Back Rehabilitation via Weightlifting

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airhog
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Back Rehabilitation via Weightlifting

Post by airhog » Wed Jan 14, 2009 7:13 pm

I am looking for a good program for back rehabilitation. Here is the situation.

My wife was diagnosed several years ago with some bulging discs and a herniated disc. I have been doing a lot of reading on the web about the pro's and con's of doing strength training on the back in order to heal the back. I have read information that goes both ways. For example,I have read of cases were doctors have told their patients that because of their bad back, they should never lift weights again, and doing so could paralyze them. And I have read other opinions where people are against using weights and exercise to correct back problems. However, I have read plenty of opinions from people who had back problems diagnosed as the same as my wife, took up weightlifting, started light, strengthed the back, and their pain has gone away completely.

My take on the issue, is that having weak core muscles and imbalances ni the core can lead to excessive pressure being applied to your discs. If you strengthen those muscles and fix the imbalances, you body can do a better job of supporting itself.

I am thinking about starting my wife on a program that will help strengthen her core.

What are your thoughts on this?


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Post by Jungledoc » Wed Jan 14, 2009 9:57 pm

My thought is that you are probably on the right track. Emphasis on the "probably". I don't know enough about her situation to give a strong opinion.

How is her back acting now? Pain free? Occasional minor pain? Constant terrible pain? Does she have any pain that goes down the legs? Any numbness or weakness in either leg? How old is she? What height and weight? Any other health problems?

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Re: Back Rehabilitation via Weightlifting

Post by Stephen Johnson » Wed Jan 14, 2009 10:05 pm

airhog wrote:I am looking for a good program for back rehabilitation. Here is the situation.

My wife was diagnosed several years ago with some bulging discs and a herniated disc. I have been doing a lot of reading on the web about the pro's and con's of doing strength training on the back in order to heal the back. I have read information that goes both ways. For example,I have read of cases were doctors have told their patients that because of their bad back, they should never lift weights again, and doing so could paralyze them. And I have read other opinions where people are against using weights and exercise to correct back problems. However, I have read plenty of opinions from people who had back problems diagnosed as the same as my wife, took up weightlifting, started light, strengthed the back, and their pain has gone away completely.

My take on the issue, is that having weak core muscles and imbalances ni the core can lead to excessive pressure being applied to your discs. If you strengthen those muscles and fix the imbalances, you body can do a better job of supporting itself.

I am thinking about starting my wife on a program that will help strengthen her core.

What are your thoughts on this?
My thought is that the back strengthening program should be done under the supervision of a qualified physsical therapist.

I did a Google search and Yahoo search using the term "back pain support groups." You might try joining a support group to gain more information about back programs.

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Post by airhog » Thu Jan 15, 2009 12:27 am

Jungledoc wrote:My thought is that you are probably on the right track. Emphasis on the "probably". I don't know enough about her situation to give a strong opinion.

How is her back acting now? Pain free? Occasional minor pain? Constant terrible pain? Does she have any pain that goes down the legs? Any numbness or weakness in either leg? How old is she? What height and weight? Any other health problems?
She is 22 years old, 5'5" Im not going to give her weight since she would murder me if I did, but she is trying to lose weight. She tells me that she has pretty regular pain in her back but she says it isnt really severe, like a 1-2 on a scale of 10. Doesnt have any weakness or numbness in the legs either, or any other joint/muscular pains.

I think the first good step that I am going to try to do is get her to do some activation type stuff and flexibility/stretching. Then maybe take it really easy.

I figure that if we start slow and light that we can't really make things much worse, and if doesn't look like its helping or making things worse, we can stop.

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Post by Ironman » Thu Jan 15, 2009 4:49 am

ah, that's just what I call fatty back. It is the normal way a back is for any fatty. When I was fat my back was like that. My fiance used to be fat, and her back hurt all the time too. In fact most any fat person I can think of talking about it has back pain too. It's just from being heavy and not exercising. Or in some cases just being heavy. It sucks but you kind of get used to it. SO when I started getting in shape I was like "oh, wow, my back doesn't hurt any more."

I would just say for rows, do a bench supported dumbbell row, or do 1 hand at a time. Use leg press until she can squat her body weight. Then try a light weight Romanian deadlift and see how it goes but don't push it.

If she has posture problems look into that neanderthal no more thing for corrective exercises. The posture problems can identify muscle problems which can be the source of someof the back pain.

Then of course all this exercise will take some weight off, which will strike at the main problem. I can tell you it is really nice not having to worry about my back acting up anymore. It's totally worth it.


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Re: Back Rehabilitation via Weightlifting

Post by KPj » Thu Jan 15, 2009 6:42 am

airhog wrote: My take on the issue, is that having weak core muscles and imbalances ni the core can lead to excessive pressure being applied to your discs. If you strengthen those muscles and fix the imbalances, you body can do a better job of supporting itself.

I am thinking about starting my wife on a program that will help strengthen her core.

What are your thoughts on this?
I think you're half way there. I want to say get a physiotherapist/phsycal therapist and work in conjuction with them, but you need to get a good one. My girl friends mum has been diagnosed with the same thing. She got a physio through the NHS. I can tell from about a mile away that her hips don't work properly and her core is weak. The physio just put her on strong anti inflammatories, and gave her lower back stretches. I'm no physio but she couldn't of gave her worse advice. Not only that but she has been told to do these lower back stretches in the morning to help her out of bed. She had about 4 sessions and the physio told her she was OK now. Not suprisingly, the pain comes back when she runs out of pills. This is a touchy subject for me.

It's worth noting that i'm refusing to help her until she see's MY physio. I think she's put off because he's mail (you need to be in your underwear). But the guy is a genius, and very professional. I would try her with some low impact movement stuff but she's really not very clear when describing her 'diagnosis' so i'm too paranoid to try anything. Plus, it's just stupid that she won't see my physio.

His name's coming up a lot now, and for good reason - he's an unsung hero in the lifing game - but Dr Stuart McGill is the guy to read up on.

His research has shown that people with lower back pain, generally have a strong lower back. Interesting? Confusing.

Probably the biggest cause of lower back pain is repeated, low load flexion (rounding). That refers to picking things up off the floor, sitting down, standing up (rounding as you stand) and, well, anything else that has you in flexion. What she needs to learn is how to move properly. An example would be if you watch a pro golfer pick up a golf ball - he'll do a single leg, one armed deadlift. That's no accident - he/she's been told to do that.

It does sound like her core needs brought up. This doesn't need to involve lifting heavy weights. It's more a case of 'function' than strength. She needs to learn how to stablise her spine properly, and do so through appropriate movement patterns. She needs to learn how to keep as much stress as possible off the lower back. This is done through propper movement and function.

I'll post a few simple, basic movements later, that won't be any higher impact that getting off a chair. You'll recognise some of them from NNM.

KPj

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Post by Jungledoc » Thu Jan 15, 2009 7:21 am

airhog wrote:I figure that if we start slow and light that we can't really make things much worse, and if doesn't look like its helping or making things worse, we can stop.
Sadly, I'm not sure that is entirely true. I think you CAN make things worse. The alarms go off in my head when I read "flexibility/stretching."

Most of us don't need to be more flexible in our low back, and stretching it can make pain worse. The job of the low back is not to move much, but to be capable of stabilizing the spine.

Most of us need to stretch our quads, but not our hamstrings. Our hamstrings feel tight because our pelvis is tipped anteriorly, which tightens the hammies. We really need to improve the position of the pelvis to "loosen" them. Most efforts to stretch the hamstrings stretch the low back anyway.

Her priorities should be posture, weight loss and over-all strength. Single-leg work with good back position are important.

I agree that a good PT would be helpful. There are lots of not-so-good PTs out there.

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Post by airhog » Thu Jan 15, 2009 9:09 am

Jungledoc wrote:
airhog wrote:I figure that if we start slow and light that we can't really make things much worse, and if doesn't look like its helping or making things worse, we can stop.
Sadly, I'm not sure that is entirely true. I think you CAN make things worse. The alarms go off in my head when I read "flexibility/stretching."

Most of us don't need to be more flexible in our low back, and stretching it can make pain worse. The job of the low back is not to move much, but to be capable of stabilizing the spine.

Most of us need to stretch our quads, but not our hamstrings. Our hamstrings feel tight because our pelvis is tipped anteriorly, which tightens the hammies. We really need to improve the position of the pelvis to "loosen" them. Most efforts to stretch the hamstrings stretch the low back anyway.

Her priorities should be posture, weight loss and over-all strength. Single-leg work with good back position are important.

I agree that a good PT would be helpful. There are lots of not-so-good PTs out there.

Sorry, I should have been more specific. I have done some functional tests on her lower body, and definately found some issues with flexability, and muscles being tight. I wasn't suggesting stretching the back at all actually.

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Post by pdellorto » Thu Jan 15, 2009 9:36 am

Tough subject. All I can really think of is:

- addressing mobility concerns that might transfer to the lower back. So thoracic mobility, hip mobility, etc.

- working in slowly to the "lower back endurance" approach. Get it stronger, but with an emphasis on endurance. I found that planks (which forced good posture) and of all things reverse hypers (done light, with a pause at the top) helped my back alot. When I'm achy, doing reverse hypers makes that ache go away - sees to de-compress my back.

- start working on any weight issues. Extra bodyweight will only make this all harder.


But I'm no expert on this at all! I'm with KPj and Jungledoc - if you can find a real expert, a good PT, go with that. The lower back is nothing to mess with, not based solely on our advice especially. Good luck!

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Post by Blue Running Man » Thu Jan 15, 2009 6:58 pm

I have lower back pain, I suffered no back pain, until one day, at the gym when I was 19. I was doing some leg press. Wham, stabbing pains in my lower back. I experienced some shooting pains down one leg. It was pretty bad(7-10), I couldn't bendover or do much of anything, I woke up the next morning and their was a dull minor ache in my lower back(3-10). I figured a couple more days and I would be 100%. Not so, It took a month of so, of rest, seeing a chiropractor and a cortisone injection to make the pain stop.

Fast forward 5 years, and I still have minor back pain. What happens is ever so often, my lower back will get caught in flexion and wham, that stabbing pain all over again. A day later, it's just a dull ache. This happens I would say 20 times over the past 5 years. It has happened on the calf raise machine, it's happened during deadlift, it's happened during leg press(multiple times). It has also happened stretching, laughing, and sneezing. Never squatting.

The things that make my back feel better: Swinging a baseball bat, swinging a golf club, "spinal flossing" exercises. Also, even when I have pain, I'm always pain free when I squat, deadlift, clean,etc. It's as if the back loosens up and the pain goes away.


The key for me staying pain free is avoiding lumbar flexion, and keeping my core contracted. I can lift/play sports, do anything, as long as I keep the tension on my muscles, and off the spinal ligaments.

It's as if, the spinal ligaments will never heal, but it I keep my core contracted, stabilizing my spine, I have a perfectly healthy strong back.

The exercise equipment I need to be avoided is the Leg Press machine, 45 degree, and horizontal. I'm fine if I can keep my ass in the seat, and really squeeze the handles of the machine, driving with my hips. However, every now and then, when the stress of the exercise shifts from hip, to quad. I loose tension in my hamstrings, my back rounds, I loose tension in my erectors, and then I get strong stabbing pain in my lower back again.

After this happens, I take a couple minutes to wait for the pain to die down to a dull ache. Afterwards, I can even do dead lifts, pain free. As long as I keep tension in my core, and avoid lower back flexion.

When I watch other people in all the gyms I've gone to, I see nothing but rounding of the lower back during the leg press. It's like they are driving the weight with the lower back and quads. I seriously cringe when I see people in the sled. It looks to me like an accident waiting to happen. But it never does.

I'm not sure where I'm going with this, just needed to get my frustration out, since it happened again today.

---
I guess the message is, avoid lumbar flexion, Work on building a strong core, Lumbar Flossing (twisting) exercises may help.

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Post by Ironman » Fri Jan 16, 2009 5:36 am

That's weird. If I end up working my lower back too much and have to let it rest a while, I do leg press instead of squat. I never notice the back doing anything. Then the next week I can squat again.

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Post by stuward » Fri Jan 16, 2009 5:53 am

With leg press you need to restrict the range of motion so that your back stays in a natural arch and your hips stay on the cushion. Ironman, I expect you do that instinctively. That's why the exercise works for you. Blue Running Man, you need to reduce the weight and use proper form.

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Post by KPj » Fri Jan 16, 2009 11:07 am

I would try her with these movements, which would teach her to stabilise her spine and wake up her glutes. They are very low impact movements i.e. if they cause pain then you REALLY need to go to a specialist.

Plank, Side Plank, And Birdogs are in the following/first link. I watched it with the sound off so I don't know what he says but the form looks good on them. A note on 'birddogs' would be to keep the abs tensed (he SHOULD tell you that), don't let the back arc too much, and don't let the legs kick to the side.

A note on planks would be to note let the back arc to much. Squeeze glutes and the abs. Getting the glutes and abs working together for good hip alignmnet is what you're after. Focus completely on form at first. Obviously, tense the abs as well. And don't let the neck hyperextend/look up. Keep it neutral.

http://uk.youtube.com/watch?v=wS-oq6EPi ... re=related

Now some movements to switch on the glutes

Glute Bridge
http://uk.youtube.com/watch?v=XHfXrygn1 ... annel_page

With the glute bridge, make sure lower back, glutes and hammies form a straight line at the top of the movement i.e. make sure the hips 'extend'.

Side Lying Clams (these emphasise the glute medius )
http://uk.youtube.com/watch?v=5zhAJiBmJ ... annel_page

I would say 8-10 reps of each and do ot as close to every day as possible. If anything causes pain then don't do it. If she get's to 4 reps and is fatigued them obviously don't try for 10. Play it by ear and be sensible. I would also advise it in this order - Planks, Side planks, Glute bridge, Clams, Bird dogs (bird dogs pull it all together, hence, it's last).

If these go well, and you have access to cables, then the following exercise is basically the business for lower back health, since it teaches you how to RESIST rotation. (rotation at the lumbar spine isn't a good thing - especially for back pain sufferers). The others teach the lower back to be stable, and switch on the glutes. Pallof Press is the next step.

Pallof Press
http://uk.youtube.com/watch?v=aJqiH13zi ... annel_page

I would stick the first 5 movements and see if it relieves anything over the course of 2-3 weeks. I would also advise stretching the hip flexors before doing this, assuming she's had a pretty sedentary life (like most people i.e. a lot of sitting).

KPj

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Post by Blue Running Man » Fri Jan 16, 2009 11:55 am

stuward wrote:With leg press you need to restrict the range of motion so that your back stays in a natural arch and your hips stay on the cushion. Ironman, I expect you do that instinctively. That's why the exercise works for you. Blue Running Man, you need to reduce the weight and use proper form.
That's what I'm saying. When I watch people leg press, their butt never stays on the cushion. It's always lifting off and their lower back is rounding. Yet these people never experience the pain that I do.

When I do load up the sled, I do use a weight that is about 45% my 1RM. Probably less. I can (quality) squat 350 1RM, and I don't ever go over 400 on the sled.

As far as ROM is concerned, I would love to be able to use more ROM than I am. My knee angle is not even close to breaking 90. I have severely restricted my ROM because of this problem. With the ROM I'm using now, I might as well not even bother unlocking the machine.

The problem isn't when I am at the bottom of my ROM. I am able to keep my butt in the seat when I push from the hole, but when the sled moves, 3-5 inches, it's as if the tension leaves my hamstrings/glutes, and my quads take over. This shifts the posterior stress onto my lower back, my butt will raise, very slightly (emphasis on very slightly), nothing like the rounding I see of others that suffer no back pain.

In any event stu, your right. I should just drop more weight and work on keeping my form perfect. However, my concern is that the injury can and will happen when I don't have any weight on the sled, so I'm tempted to drop leg press completely. Maybe I will for a couple months, and then start very slowly again.

Good news, I woke up this morning only dealing with minor back pain, as if yesterdays problem never even happened.

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Post by stuward » Fri Jan 16, 2009 12:11 pm

Blue Running Man wrote:...I'm tempted to drop leg press completely. Maybe I will for a couple months, and then start very slowly again...
If you have access to a trap bar, try that. Your range of motion is automatically limited and it's very easy on your back. It's definately a good replacement for leg press.


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