big part of why Deadlifting is so good for back rehab, when loads are increased over time, with proper attention payed to perfect form, the lifter learns to master abdominal pressurization. When using abdominal pressurization becomes second nature, the lifter has aquired a powerful tool.

The strength and knowledge and habit of using proper body position, combined with abdominal pressurization is the ticket to pain free living.

I do think that dealing with and perceiving pain is "in the head" and therefore subject to some concious control - but only up to a point. In my case movement sometimes produced lightning bolts of pain that left me gasping for breath with a simultaneous collapse of my right leg that caused me to stagger or fall. Numerous times my wife was in tears watching me struggle. Anyone who tells me that was all in my head can F*** themselves.

Accute pain is one thing however, the lower levels of chronic pain many of us experience is completely different. My experience with chronic pain suggests that Dr. Sarno is right. Even allowing that point, I claim that a good workout is an excellent stress reliever and therefore just the thing for sufferers of chronic pain.

But dont forget the abdominal pressure.

Dave Werner
Crossfit North

Donald Woodson
10-12-2004, 03:59 PM
Well put Dave. I know my one little subluxation hurt like a SOB, lightning jolts and all. I don't even want to try to imagine what you went/are going through.

Michael Keller
10-12-2004, 07:10 PM
Great advice from both Brian and Dave. I'm sure some of the minor back aches are in peoples heads, but like Dave, feeling pain like I have never felt before in my life is not an illusion. When mine first flared up a few years ago, I literally collapsed in the floor, crawled to the bathtub and it took me over 30 minutes to get off the floor and into the tub. Getting my pants on and tying my shoes were another chore. Thankfully, with exercise, stretching and careful movement, I have not repeated that episode. It's now more an annoyance than anything. Standing for any length of time is difficult and my right leg goes numb, but it's a dramatic improvement from where I was. I'm now doing DL's with slightly more than my bodyweight (200 lb. DL's) with no pain, and I can feel my back getting stronger. I am going to have to work on the abdominal pressurization--that's something I have not been consciously doing.

Alex Kus
10-12-2004, 08:04 PM
Hi,

This thread comes at a good time for me. I herniated my L4-L5 and L5-S1 discs in April, doing deadlifts. I still have significant weakness in my ankles and toes along with chronic and acute pain. I have been doing physio since the injury. I have tried to come back to Crossfit a few times, but each time I pushed too hard too soon and really wasn't ready. I realized in the last few weeks that really focusing on strengthening my lower back and transverse abdominus is extremely important. When I do my exercises as often as I should, my back feels way better, and doing them can actually get rid of the pain for a short period.

All of the attention back injuries have been getting on the board lately has gotten my motivation back to really work at healing this injury. It was really demoralizing getting injured like this after reaching such great heights with Crossfit. Hearing about people who are successfully rehabing is really encouraging. I have been referred to a neuro-surgeon in November to discuss my options, but I hope that I will be able to come back from this with proper exercise. I am just glad that this site/board exists, it really is a great resource. Thank you.

Alex

Donald Woodson
10-13-2004, 05:31 AM
Well I watched that show on back pain last night, and found it very inciteful. My worse suspicions are true. There is a multimillion dollar industry "fixing" people's backs whether they need to be fixed or not. Companies that make titanium splice plates and rods actually give kickbacks to orthopods to use their products. And most of the time, these surgeries don't even help the patients. Then they have the audacity to lobby for protection from lawsuits! That really ticks me off.
All I can say Alex is, BEWARE! Get second, third and even fourth opinions before you opt for surgery. And don't rule out chiropractors. Mine saved me from surgery.
But I firmly, very firmly believe that what Brian and Dave have said is THE way to go. Make your body heal itself. It really is mind over matter, and persuading your body to adapt. Paying special attention to flexibility, perfect form, abdominal pressure, and symetrical balance.
(And Dr Sarno does know what he's talking about, once you know the whole story).

Mark Mueller
10-13-2004, 05:56 AM
From my particular perspective I have to agree with Dave wholeheartedly about the hip flexor tightness. I suffered from lower back pain for years...just learned to live with it....it was going through rehab for my knee and doing the stretches for the ITB that really loosened my back up and got rid of the pain. I felt kind of stupid for awhile because it was such a simple solution.

Brian Hand
10-13-2004, 06:47 AM
Good stuff all around!

What are people doing for hip flexors? A couple things that have helped loosen my hip flexors, lunges with a stick or bare bar in the overhead position and back bridges. Bridging is NOT for anyone with disc pain! But I must say I tried it and my quads and hip flexors did loosen up. The overhead lunges though, they are fantastic, the trailing leg really stretches the hip flexors and it is probably tolerable pretty soon in the healing process, as always, pain would tell you. Doing it with your feet in place, rather than as a walking lunge, would seem like the place to start.

Ron Nelson
10-13-2004, 11:57 AM
As discussed elsewhere on the board and in this month's CFJ, lunge exercises really help loosen the hips. Take another look at the variations as depicted. Also look at the Dumbbell Work thread (Dave was a significant contributor to the thread) over on the Exercises area. I do a "Sampson Stretch" before each workout, especially when it calls for hip flexibility (ie, the olys and DL's).
For me, that particular stretch also helps keep the lower back in check. I think someone here said the Sampson is like the "crescent" pose in yoga as the arms are stretched overhead and back as far as the shoulders will let them and the whole torso then looks like a "C" when done fully. It's a great stretch and gets lots of stares at the gym.
As for my pain, it thankfully tends to be muscular, not of the disc variety. As some of you know, my wife suffers with sciatic nerve pain. DL's are no problem for me, but should I have the wife try some light weight DL's or get her to do some reverse hypers?
I have noticed that my pain has been almost eliminated since starting CF and doing the core drills in the WOD.

Ron Nelson
10-13-2004, 02:34 PM
Oh yeah,
could someone post a link to show doing reverse hypers on a ball??
Or, you could just shoot me a link via e-mail. Want to show it to wifey-poo.

Brian Hand
10-15-2004, 05:20 AM
Ron, I could not find a picture of this, let me try and descibe it, it is pretty simple. You can do it with the ball on the floor. Lay across the ball face down and roll forward so your forearms are on the ground. With legs straight, just raise and lower the legs, letting the spine flex at the bottom and extend at the top. If this is not comfortable, you can let the legs bend at the bottom, and staighten them as you raise them, as comfort permits. With bent legs it is kind of a horizontal squat, if that makes sense. If it is comfortable on the floor, you can get a better range of motion by putting the ball up on something, I put the ball at the foot of a bench, and hold onto the bench for stabilization. This way the legs start dangling more or less vertical. For someone who is still tender, one of those capsule shaped balls might be a good idea at first. Let me know if that doesn't explain it, I will take the camera to the gym and see if I can recruit a model to demonstrate.

Ron Nelson
10-16-2004, 12:32 PM
Brian,
I'll try it myself as described today at the gym. I think you've nailed it, but I'll let you know. Once again, thanks for all the help in the back area.

Ron Nelson
10-18-2004, 01:46 PM
Brian,
Tried the reverse hypers as described. Worked great!! Then I did the 50 back extentions in the WOD. Ouch!!!!
Thanks for the help!

Brian Hand
10-19-2004, 04:24 AM
Robb Wolff suggested sled dragging on another post and that is definitely a suggestion that should be added to this thread. With a waist harness, you can drag heavy and get a pretty awesome strength workout that is similar to hill sprints. Backward and forward dragging are the mainstays. The ankle-dragging is obviously not a good idea with a lumbar disc acting up.

Dragging is also easy on the body, not hard to recover from, you can definitely drag four times a week if you want to. This is helpful in a rehab situation where you're trying to recover lost ground a little at a time.

The two things I think keep people from sled dragging are the equipment, and weird looks in the park. I doubt this forum will struggle much with the weird looks in the park. The equipment is not a bad buy, and if you're a tinkerer, it is so easy to improvise there's no reason not to give it a go.

Steve Shafley
10-19-2004, 08:47 AM
Those at the end of their rope regarding back pain should check out the books by Sarno.

Other than that, Dan John's Get Up has a good article by a physical therapist named Matt Spiller regarding this topic.

Barry Cooper
10-19-2004, 12:29 PM
This is going to sound strange, but I think the best rehab exercise for most back injuries is not the standard deadlift, but the stiff legged deadlift. The reason I say this, is that the need for abdominal tension is much more pronounced and obvious in that movement. I have always thought of it first and foremost as an abdominal exercise, even though it is generally listed as a back exercise.

You should be able to get significant tension in your abs just with a 45 lb. bar. Focus on it. It's the same tension whether you have 45 lb, or 405 lbs (which is about where my PR is).

One other random thought: what hurts your back is generally a split second. It's a 1/16th second break in form, due to lack of concentration, or momentary lack of strength. You can hurt yourself just as bad picking up your young'un wrong, or a bag of concrete, as from a major lift. Mindfulness and CONSISTENT attention to basic principles is very important.

I don't think if you've never hurt your back seriously before you can really grasp how AGONIZING it is. I'm pretty tough, but it literally made me cry just getting out of bed. I couldn't help it.

Zuerchers are a great prophylactic too, IMHO.

Beth Moscov
10-19-2004, 02:15 PM
Barry - I absolutely agree. I didn't have any relief from back pain (and I did all the psychological stuff too) until I started adding in straight leg deadlifts. I started with no weight - not even a bar, just a wood dowel. When that didn't hurt the next day, I added weight. Eventually I added squats and regular deads and made a personal best a few weeks ago with NO back pain during or after.

Brian Hand
10-20-2004, 04:36 AM
I think the exercise that wakes up the abs and gets them working to support the back is an individual thing. For me, front squats did the trick. Zerchers are probably second. My abs got lazy when I used a belt and they didn't come back online for a while after I decided to quit the belt. I wonder if there is a better way to find that waker-upper exercise.

Another very basic principle that I think applies here is, do some remedial direct work first to get the muscle firing, then move on to the compound movements. This helps prevent you from developing bad biomechanics where other muscles are forced to carry the load of the lazy ones. In this case I'd say the back flattening exercises for the TVA are a remedial prerequisite for trying various squats and deadlifts (along with the reverse back extentions and regular back extentions). Hanging knee ups might be another good one, done hanging from a bar with or without straps, *not* one of those things where you rest on your elbows with your low back touching a back rest. Kneeups are another exercise I do in every warmup.

Barry Cooper
10-20-2004, 06:10 AM
I agree on that. My favorite ab exercises are leg raises to the bar ("Russian" leg raises)--Tommy Kono used to start his workouts with like 20, as I understand it--elbows to knees, and press downs like the powerlifters do. I usually do the whole stack for sets of 20.

I would also like to put in a plug for Pilates. They have ALL of that stuff in there: keeping your back flat under a variety of pressures, working your breathing in, lengthening your neck. It really is a very clever system, and I attribute part of my ab strength to doing that several times a week for a long while. I got into it about 1995, when there was only one out of print book available on it.

Barry Cooper
10-20-2004, 06:26 AM
I would also like to put in a plug for the Feldenkrais method. It's not so much a rehab method as a technique for teaching body awareness, which in turn should reduce the lack of attention that causes injury. It was, though, created by Moshe Feldenkrais to help rehab a soccer injury. Successfully.

Edward D. Friedman
10-20-2004, 12:46 PM
Struggling with some of these low back issues myself. Does anyone have experience with the protocols developed and advanced by Paul Chek. I've read some positive testimonials from practitioners ( not trainees,) whom I believe to be objective and I'm thinking about working with a CHEK certified instructor in my area ( Long Island, New York.) It's expensive and I'm would appreciate any feedback that would help in my information gathering / decision making process.

Thank you

Stay Strong

Eddie

Brian Hand
10-20-2004, 02:30 PM
Eddie, I read everything I can get my hands on by Paul Chek, I think it is very good material. I certainly would not assume that just because someone has *any* certification they are any good, including doctors. I think it is a good idea to do your homework and learn what you can, ask around and see who has helped other people with similar issues, and grill them a little before you sign on to make sure you are confident in their skills. Far from a foolproof system, but probably the best you can do.