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Other/Mixed Low Back Pain Help, Please and Thank you

Other strength modalities (e.g., Clubs), mixed strength modalities (e.g., combined kettlebell and barbell), other goals (flexibility)
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Miguel

Level 5 Valued Member
Greetings StrongFirst,

I wanted to know if anyone out there, (mostly aimed at SFG I&II, SFB, and any therapists or doctors) has had any success with reducing/eliminating low back pain by either body weight or KB exercises.

Background: A friend of mine asked me to train with her, but certain positions make her back spasm and potentially lock up. She has seen PTs, chiropractors, done pain meds and muscle relaxers, all to no avail. Last step is MRI, but that has to wait until she is Stateside.
Pain Characteristics:
Began 8-9 years ago (no accident or trauma)
Lower back exclusively
Twisting to either side provokes spasms
Sneezing provokes spasms
Pain can be debilitating to such a point she needs to be taken away in an ambulance
Sometimes she cannot move for days
Sometimes she can do certain stretches and avoid the onset of spasms and pain

She likes to run (when I hurt my back, my Trainers said not to run, jarring impacts are not helpful, so I warned her off running. Wrong?)
She likes to do Insanity (not well versed in it, but I understand there is a lot of jumping around. Waved her off of that too, wrong?)
When last I saw her I advised Rocks, Bobs, quadruped crawling, and naked get-ups. Wrong?

I would really like her to be pain free, she is really trying to work out more and lose weight.
Thank you for your time and efforts, SF.
 

Steve Freides

Staff
Senior Certified Instructor
Elite Certified Instructor
@Miguel, Strong First, period.

I can speak only from my own experience but here's what I have learned (all of which should be cleared by her current doctor):

When movement can provoke pain, don't move quickly. Slow, careful movement works much better and build confidence in movement.

Based on the above, no running, no Insanity, period - not up for discussion.

Because twisting provokes spasms, getups should not be your first choice, and also not crawling.

Sneezing - there's nothing to be done about it except to figure out what makes you sneeze and try to avoid it.

Buy and read "Treat Your Own Back" or "7 Step To A Pain-Free Life" by Robin McKenzie. This is an absolute must. McKenzie is gold.

Work on hamstring flexibility and hip mobility in ways that do _not_ cause the lumbar spine to bend or twist. But work on them - both can be key to reducing low back pain, and both are things lacking in most sedentary people.

When she has enough ability to deadlift a kettlebell without pain and in good form, start there. Begin with the bell raised (on a box or platform) if necessary. Cycle elevation and weight, e.g., 8 kg on a 12" box, then 12 kg on a 12" box, then 16 kg on a 12" box, then 8 kg on a 10" box while stressing proper form and maximum tension. Eventually progress to a barbell. Continue to stress proper form and maximum tension. Get _strong_ _first_.

Rocking and bobs - good when lumbar doesn't move, bad if it does, so form is everything here. If she can't do them in perfect form then she shouldn't do them.

Follow McKenzie's advice for non-training time.

If and when she is strong enough to run in good form, she may try a little but again form matters. Cadence must be high, 160 footfalls/minute minimum, 180 is better and recommended, stride must feel short to the front and eventually can feel longer to the back. No junk miles. A little speed work is good as it usually helps form.

Lumbar stretching should be done sparingly if at all until she's well enough to tolerate it.

Hope that helps.

-S-
 

RobbieF

Level 4 Valued Member
Personally, I would go and see a good physiotherapist (or physical-therapist if you're from the US), I know it might be expensive but can you put a price on good health? Also, you may want to get a manual therapist to give you a psoas release which may give you some relief.

For training I would try and strengthen the core and glutes in bid to "bulletproof" the lower back. Exercises like glute bridges and side lying clamshells done unloaded in a slow and controlled manner and avoiding any extension and rotation of the lumbar spine. As for core exercises try deadbugs done in a slow and controlled manner: focus on your breathing while performing it, inhale in the start position, exhale when you're lowering your legs down and inhale when coming back up. On the note of breathing, do some diaphragmatic breathing face down on the ground (crocodile breathing) and lying on your front - this might realign your diaphragm with your pelvic floor. See how she responds to the exercises - if they cause her ANY pain snd discomfort do not perform them. As for progressing with exercises use the 10% from week to week, ie only increase the workload by 10%.

As for resources Kelly Starrett has some stuff on YouTube on lower back pain and psoas stuff, Eric Cressey has a good 3 part article on T nation called Low back savers. Again approach these exercises with caution and see how your friend reacts to them.

NOTE: I am not a doctor, I have done some sports injury rehabilitation modules at university but that does not make me an expert by any means. I'm going to say it again, invest in a professional that can help your friend.
 
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Al Ciampa

Level 7 Valued Member
Certified Instructor
@Miguel not enough info... how overweight is she? How old is she? What is her lifestyle like, job, etc? How is her eating? How much water does she drink? Alcohol? Any meds? What does her posture look like? What about when sitting? Does she take any supplements? How does she sleep? What changed 8 years ago? Psychological trauma counts here.

You need to paint a better picture for us.
 

Craig Fern

Level 5 Valued Member
since I have had lower back pain in my QL muscle on and off for about two years, I found this thread to be of interest.
I have been thru PT with an excellent therapist but the pain seems to keep returning.

Steve, I have read McKenzie's book and more recently Stu McGill's new book,the Back Mechanic. The two approaches could not be more different. Dr. McGill states that one should do no stretching of the lower back and gives examples of flexion based stretches that you should never do whereas Mckenzie's protocal recommends flexion based stretching.

BTW, if anyone has suggestions to get rid of QL muscle discomfort, I would love to hear it.

thanks!
 

Steve Freides

Staff
Senior Certified Instructor
Elite Certified Instructor
@Craig Fern, they're both right. :)

I don't agree that no one should ever stretch their lower backs - there are ways to do it that even my flexion-intolerant lumbar spine not only tolerates, but actually likes. But the devil is in the details. For me, it took a long time post-injury until I was able to stretch my lower back, and I don't do it much, but it is possible, basically by applying the principles we teach at our certs and at Flexible Steel.

QL - see the 90/90 stretch in S&S.

-S-
 

Craig Fern

Level 5 Valued Member
thanks for the quick response Steve. I fall into the category of extension intolerant back pain. For me I immediately feel better if I do some of the flexion based stretches but after reading McGill's book, I am not sure if I should do them or not.

I enjoy the 90/90 stretch and will keep at it more often.

I'm in the New York area and would love to attend a flexible steel seminar. Hopefully there will be one scheduled soon.

thanks again,
Craig
 

Steve Freides

Staff
Senior Certified Instructor
Elite Certified Instructor
Explain extension intolerant a little more, please. I don't do certain exercises, e.g., the one they call a Superman, or any back extension exercise - for me, keeping my spine in neutral is what's best.

Cossack Stretch can hit QL.

Flexible Steel: May 21 in Putnam Valley, NY, about an hour North of the city. Link in the Everything Else section of the forum.

-S-
 

Steve W.

Level 8 Valued Member
From hearing McGill talk and reading the article/video series below (a very worthwhile read that gives a sense of his approach), it seems like he is a very "it depends" kind of guy, who carefully and individually evaluates each case and tailors a protocol based on what he finds, although he does have general principles that he uses to guide him.

A Day with Dr. Stuart McGill (Part 1)

A Day with Dr. Stuart McGill (Part 2)

A Day with Dr. Stuart McGill (Part 3)

A Day with Dr. Stuart McGill (Part 4)

A Day with Dr. Stuart McGill (Part 5)

A Day with Dr. Stuart McGill (Part 6)
 

Anna C

Level 9 Valued Member
Elite Certified Instructor
Sinister
Steve, I have read McKenzie's book and more recently Stu McGill's new book,the Back Mechanic. The two approaches could not be more different.

I recently got those two books and had the same impression. I was thinking I need to go back and study both of them more. But then, I don't have a specific back problem to solve, so I just want to keep mine healthy... I'm left not knowing which content is best to apply.
 

Steve Freides

Staff
Senior Certified Instructor
Elite Certified Instructor
If it's not too much trouble, it would be helpful to the discussion to cite specifics, including quotations, from each book as to where they disagree.

-S-
 

Miguel

Level 5 Valued Member
@Miguel not enough info... how overweight is she? How old is she? What is her lifestyle like, job, etc? How is her eating? How much water does she drink? Alcohol? Any meds? What does her posture look like? What about when sitting? Does she take any supplements? How does she sleep? What changed 8 years ago? Psychological trauma counts here.

You need to paint a better picture for us.
@aciampa , Sorry Al. I will get it right one of these days, just don`t ask me when.
5 feet 8 inches
167 lbs
37 years of age
At least 64 ounces of water daily
"I eat a lot... I love my carbs and sugar"
No alcohol
"Benadryl whenever I eat sugar, so just about daily, and melatonin, only some nights" Sugar allergy, I think...
"I do not sleep very well"
"8-9 years ago, we moved, I started working out @4:30am, had 4 kids under 7, husband started a new career, nothing major"

She has poor posture, hunched upper back, slouches, favors right hip when standing, hunched and slouches while sitting.
Rocks, bobs, stand up slowly... she stood taller, had a weird, why do I feel different look on her face, then slowly lost posture and sunk back in and down over a few minutes.

And thank you, sincerely, to everyone.
 

Anna C

Level 9 Valued Member
Elite Certified Instructor
Sinister
She and I have some things in common. I don't have much input on the back pain and spasm issues, but on posture... my posture has improved greatly in the last 2 years. The biggest contributors:

1) Original Strength resets - rocks, bobs, and crawling (quadruped and spiderman) - all helped tremendously. At least 3x/week as movement prep for other training.
2) Building strength in the muscles that support the body was essential. The body "hangs" differently when you build up the structure.
3) Mobility work had to happen, too. The strength work can bind you up if you don't also work to free your restrictions. Massage, foam rollers and other devices, and T-spine mobility drills.
4) Breathing practice. I'm still working on this one... still working on all of them, actually... it's a continuous process.

I've never found it very helpful to remind myself to sit up straight, pull my shoulders back, etc... the body does what it can, and what it feels is best. You just have to give it the room and ability to do naturally what is most healthy for it. Good posture through restoration of "Original Strength"... yes, they are definitely onto something.
 

Matts

Level 3 Valued Member
Miguel, I don't know whether she has any structural problems leading to her back pain, but she sure sounds like she's typical of so many in modern cultures. In many cases, and I learned this a long time ago the hard way, when people get stressed out and repress it, the lower back (or some other target organ) gets a lot of pain, to slow people down and get them to pay attention. When you mention the events of 8-9 years ago, those are ALL major stress factors. There are tables of stress factors, and moving is very high. New careers for yourself or spouse are very high, anyone with kids can tell you that 4 under 7 has been stressful with the pregnancies and caring for the young ones. It's easy to get in a mindset where you just soldier on, but people can only do that so long. It's much better to admit it's hard or stressful, deal with it in a healthy way, then soldier on. haha She'll feel much better and be happier if she can get relaxed emotionally, ditch the sugar & benadryl, and do the resets, etc. and some S&S.
 

Miguel

Level 5 Valued Member
Thank you all, from the bottom of my heart. I have a lot of goals here and there, but trust you me, I want to help her and see her as pain free as possible, so much so that I wish there was someone here I could take her to.

I will apply some of the wisdom here and check in with you folks a bit later.

Thanks again, Strong First.
 

Anna C

Level 9 Valued Member
Elite Certified Instructor
Sinister
If it's not too much trouble, it would be helpful to the discussion to cite specifics, including quotations, from each book as to where they disagree.

I'm still intending to get back into the books and try to answer this, but in the meantime, I listened to this podcast (mentioned by @kbell12 in a recent post) -- it is pure gold!! RT 161 | Dr. Stuart McGill - The Truth About Optimal Back Health | Rdella Training : Strength Training | Functional Exercise | Kettlebells | Fitness

So much good information there!! And, in the podcast, Dr. McGill does discuss some of the ways that his book differs from McKenzie's, and it makes more sense to me now. He says basically they agree in many cases, but Dr. McGill emphasizes that every situation is different, so the things that McKenzie says won't necessarily apply well to everyone.

A lot of the information is similar to the Dr. McGill articles linked above (also good reading, thanks @Steve W.)

Also, @Miguel , I have been thinking about posture and how much of a psychological component there is to it. A person can do all the right things to improve their posture, but if they don't FEEL tall and proud, it will not manifest in their carriage. The good part is that it works the other way, too... as you continuously practice it and work on it... how do we say?... you begin to "own" it.
 

Steve Freides

Staff
Senior Certified Instructor
Elite Certified Instructor
Very interesting, @Anna C.

In my own recovery, I didn't implement everything McKenzie suggest, either, but the reasoning was pretty simple. I was in a lot of pain, and that in turn made it pretty easy to figure out what worked and what didn't.

With a lumbar spine injury that produces referential pain - your leg hurts, not your back - one of the signs of progress is the centralization of the pain - you make your back hurt and not your leg. That, while also pretty unpleasant, also makes it pretty easy to figure out what one should and should not do. (I had to go back on Percoset after my first session of McKenzie exercises with the PT but the pain was centralizing, and the PT and I both knew that was good, so we backed off a little but it was the right road for me.) I was on Percoset 24/7 for three weeks immediately following the injury, off it after a cortisone shot, on it again for a few days after the first PT session, and then off it for good after that.

I didn't stretch my back for 9 years after my injury, and I still don't stretch it much now.

JMO, YMMV.

-S-
 

Phil12

Level 8 Valued Member
From hearing McGill talk and reading the article/video series below (a very worthwhile read that gives a sense of his approach), it seems like he is a very "it depends" kind of guy, who carefully and individually evaluates each case and tailors a protocol based on what he finds, although he does have general principles that he uses to guide him.

He is for sure. I just really wish there were more PTs and other professionals out there educated on this kind of stuff.
 

Miguel

Level 5 Valued Member
Ladies and gentlemen of the Forum, and in particular, those of you who chose to contribute in this thread:

THANK YOU!

I know this is not a place for "Doctors", but your advice is sound, relevant, and most importantly, practiced and proven. I believe Mr. Mike Moran said something like experience trumps science, and I am crossing every digit I have in hopes that your experiences can help my friend. And here is why your advice is SO valuable: You owe her nothing, heck, you owe me NOTHING. There's no check, no fee, no credit card numbers involved, just an honest and genuine desire to see folks move better and be STRONG.

I am humbled and honored to be a part of this "Society of Strength".

She has been given the complete "data dump", and she has all the tools necessary to begin her "rebuild". I will see her again soon and hopefully I will have good news.

@Steve Freides , @Anna C , @RobbieF , @Steve W. , @Matts , and @aciampa ,
I am in your debt. My scope of influence is rather small, but if there is anything I can do for you, please do not hesitate to ask. Thank you.
 
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