October 14th, 2009

Robertson Training Systems Newsletter 5.18

My Thoughts on the Lumbar Spine and Low Back, Part I

In this new series for my newsletter readers, I’m going to discuss my training thoughts and strategies when it comes to the various joints of the body.

I can’t tell you how many times I get asked about how to “fix” a dodgy back, if I still prescribe the exercises originally outlined in Magnificent Mobility, or a whole host of related questions.

Rather than writing an individual e-mail or response to every single question, I think it would be best to develop a position statement that I can reference people to going forward.

Obviously, this isn’t something that’s static – the more I read, coach, and learn, the more my thoughts and viewpoints change.  But if nothing else it gives a clear indication of my thoughts right now.

General Thoughts on Training the Core and Lower Back

We know that approximately 80% of the population will suffer from low back pain at some point in time in their life.  Whether they are elite-level athletes or Average Joe’s, the fact of the matter is that low back pain and dysfunction is something that can and will affect almost everyone.

I have some very general rules when it comes to the clients and athletes I work with:

1 – Do No Harm!

When you’re working with the lay population that comes to you for fat or weight loss programming this rule is very applicable.

(Note: I think I might have accidentally stolen this from Mike Boyle, so if I did Mike, I apologize!  But it’s still great advice.)

If someone’s only goal with you is to lose body fat, what is the need for them to squat 315 pounds?   Or to deadlift 405?  I realize this may be heresy coming from a powerlifter, but I think it’s critical to differentiate our clients’ goals from our own.

When it comes to fat loss programming we have so many variables at our disposal (exercise selection, sets, reps, rest period, time under tension, etc.), I don’t think we should get too caught up in loading for loading’s sake.  I’m getting a little off topic here, so I digress.

2 – Do everything possible to minimize risk

On the other end of the spectrum, we have our elite-level athletes.  Especially in the speed/strength/power sports, there’s an inherent risk with loading.  This doesn’t mean we force the issue with loading, or knowingly put our athletes at risk, but it does mean when you’re working to bring up an athletes squat, power clean, etc., there’s an inherent risk involved.

For example, I work with at least a half dozen powerlifters at IFAST.  The goal in powerlifting is to have the biggest total (squat, bench and deadlift) possible.  There are safe and effective ways to deadlift, but you always run the risk of injury when you handle near-maximal weights.  It’s the nature of the beast.

The goal, in this case, is to minimize the risks involved.  Make sure safe and efficient technique is used at all times.  Vary the loading over the course of the year to ensure time for biological adaptations.  Consider the athlete’s development, and individual strengths and weaknesses, and address those within the programming.

The list goes on and on.

When it comes to high-level athletes, injuries are an unfortunate part of the game.  You may not be able to avoid them entirely, but as a coach you can do your best to minimize the risk and maximize the reward.

3 – Rarely do nothing

I worked in a chiropractic rehabilitation facility for three years.  I’ve spent another 3 years performing one-on-one personal training, and on either end of that I’ve worked in facilities where I’ve worked with a broad spectrum of clients and athletes.

One of my pet peeves is when people assume that time off is going to heal them.  If you have inflammation or swelling, sure, time off will allow the tissue to heal to a degree and the swelling to dissipate.

BUT, quite often what we see are clients with mechanical low back pain.  In other words, it’s not the swelling or inflammation solely that’s causing the pain – rather, it’s their personal strategies for moving, sitting, standing, etc. that are causing the pain.

No amount of rest is going to heal this!  As soon as you reproduce that movement or position, you’re going to be right back where you started.  It’s like the runner who has a mechanical issue with their gait; time off may help you “feel” better, but as soon as you get going again those old issues seem to creep back up.

You absolutely have to address the underlying issues if you want to get better.

Quite often if I get a new client who comes in with low back pain, I’ll tell them that all I want to do is warm them up and see how they feel.  We’ll go through our foam rolling, dynamic mobility, and acute corrective work, making sure that we’re militant about proper technique and moving from the appropriate areas (more on this in the training section).

More times than not, within 20-30 minutes they’re feeling remarkably better, and they’re now open to finishing the workout.

If this is the case, again, we have to make sure that they’re moving appropriately and watch them like a hawk.  Too much range of motion, substituting lumbar spine motion for hip motion, or anything of the like can irritate the issue and set you back.  When in doubt, remember Rule #1!

As far as the workout goes, I never have them move into pain.  If the pain increases at any point in time, we stop and re-evaluate the movement.  If it’s solely a technical issue, we need to refine technique.  They could be using too much load, or going through too much range of motion.  However, some times it’s merely a question of exercise selection, so we may need to find an alternative.

4 – Everything is individualized

As I write this, I sit and think about all the crazy, extreme cases of back pain and dysfunction that I’ve seen in the last 10 years.

People who were so locked in extension, they had virtually no flexion at their lumbar spine.

People whose hips and t-spines were so stiff their back hurt performing virtually any motion.

A young kid who couldn’t straight leg raise more than 10 degrees without ridiculous lower back pain.

And a Division III softball player who couldn’t hold a side plank for more than 12 seconds!

Of course, these are all extreme examples, but they help illustrate a point:  We all need to have a basic core philosophy, but at the end of the day everyone must be assessed, trained and coached as an individual.  There are the 95-99% of the people that your philosophy fits to a “T,” and then there are the proverbial “exceptions to the rule.”

When it comes to back pain, everything must be handled on a case-by-case basis.

So that concludes Part I – it was a bit longer than I was expecting, but hopefully it shed some light on my basic guidelines when it comes to treating and preventing low back pain.

In the next edition, we’ll talk more specifically about training and coaching strategies to give you ultimate success with your low back patients and athletes.

Until then, good luck and good training!

Stay strong

MR

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