If there is one thing that frustrates me more than anything it is seeing people remain in pain from following a plan that is based on poor information and doomed to fail. I regularly see clients who on the first visit tell me the things they have been doing to help their problem in the belief it was the right thing to do. Some had made this decision themselves, whereas others were given advice from someone else, or found a video on You Tube. Back pain is by far the most common injury with statistics showing 85% of the population will suffer with this at some point in their life and it does not discriminate who it affects. As it can greatly impact inactive people, fit people, young kids, sporting athletes, and older adults. Most of the strategies people adopt thinking it is helping are merely treating the symptoms and based on information that is never going to work and in some cases make it much worse! Most of these methods neglect the reason WHY the pain is there in the first place which leads to gradual progression of the problem and eventually more severe pain. This article I am going to discuss what are common myths relating to back pain and what you can do to avoid making these mistakes and get rid of your pain for good.
Stretching can be a great method to introduce in the beginning for back pain sufferers, but not always, as some people may be too mobile which is the problem and stretching is making it worse.
What is very important to understand is what stretches people use and more specifically WHERE they are stretching. Often the area they feel the pain in is where they try to stretch it out. While this appears to make sense to try and release what feels tight, what this is actually doing is making the back even more vulnerable to pain.
For most back pain people they have lost stability and what is called “good stiffness” of their back muscles. The best place for the lumbar spine to function and be safe from damage is when it remains in neutral. Think about how many exercises where the ability to keep your lumbar spine in neutral is important? From squats to deadlifts, push-ups, chin-ups, lunges and even walking the need to keep the lumbar spine in neutral is vital. Any excessive movement here creates a loss of performance and compensation that leads to dysfunction and eventually pain.
“The spine does not want to be bent, it wants to be held still.”
Constantly loosening the lumbar spine especially with stretches that pull the knees to the chest or round out the lower back aggravate your discs. And if you continue to do this repeatedly you are now a big step closer to developing chronic pain. The stiffness in their back could be due to poor stability in the first place so continuing to weaken your stabilisers will only make you worse.
People tell me they feel good after they stretch. And while the stretch may give you some temporary relief via reducing the pain sensitivity in the nerves it is setting you up for long term problems.
I remember a client who was suffering with a disc bulge for years and he would love to use Yoga poses and various stretches where he pulled his knees to his chest to try and stretch out his back in the belief this was doing him good. What was actually happening was this stretching routine was the catalyst for his back pain. It took me several months to convince him to stop doing this routine and let his back stiffen up.
He inspired me to make this video which was based on movements he was doing.
Now this does not mean ALL stretching is bad. Only the stretches that try to move your spine out of neutral. Stretching of the hips and thoracic region may be a great addition and often are a big part of our back pain programs. It must be noted that these areas of the body have focus that is primarily designed to provide mobility for the body. They are also easily stiffened up from lack of activity like sitting for long periods and from poor exercise choices such as sit-ups. These areas will benefit greatly from stretching and various mobility work.
Lastly there are some people where stretching and mobility work is not needed at all. These people fall into the hypermobile category and where their body is lacking stability. They will respond more favourably to strengthening and stabilisation exercises. Ironically these people are often addicted to stretching and flexibility work for they are very good at it and will often comment they are too tight and need to loosen tight muscles.
This is also why Yoga is not a good remedial strategy for back pain. Some poses may be okay, but you must be very careful as to the choice and use a specific routine for you as opposed to loosening everything as used in a class setting.
Take home message here is stretching is okay if it targets areas of stiffness in the hips, thoracic and other parts of the body such as calves or neck. You MUST NOT stretch the lower back itself and avoid flexing your spine. Lastly improving your stability may be the solution and no stretching is required.
See article - What Is Stability Training?
This is a very interesting one and the test most people use to confirm this is if they can touch their toes or not. I must admit I used to think this myself many years ago until I found out that it is very rarely anything to do with the hamstrings.
Poor toe touches will have more to do with hip mobility and the hamstrings are actually tightening up to protect you. The difference between hamstring muscles and the sciatic nerve is very important to differentiate. When the knees are locked out this is a nerve stretch and nothing to do with the muscles at all.
When people have trouble touching their toes, they usually blame it on having tight hamstrings, because that’s what they feel when doing the movement. But as we discussed earlier this is usually just a reaction to something else. Gray Cook in his book "Movement" discusses this in great detail and he has many videos on this exact subject I encourage you to check out.
He describes this best below when people cannot touch their toes it is usually do to one of 4 things.
This is why I don't use the toe touch instruction as a test that as the results can give very misleading information that could set you up for all types of trouble. The true hamstring tight person will fail the tests above and you will see a posterior tilt of the pelvis when lying on the floor or in a standing position. This person looks like the have no butt.
One thing to consider is the role of the hamstring in providing the stiffness to the hip joint that is lost due to poor stabilisation around the hip/pelvic area. In our article on hamstrings we refer to this as a slave muscle where the hamstrings are forced to pick up their workload due to weakness elsewhere. For example if your glutes are weak and not functioning correctly, which is extremely common, the hamstring has no choice but to increase the workload. It will never improve its flexibility or stop working for it is the only thing left holding you together. The solution is to improve your pelvic tilt and gluteal strength.
For more information relating to the hamstrings make sure you read our full article – Why Hamstrings are mistakenly blamed for injury
Rest is a good thing for most injuries as it allows the body the opportunity to heal itself. However you can have too much of a good thing when it comes to back pain. Lying in bed for too long can make matters much worse and many people will often feel worse first thing in the morning.
The reason this happens is the discs in the back re-hydrate overnight by filling up with a concentrated protein that is a water-like substance. This is how our discs receive their nutrition to remain in good health. When this happens they swell to a larger size which is fine for someone with good spinal mechanics and position. But it is bad news for someone whose spine is not in optimal alignment as these larger discs now pose problems and makes movement very stiff and awkward until the discs reduce back to their normal size.
I cannot tell you how many people have called me to say my physio says I need to stop training and rest until my back gets better. This person needs to move, they just need to know what things are the right things to do. If they do not find a way to position their spine in the optimal way during movements like bending over the discs will continue to cause more and more pain, changing the way they move throughout the day. This compensation becomes a big problem as it sets off a chain reaction of new problems and a vicious cycle of never-ending pain.
This means that exercise is very important, but it must be chosen carefully. A great warm up routine I have given to people in the past is based on some of the exercises in the video below. I must make it clear I DO NOT always use this same routine. It all depends on the person as some may use only one or two of these.
Take home message here is to rest where needed but not excessively and make sure you spend time walking and warming up in the mornings to decompress the discs. The long term solution is to improve HOW YOU MOVE. For this is the source of your back pain. You did not get a sore back from lack of sleeping or lying down, bad luck, or getting old. You got a sore back from moving poorly so now you must spend time learning how to move correctly.
Want to follow along and keep the important tips on one sheet nearby? You can download our Free Cheat Sheet below by clicking the image below.
We have been convinced to believe that anyone with strong abs is less likely to be injured and that if we spend time getting our abs to burn it is a good thing. Even therapists and Doctors have been known to prescribe planks and abdominal exercises to treat back pain and various other injuries
What people fail to understand is that your abs are unable to move you, other than making you wiggle or flop around like a fish out of water. You need your arms and legs to move you for your abdominal muscles are not capable of doing much. Basically the abdominal muscles have very little influence over how you move, for this is not their true purpose. We have discussed this in great detail in many articles before and I suggest you read this article in detail to see more.
Most of the current core workouts is all about training abdominal muscles in isolation. This would be doing crunches, planks, back extensions and many other typical ab exercises. The belief here is that if you train your abdominal stabilisers in the same way you would with a bicep curl to make a bicep stronger, you can have a stronger core and it will correct the problem. Unfortunately it does not work this way at all.
Watch the two videos below where we give good examples of this in action.
The abdominal stabilisers are not dependent on strength, but TIMING is of most importance, and it has very little capability to move you. It works best when used in conjunction with your arms and limbs as a reflex muscle to stabilise in preparation for movement.
This means that sit-ups and planks and all the various other isolated abdominal training will have very little influence over changing how the abdominal muscles work in movements that are the trigger of your pain such as bending. It makes no difference how strong your abs are if you continue to bend over poorly. The problem is not with the muscles but with the brain and how you coordinate movement. You could have the ability to hold a plank for 10 minutes and repeatedly bend like this and still end up with a disc bulge.
This myth really is a continuation of the last myth with the belief that strong core will make all the difference.
In recent years there has been an explosion of Pilates studios and physios including clinical Pilates as part of their treatment plans for injury. While there are some good exercises and emphasis on basic stability used with Pilates and some people may in fact report they feel good after this, there are several key issues I have relating to using this method. Being qualified in Mat-work and Reformer myself I have a great understanding of the principles taught and appreciate exactly the intention of this method.
Firstly anyone participating in a class situation is already going to encounter a problem. We are all very unique and the mechanism for your injury, muscle imbalance, posture and the reason you are in pain will be different with each person. Just like Yoga this means that it is impossible to follow a one size fits all program. What helps one will likely hurt another even if they have the exact same diagnosed injury. The pain is the same, the reason for getting it is different.
Secondly one of the key principles taught in almost every exercise with Pilate is to “imprint”, flatten your back out by rolling your pelvis into posterior tilt. The reason for this is based on the research around the TVA which is a very important abdominal muscle for creating stabilisation of the lumbar spine and pelvis. It is activated by drawing the belly button in towards the spine. However there is no need to move the spine into a flat back position to recruit the TVA. This can and should be done in a neutral position and is more effectively used as bracing instead of hollowing as found in research by Dr McGill.
This imprint technique is the perfect way to create disc bulge and moving out of neutral is not healthy for any person, but especially someone with back pain already. The belief here is similar to myth four believing that all you need is strong abs, when in reality you need much more than that as we already discussed. Also the breathing endorsed in Pilates is dysfunctional and against the way we are meant to generate a normal breath. This again is to try and engage the abs all the time in the belief it creates better stability.
Good article to read about breathing is here – Do you know how to breathe correctly?
Lastly it does not teach people how to stabilise or move in a standing position. While there are several exercises that are beneficial and provide some great progress in the early stages, there must be an evolution to moving in a standing position, and with load. Most Pilates programs do not prepare people well for this at all as they spend all their time sitting, kneeling and lying on the floor. Even the reformer work which many consider the gold standard of core training is very robotic and runs on rails that only go forward and back. While it creates instability it is not functional for everyday life where we are moving in 360 degrees and more importantly standing up.
Please do not see this article as an attempt to rubbish Pilates training as I have many great friends who own and operate studios that provide great programs for their members. My point is to show people that this training can be a great starting point but it is not the best solution. If you do not evolve to training that evaluates standing positions and identifies and changes faulty patterns of movement like bending, squats, lunges integrated with upper body movement you will be unlikely to find a long term result.
This is going to be a very quick one as it is such a ridiculous statement to make. I cannot tell you how many times I have heard this, and not just for back pain but all injuries. While weight gain can place some additional stress and compression on joints it is not true that simply losing weight will make your pain go away. If this was true then you would never see any skinny people with pain, and every heavyweight Olympic weightlifter should have back pain, but in both cases this is not true. I have seen many skinny and some of the fittest people suffer with severe back pain. I have also seen many overweight people with no back soreness or pain.
I will say this again and again, it comes back to HOW YOU MOVE!
If you move poorly it doesn’t matter how much you weigh you will expose your joints to potential injury and inevitable problems. There is no correlation with weight and back pain.
When everything fails it seems that the logical solution is surgery. In some cases surgery may in fact be necessary but you must understand that surgery does not address the reason for the pain and it also comes with high risks. I have met many people much worse after surgery and left to spend the rest of their life in chronic pain. Exercise intervention can do very little and in some cases make matters worse and there is no going back once surgery has been performed.
There is a lot of debate around this subject and many contradictory statistics you will find very easily on a Google search. The study by the Malaysian Orthopedic Journal has some very detailed findings and it also concludes there is more information required to justify the steady rise in spinal fusion surgeries. In my 15 years of working with hundreds of cases of different back pain cases, I have yet to meet a person better after spinal fusion.
Here is some damming quotes about back surgery.
"95% of the challenging patients see do NOT need surgery, even thought they were told that was their only cure. My opinion based on three decades of experience, working with patients who have been successful with surgical avoidance and in dealing with the "failed backs" caused by unsuccessful surgery.” – Dr Stuart McGill world renowned researcher and scientist on back pain.
“The success rate of the spinal fusion for back pain was about 24 percent, but we still kept doing it. Then, in 1994, when this paper came out Washington showing that the return-to-work rate one year after a spinal fusion for back pain was 15 percent, I just stopped. Every paper since then has showed pretty much the same dismal results; there's maybe a 20 to 25 percent success rate of spinal fusion for back pain... And the downside of a failed spine surgery is terrible. It's really bad. These people are condemned to live their entire lifetime, 30 to 40 more years, in chronic pain."– Dr David Hanscom
In the book Surgery the Ultimate Placebo by Dr Ian Harris on page 134 he makes the comment - “The other thing about spinal fusion surgery is that even the case series aren’t that great. Re-operation rates of 20% or more after only a few years are common, persistent pain is common, and ongoing need for treatment such as physical therapy and opioids is common. The failure of spine surgery is so common that it has been given a name; failed back syndrome.”
Even the Mayo clinic is out on this one -“Spinal fusion is typically an effective treatment for fractures, deformities or instability in the spine. But study results are more mixed when the cause of the back or neck pain is unclear. In many cases, spinal fusion is no more effective than nonsurgical treatments for nonspecific back pain.”
I appreciate that some people may be in severe pain and the desire to make it go away makes surgery appealing, even with the low success rate and high risks. As with any surgery for chronic pain it is wise to exhaust every option first and try as best as you can to find the source of your pain and not just treat symptoms.
You can read about 3 specific cases of people we have worked with where surgery was used that either did not work or made them much worse. In 2 of these cases these clients were almost back to full strength and able to live their life without limitation. See article - How these 3 people used exercise to treat back pain.
The simple answer is LEARN HOW TO MOVE CORRECTLY!
There are many things you will need to begin doing, and there are many factors you will need to consider. A thorough assessment of your posture and movement is critical and will reveal many of the underlying causes of your pain. Based on the results of this assessment you can implement a corrective exercise program that focuses on rebuilding movements, stability and strength.
Make sure you click on the various links throughout this article as they provide you with many of the exercise solutions you will need. Our most popular article is in the link below
We also have a great program called Back Pain Secrets you can download with 90 minutes of video and a PDF report that takes you through all of this assessment process and provides a step by step program to help guide you on implementing the corrective exercises. This is not a one size fits all program but a way to identify what your body specifically needs.
Click the image below to see more and get your copy.
There is so much confusion surrounding health and exercise these days it is no wonder people fall into the trap of following many of these myths. There is so much information available you think it would help us, where instead it seems to be doing the exact opposite. Our intention with this article and all the videos and information on our website is to provide you with simple information you can easily use to obtain good health. We use a combination of our extensive qualifications combined with constant research and application of over 14 years of experience working with many cases of back pain and injury. The one thing that is common to all cases is that it will always come back to movement and that there is no one size fits all program that works. Only the program specific to your needs will provide the solutions you are looking for. It may take some time but it is well worth it to get rid of your problem for good.
Nick Jack is owner of No Regrets Personal Training and has over 14 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise. He has worked with professional athletes in Golf, Tennis, Basketball and Football but is known throughout the local community more for his work with injury prevention and rehabilitation. Having participated at high level in many sports himself and also recovering from several serious injuries he has spent considerable time developing detailed assessments and programs to cater for injury and pain.