There is no secret or mystery to this.
Those who are currently (or who have worked with me previously over the past 8 years) will have heard me say this:
“After working with me for 12 weeks there is no excuse for not understanding why you back gets bad.”
“…and if I see you hobbling down the street in 5 years time like Quasimodo, I will tell you that you deserve you back pain.”
For those who have not yet worked with me, this can see quite a cold and flippant statement, but let me explain.
You need to do just TWO things to build and keep a pain free back:
1. Identify and remove your pain triggers.
2. Identify and strengthen your muscular weaknesses/imbalances.
If you do those two things consistently and successfully, then a pain free back will be yours for life.
So lets break those two steps into more detail, with some common examples.
Identify and Remove Pain Triggers…
aka stop poking the angry bear with a stick.
Working on identifying and removing your pain triggers/aggravators is the MOST IMPORTANT step.
In fact 80% of your success depends upon this.
To understand, lets change to context to gain some objectivity.
Imagine you have a graze/cut on your arm and instead of letting it heal, you pick at it every 5 minutes.
Would you really expect it to get any better?
No, and your back and its aggravators are exactly the same.
We have two important principles to apply here.
1. Bank Balance.
2. Athrogenic Muscular Impairment (AMI)
Imagine the amount or work (or aggravation) your back will tolerate each day as a finite bank balance.
Once this bank becomes too low or goes into overdraft a flare-up (or full blown implosion) will occur.
This helps explain the cycle of bad vs good days.
Bad days are when the bank account is low and if you do something to exceed the amount, your back will let you know.
For example, if compressed flexion is an aggravator for you (so sitting with bad posture for hours a day in an office chair/car seat/bar stool/couch) and you slowly drain your bank account over the course of the day and have just $5 left to spend.
You go to pick up a back of food shopping from the floor and spend $7.50 in one movement. Seemed like nothing major at the time, but there you are in overdraft for the next couple of days.
By identifying and removing/modifying your aggravators you can spare the bank account and leave plenty in reserve for those less then perfect movements when they occur.
Arthorgenic Muscular Inhibition (AMI)
…AKA How you create muscular imbalances.
The next issue is how your body changes its software in response to your movement and posture habits.
Those familiar with Stuart McGill’ work will understand this as the corruption of “movement engrams”
The most obvious example of this is gluteal amnesia (or lazy ass syndrome) developed by sitting with poor posture for hours a day.
BUT…this is not just limited to those who sit with bad posture.
Apart from clients sitting with bad posture, the next most common issue is “chest poking”…or as I call it “turning yourself into a tree.”
In fact, this issue is now becoming more and more common as people understand that sitting too much is bad, so they invest in standing desks…and replace one problem with another.
One thing to bear in mind…THE BEST POSTURE IS ONE THAT IS CHANGING REGULARLY.
If you sit, stand, kneel, hang upside down, float, etc…for long enough, something will get annoyed.
Why? Simply put…welcome to the world of being over the age of 25.
When you stand for long periods, you are indeed avoiding common disc issues created by compressed flexion (bulges and herniations) but you can also be creating AMI as your body learns to become energy efficient (cheat) and hang from your connective issue to hold you upright to save energy.
To do this, your body will usually shut down the abs/brace and glutes…letting you hang from the muscles in your lumbar erectors and your traps, as your pelvic tilt tips forwards and shoulder position drops.
This is indeed energy efficient…but when you come to move you will find you will begun to turn into a tree and hence will move like your are made of wood.
AND YES…it is entirely possible for your body to have learnt to become sensitive to both sitting and standing.
In fact you may have created AMI in the glutes and core via sitting for years and then standing is merely highlighting it.
If you find standing for long periods creates discomfort, this most likely what your body has learnt to do.
Identifying and Strengthening Muscular Weaknesses
If it hurts, it is probably being overworked; what you don’t feel/ can’t control is where the problem is.
The biggest mistake I see with people trying to address lower back issues (whether on their own or with an “expert”) is mis-understanding the pain they feel.
Remember your back IS NOT WEAK; it is overused as a solution to other systems/components not working correctly.
Once you have your aggravators/pain triggers in check by finding alternative posture and movement strategies, then, in theory, the back should begin to settle and you would have stopped the constant cycle of corrupting your movement engrams.
Now is the perfect time to strengthen individual components that have become weak.
MASTERING McGill’s Big 3, glute control work and Dr. Lock’s Big 3 for shoulders can together create what I call a “level playing field” in that you would have built a solid foundation.
But the key here is MASTERING them.
The goal is 100% correct on every rep. Even 95% leaves 5% error that will show itself at some point.
Once you have this foundation, it is easy to build upon it with movement skills that will help in day-to-day tasks and your training goals.
Compound movement skills such as hip-hinges, deadlifts, squats, presses and pulls will now become easy to master; giving you more movement options to spare the back in day-to-day tasks.
For example, anyone with young children should master a Kettlebell Romanian Deadlift to cover picking up, putting into cribs, putting into car seats, putting into prams, etc.
BUT WHAT IF BUILDING THIS FOUNDATION DOES NOT WORK?
Then, in some cases, the body will need extra help to reprogram those faulty movement engrams.
Here we can use tools such a proprioception walks to help the nervous system identify it has software issues that require reprogramming.
BUT…bear in mind this is a fairly new tool to the rehab box, so although AMI has been a well discussed issue for the past 20 years, an effective way to address it is still being refined and should only be used once you have covered aggravators and the level playing field concepts first.
And related videos/further reading
1. 80% of your long-term success comes from identifying and removing your pain triggers/aggravators.
2. Your back is not weak, it is overused as a solution to other issues.
3. Beware your bank balance…it will vary day to day.
4. There is no perfect single position to stay still in indefinitely, find 2, 3 or 4 positions your can cycle between.
5. Bad posture and movement habits will corrupt the software that controls your movements…pain in one hip/knee/shoulder can be a sign of this.
Freeman S*, Mascia A, McGill SM (2013). Arthrogenic neuromuscular inhibition: A foundational investigation of existence in the hip joint. Clin Biomech. 28:171-177
J. Hopkins, C. Ingersoll (2000). Arthrogenic Muscle inhibition: A Limiting Factor in Joint Rehabilitation. Journal of Sport Rehabilitation
Most Important Concept (NSBP):
Mechanics of a Disc Bulge:
Back Pain: The Biggest Mistake
Identifying Your Pain Triggers and Aggravators:
Strategies to Avoid Bending the Lower Back:
How to sit 1 (office):
How to sit 2 (Enter the Couch):
Proprioception Walks – Helping AMI and FAI