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I Have A Bad Back: Training with Back Pain

Article written by Alanna Casey

“I can’t deadlift, I have a bad back.”
“I can’t squat, I have bad knees.”
“I can’t ‘insert exercise here’, I have an ‘insert excuse here’.”
We all get injuries, we all could make excuses. Some are actually legitimate, but the majority are just that: excuses. Unfortunately, body pains are part of the world of lifting heavy things, especially back pain. But, you don’t have to accept the pain. Instead, you can do things to mitigate back pain or eliminate it all together.  
 
I will start with the disclaimer that if you have persistent, unmanageable pain, symptoms of nerve damage (numbness/tingling), or loss of bladder control then get to a doctor ASAP.
I have struggled with back pain for years. Ever since I started deadlifting/squatting over twice my body weight I have had to manage back pain, especially lower back pain. Many of my world class powerlifting/strongman friends suffer from back pain as well. Even my friends who participate in crossfit have back pain.

There are many different causes of back pain. Within the strength community the most common are muscle strains, nerve impingement, disk degeneration and muscle imbalances.

My personal back pain is from muscle imbalances which led to muscle tightening in my lower right side, which led to nerve impingement. It took me about 10 doctor’s visits and 3 years to figure that out,but I finally got it! Yay.
I would first recommend seeing a doctor about your particular issue but, given my issues I’d like to offer some advice on how to alleviate your pains.

1. Stretch
I hate stretching! Its sooo boring: it takes foreevver, it’s uncomfortable and most importantly, I cannot feel myself immediately getting bigger/stronger when I’m doing it. Yes, I understand stretching sucks. But it’s immeasurably important. At a minimum, I recommend stretching your shoulders, back, and hamstrings prior to any lifting workout. See the below illustration for some simple back stretches.
Stretching is important to your next PR attempt. Here’s why. Stretching will improve flexibility and increase your range of motion (especially important on squat).  Stretching will lengthen tight muscles that are pulling your body away from their optimal and balances position (correct posture). Stretching also can decrease your chance on injury by preparing them for work. AND stretching after you train could possibly decrease muscle soreness by increases blood and nutrient supply to muscles which helps to clear and distribute lactic acid build up.
 
 
 
2. Take note of your posture
As you are sitting at your computer at work, or driving your car, watching tv, or sitting on the bleachers cheering on your kid during her soccer game, take note of your posture. Is your spine aligned or are you slouching over? If you’re slouching, correct it. Is your head at neutral or are you constantly looking up or down? As you sit do you have equal pressure on both cheeks or are you favoring one side? 
 
I found that I had a tendency to lean to the right when sitting. This meant that my left side was constantly getting a stretch but that my right side was tense and constricted. This contributed to my back pain. I now make a conscious effort to correct my posture, no matter where I am. 
 
3. Use proper form on squats
Yes, I’m talking about squats NOT deadlift! A lot of people end up hurting their back while squatting (or trying to squat). Women especially seem to have this problem for some reason. I am referring to the tendency to lean forward when squatting (see figure below). Many people (myself included) make the mistake of allowing their back to fall forward on the squat. When this happens the lower back has to work 1000% harder and in a 3D plane instead of a 2D one. Some people call this “clamming.” When you squat, you want your upper body as erect as possible. When you feel yourself leaning forward, your lower back has to try and compensate to keep you from toppling forward. Essentially, you end up doing a good morning while squatting. If you can keep your back straight up and down, your lower back will not be overworked. 

But, in order to do that you must have enough flexibility in your hips and hamstrings, ESPECIALLY your hamstrings. During my last training cycle I stretched my hamstrings about 5-6 times a day for ten minutes (my doctor recommended 10 times a day but 5-6 was the best I actually did). I would also stretch my hips after each deadlift and squat session. One really good way to stretch your hips is to stand directly in front of a wall, get your legs into your squat stance, spread your arms onto the wall, parallel to the floor, and then squat. Concentrate on keeping your hips open and knees out; it’s the only way you will be successful. 

 
 
4. Work your lower back muscles
Your back hurting (alone) is no reason not to train your lower back. My doctor recommended that I perform isometric (static, non-moving) back exercises, with lesser weight, as opposed to full range of motion exercises. Some great exercises for lower back are:
          Barbell row
          Standing or seated good mornings (I prefer seated)
          Back extension (great exercise to make isometric)
          Reverse glute ham raises
 
5. Get a good spotter
If you know that your back might be an issue, having a good spotter for heavy exercises is a must. Brief your spotter on exactly how you want him/her to assist you. Tell him what you will say if you need assistance and exactly what you expect him/her to do. I see a lot of people “spotting” on squat but, if their partner actually needed help, I’m not sure they would know how to properly assist.
If I am spotting someone on the squat, I squat directly behind and with my partner. I put my arms under their arms by their lats. If he/she needed help I would place my hands on or under his/her chest and squat the weight up using my legs. As you spot someone on the squat you want the lifter to be able to maintain form. 
 
If you start to experience extreme discomfort in the middle of a lift, you want someone there (who is capable) to help you out to avoid injury. If you don’t have a spotter at least use a safety rack.
 
5. Know when you call it quits
There is a fine line between discomfort and pain. When pushing yourself in any exercise you will be uncomfortable. But, if you feel sharp pain, I recommend you stop your exercise. About once a month I will end a session early because my back is in sharp pain following an exercise. When this happens “pushing through it” will only cause greater damage. If you feel pain during any workout I suggest you stop that movement and either dramatically correct/change your form OR drastically lighten the weight OR start a cool down complete with stretching. It’s important not to let your ego get the best of you in this situation. Do what is best for YOU every day. Just because your lifting partner is doing a certain exercise or weight, doesn’t mean you have to do it. Exercise your brain as well as your muscles.
 
6. Deep tissue massage
I invest in a deep tissue massage about once every 4-8 weeks. If I had the funds I would do it every single week. Deep tissue massages help to release toxins from your muscles and help to prevent scar tissue from forming after muscle tears/strains. Deep tissue massage can also break up and eliminate scar tissue from previous injuries. If your deep tissue massage is an enjoyable and relaxing experience then your massage therapist isn’t doing it correctly.  A true deep tissue massage will be quite painful as muscle knots are broken up. Be sure to drink lots and lots of water following a message.
 
7. Strengthen your core
Back pain may be caused by an imbalance between your lower back and your abdominals. Strengthening your abs will help correct this imbalance. I recommend training abs 1-2 a week, especially women.
 
8. Ice
I recommend icing your back for 20 minutes prior to going to sleep. Just make sure you don’t fall asleep with a bag of ice on your back and wake in a puddle! Icing will reduce inflammation and ultimately decrease your pain.
 
9. Osteopath vs Chiropractor
If you do all these things and still have back pain I would recommend and MRI. If the pain isn’t caused by a herniated disc, you might have a nerve pinched. In this case a Doctor of Osteopathic Medicine (D.O.or DO) would be able to best help you. Unlike a chiropractor, an osteopathic physician is a doctor. I have found that osteopaths are more likely to offer a more permanent solution to pain rather than short term pain relief. My osteopath realigned my spin and corrected the nerve impingent. I had been to a chiropractor many times before and he offered a 60 second massage, 60 seconds of hip stretching, and 10 minutes of a TENS unit (electrical stimulation). That did offer me relief but it only last a day or so. When I go to the osteopath my relief lasts a month or so, big difference.

 

I hope this article helps you to manage your back pain. Remember, pain doesn’t mean you shouldn’t use a particular muscle group, just that some sort of correction needs to be made and attention given.

 

15 thoughts on “I Have A Bad Back: Training with Back Pain

  1. Been dealing with (sounds like) the exact same problem for years! Found some of these solutions as well, but several of them are new to me–thanks for writing this!

    Another thing that’s been helping me a lot (to my great, skeptical surprise) was seeing an acupuncturist with a background in sports medicine. After two or three visits it felt like my lower back muscle was in a completely different position than it had been for years. Weird, but my range of motion in my right leg dramatically increased. Still revisit her for maintenance periodically. It’s not too expensive so it might be worth a shot.

  2. Thanks for publishing this article. I herniated a disc (L5/S1) over a year ago and still have a fair amount of back pain. I saw three different doctors all of which told me to me I would never lift again. However, I finally found a great PT who was able to help me through a combination of ASTYM and dry needling and I’m back to lifting. I’m no where near as strong as I was before, but i’m getting back there. The biggest thing is recognizing that just because you have a back injury doesn’t mean you can’t work out. Also everyone’s body is different and responds differently to different treatments. I had to try a lot of things before I found relief. Other things that have helped me are stretching, yoga, and foam rolling after my workouts and on off days. Oh and course fish oil.

  3. As a chiropractor, I’ll simply say the chiropractor you went to apparently didn’t know that chiropractic means “practice by hand”. My point being if he/she didn’t adjust you (ie realign your spine), they didn’t even do chiropractic on you. That’s too bad, we’re supposed to be better at it than any other profession, DOs included, and it’s been proven time and time again in peer reviewed scientific literature to be one of the best, long-lasting methods of relieving back and neck pain. Personally I have helped patients avoid surgery for all kinds of disc issues, and have helped many get back to lifting, practicing martial arts, or doing their sport of choice using little more than proper adjustments and active rehab exercises. Beyond that, I love this article.

  4. I agree with the chiro posting above me, as I’m a chiropractor as well. I think your article is great and full of great advice…but the chiropractor you went to sounds like a dip shit.

  5. As a Physical Therapy Student, former MMA fighter and powerlifter, I believe that this article has some good pieces of information for the general public. This article in essence states that “movement helps lower back pain”. However, recommendation 9 is incomplete.

    Depending upon the state, MD, DO, PT, and DC are all capable of performing manipulation. Only DO and MD are able typically able to give narcotics; however, this may change in the future. Imaging privileges are setting, state, and legislatively pending upon who can order MRI and X-rays. Currently, you still need a multi-professional approach to receive all of the pieces to the puzzle; however, you do not necessarily need several interventions.

    Medication and imaging are not necessary in order to reduce pain and disability. We can see here (http://www.cebp.nl/media/m488.pdf), that Physical Therapy in conjunction with medical care not only dealt with the most disabled individuals in the study, but yield superior results. Now confidence intervals and statistical significance can be argued. In this study, it is questionable if these were findings based on luck and needs to be investigated further. However, I believe there are several other things which need to be observed. First, a treatment based classification vs a pathoanatomical (http://www.physio-pedia.com/Treatment_Based_Classification_Approach_to_Low_Back_Pain) approach has been shown to reduce costs and yield greater benefits. (http://journals.lww.com/spinejournal/Abstract/2006/03150/Identifying_Subgroups_of_Patients_With.4.aspx).

    It should also be noted that patient expectations are a HUGE part of what is going to go into the effects of treatment. Being a “salesman” is key within your intervention. We could pull up multiple medication trials to see that placebo having almost or more effects than the actual medication, but this is on the subject we are talking about (http://web.b.ebscohost.com.dml.regis.edu/ehost/detail?sid=8fb0bb10-367e-44bc-98c0-7387d1878f99%40sessionmgr115&vid=1&hid=126&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=aph&AN=59249103).

    My point is this: a good medical team is invaluable. In Washington and Wyoming you will likely need and MD/DO, a PT, and a DC to effectively deal with your lower back pain. In Colorado or Idaho, you will likely only need a MD/DO combined with a PT or DC. The key is to find a good practitioner. The DC’s above have stated this. I believe that the evidence clearly presents that manual therapy, exercise, and potentially some pharmaceutical intervention is the optimal approach to dealing with back pain. Regardless if it is a DC, PT, MD, or DO administering these interventions, they are shown to be effective in the hands of a skilled practitioner.

  6. “Unlike a chiropractor, an osteopathic physician is a doctor.”

    That is weird, my degree says “Doctor of Chiropractic” as does my state license.

    1. I apologize for my misspeak. “Physician” is what I should have said.

  7. A good correction would be: DO is a physician, DPT and DC are not.

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  11. Yes, thank you Kevin Holmes for the correction. A DO is a physician, a DPT / DC are not. I apologize for my misspeak. I understand that chiropractors are doctors in their field. I did not mean to try and take that away from you. 

    Perhaps I didn’t see a quality chiro. But I went to him 2x a week for about 2 months. I thought what he did was working which I why I kept going back. I would try to realign me by laying me face down on a table and swinging my hips downward and to side (the table itself had a hinge). My pain relief was short term. 

    I had no expectations when setting the DO. I hadn’t even heard of a DO until my primary care doctor referred me to one. Every time I go to the DO, he or she is able to pinpoint the problem and literally fix it right then and there by adjusting me. This blows my mind. 

    I’m sure there are chiros out there who are much more helpful than mine was. I have friends who say they have great chiros who are amazing. I just haven’t experienced that myself.

  12. Ms. Casey,

    I understand that you are writing this article from the perspective of your own personal experience with back pain and you are obviously entitled to your own opinion. However, I must point out a glaring mistake in your last paragraph comparing Osteopaths and Chiropractors.

    “Unlike a chiropractor, an osteopathic physician is a doctor.”

    Chiropractors are recognized by law in all 50 states and in many countries around the world as doctors. This is an undeniable and easily discoverable fact.

    It is unfortunate that you didn’t see the desired results and have as positive an experience under that particular chiropractor’s care as you have had with your osteopath. That being said, please understand that it is not acceptable to publish incorrect information about the status of an entire profession that has fought hard battles for appropriate recognition.

    I’m sure your article will be helpful to many people and thank you for taking the time to write it. To your continued success.

    Cheers.

    1. Hmm, while I agree with some of what you have said, being a chiropractor is not really the same as being a medical doctor, and doesn’t require as much schooling and training. They are useful for different things, but it is VERY important to not neglect the fact that chiropractors have rightfully been accused of using a lot of pseudoscience in some of their practices. I say this as someone who goes to the chiro. However, no amount of spinal adjustment will help gluten intolerance, babies do not need spinal adjustments, etc. These are some of the things that some chiros spew, so I can understand both sides of the fence.

      This will help others understand the difference too.

      http://www.diffen.com/difference/Chiropractor_vs_Doctor

  13. Thanks for this article! I’ve been battling with back pain for years and it’s always kept me from achieving my goals. There are definitely some things I haven’t been doing that I hope will help me get to the next level.
    Do you have any progressions or scaled exercises to help achieve that perfect squat form? I think that’s one of my main problems. My form isn’t terrible but coupled with tight hamstrings I would bet that slight forward lean is where my trouble is coming from.

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