There are few certainties in life. Proverbial wisdom counts death and taxes among them, but back pain should be on that list. Everyone seems to suffer it at some point, and it’s incredibly debilitating because our backs are involved in almost everything we do.
This article is an exploration of all the things I tried to heal back pain. What finally worked was rethinking how I use my back, and surprisingly, heavy resistance training.
- The 30s’ welcome gift of pain
- The lifting belt
- Rest, ice, anti-inflammatories, massage
- Hamstring and hip flexor stretches
- Ab training
- Deeper causes
- The secret: gluing the lumbar spine
- Progressive squats and deadlifts
- No more sore back
- Summary: what worked and what didn’t
The 30s’ welcome gift of pain
The third decade of life comes with a change in recovery ability for many people. Some of the idiocy you used to be able to get away with in youth results in sore joints and tendons (golfer’s and tennis elbow for instance, which I outline how I dealt with here) and of course the sore lower back.
I actually had low grade back pain throughout my twenties, but it only got bad in my thirties. I suspected it was the result of minor gym injuries due to bad exercise technique, such as letting my back round when deadlifting.
(One time in particular on the leg press, after bringing my knees right down to my chest and making my back round badly as usual, I felt a distinct pop and intense pain. I had to drag myself up with my arms and hobble home, and was out of commission for at least a week—even sleeping was painful. Fortunately it didn’t seem to cause major long term damage, but it probably contributed to the general degradation leading to the constant pain I got later.)
In hindsight poor exercise technique was partly the cause, but my issues ran deeper. Regardless, the pain was such that I could no longer ignore it and hope it miraculously disappeared. It was time to look for cures.
The lifting belt
The first go-to was a lifting belt. It was useless if not downright detrimental. A lifting belt provides a false sense of security without addressing underlying issues, and the extra load I could use in the gym meant I hurt my back even more.
There’s nothing wrong with a lifting belt per se, but by itself wasn’t useful for healing or preventing further injury.
Rest, ice, anti-inflammatories, massage
Common wisdom prescribes inflammation reduction and rest for injuries. Once the inflammation subsides, you might introduce some type of massage.
These were the next things I tried for my back. I applied ice, took anti-inflammatories and avoided any activity that seemed to exacerbate the injury. Once the worst of the sting seemed to have subsided after a flare-up, I foam-rolled the affected area, and graduated to rolling around on a couple of tennis balls. And when even the tennis balls didn’t seem to be applying enough pressure, I tried hard field hockey balls.
This all seemed helpful right up till I went back to regular activity and pain came back. Even then I kept up the self-massage if the pain wasn’t too acute, and while that felt good, it only helped for minutes, after which the pain and stiffness came right back.
It was only later I learned that type of pressure on the spine can actually be dangerous. Further, inflammation is an integral part of the healing process, and getting rid of it probably isn’t a good idea. Suffice it to say this whole approach wasn’t cutting it.
Hamstring and hip flexor stretches
You don’t have to spend long hunting the internet before you find the theory that tight hamstrings and hip-flexors are to blame. Apparently they make the lumbar spine round, and that leads to subsequent injury and pain.
Fantastic, I just had to lengthen my hamstrings and hip flexors then.
To this end I undertook a stretching program. Every morning and night I’d spend minutes stretching my hip flexors and hamstrings. It was incredibly boring, but if it would fix my back problems it was worth it.
Like magic my flexibility improved; after barely being able to touch my toes I could now bend over and, with straight legs, almost get my palms on the floor. For about five minutes after stretching, that is. Annoyingly, after five months of this stretching program, my back was just as sore.
The thing about that type of passive stretching is that it’s mostly neurological. It doesn’t result in any real lengthening of tissue, it just temporarily permits more movement.
Back to the drawing board.
Another common theory is that back injury is caused by strength imbalance in the core, and that by strengthening the abdominal musculature in particular, you’ll fix the problem.
On its face it seems reasonable, and I’d never been in the habit of training my abs, so it was worth a try. I set up a routine of weighted ab work every time I worked out. I’d hold a 20 kg (45 lb) plate over my chest and do full sit ups (some advise against this exercise, but I’ve never had an issue with it). I also did leg-raises, and cable crunches.
My abdominal strength increased a lot. My back pain, however, remained. Another avenue exhausted.
A lot has been made of the idea that modern humans tend to underuse the gluteus muscles because of excessive sitting and sedentary lifestyle.
After some reading about it, it seemed likely to be the case with me. By treating my lower back as my body’s central pivot point, I was loading my lumbar spine when it was rounded, and making it do work that should have been done by the glutes and hamstrings.
The secret: gluing the lumbar spine
The biggest factor in healing my lower back was mentally reframing it as a static support structure instead of articulating joint. I trained myself to keep my lumbar spine neutrally set in a slight curve, initiating any hinging forward or back at the hips, not just in the gym, but in general life.
This shifts work from lumbar muscles back to the glutes and hamstrings, and eliminates rounded lumbar spine loading.
You can’t entirely eliminate bending in the lower spine, and wouldn’t want to, but the emphasis shift makes a big difference.
Relearning how to use my hips and lumbar spine was hugely beneficial, but my back still gave me problems in the gym. I took some video of my training and noticed my lumbar spine was still rounding too much at the bottom of squats and deadlifts.
Using my lower back as a hinge for most of my life meant I was short on a healthy active range of motion. Presumably a combination of some structures being inadequately flexible, and a lack of strength somewhere in the chain.
Progressive squats and deadlifts
I’d read some scientific papers showing you could make permanent increases in range of motion with stretch under load. It sounded like a direction at least. I realized that the bottom positions of the squat and deadlift were stretches in and of themselves, so much so that I was being pulled out of position.
Obviously full range of motion was out, but it seemed reasonable that slowly increasing it over time might work. Just enough to challenge current limitations, but not so much that I overdid it and ended up in the old pattern of loading up my back in the rounded position.
I came up with a plan to do both movements with a partial range of motion—ie, only as much movement as I could do while maintaining a good back position. This meant deadlifting off blocks, and not going the whole way down during squats.
Over time I progressively lowered the blocks I deadlifted off, and went down a bit further when squatting. The process was guided by video footage off my phone.
No more sore back
In short, it worked. I think it took about six months, but eventually I could deadlift off the floor and squat butt-to-heals with a neutral spine.
Interestingly, without warming up or prior stretching, I could also bend down with straight legs much further than I’d ever been able to. I seemed to have made significant changes to my flexibility.
The whole approach was magic. To this point, my back pain has totally gone.
Summary: what worked and what didn’t
Back pain can be a strange thing, and often the cause is unknown. Mine turned out to be the result of using my lumbar spine as a hinge, and poor spine position during exercise. I completely eliminated my pain by reframing the role of my back and increasing mobility so that I could exercise with good technique.
What didn’t work (or provided temporary benefit at best):
- Using a lifting belt
- Massage, including foam-rolling and rolling on tennis and field hockey balls
- Abdominal exercises
- Hamstring and hip flexor stretches
- Relearning to use my lumbar spine as a static supportive structure rather than a hinge. I trained myself to use my hips to do the hinging I previously used my lower back for.
- A program of partial range of motion squats and deadlifts. Over time as my body adjusted, I gradually increased the range of motion until I could do both movements fully with a neutral spine position.