How to train safely with back pain

How to train safely with back pain is a complex approach that requires understanding the causes of the pain, modifying training habits, and carefully introducing exercises that aid recovery without further straining the spine. The goal is to maintain physical activity while minimizing the risk of more serious injuries and promoting long-term back health.

Understanding Back Pain: When to Stop and When to Continue?

Back pain is one of the most common complaints among people engaged in physical activity, as well as among those with a more sedentary lifestyle. Understanding the signals our body sends is crucial for safely continuing training or stopping it. Not all pain is a danger signal, but distinguishing it is vital.

When to Stop Training Immediately:

• Sharp, stabbing pain: If you experience sudden, sharp pain, especially with certain movements or positions, stop immediately. This could indicate a serious injury, such as a herniated disc or muscle tear.
• Pain radiating to the limbs: Pain that spreads down the leg or arm, accompanied by numbness, tingling, or weakness (radiculopathy), is a sign of nerve compression and requires immediate consultation with a doctor or physical therapist.
• Pain accompanied by other symptoms: Fever, unexplained weight loss, problems with bladder or bowel control – these symptoms, combined with back pain, are emergencies and require medical attention.
• Constant pain at rest: Pain that does not subside even when at rest may be a sign of inflammation or a more serious problem.

When We Can Continue with Modifications:

• Mild, moderate pain: If the pain is dull, vague, and more of a discomfort than sharp pain, and does not worsen with movement, you can try to continue, but with modified exercises.
• Muscle soreness: Often mistaken for back pain. Muscle soreness is a normal bodily response to new or intense exertion and is usually felt as general muscle discomfort. It subsides after a few days.
• Pain that decreases with movement: If the pain is worse in the morning or after a long period of rest and decreases after moving or light exercise, it is often related to stiffness or mild degenerative changes.

When in doubt, it is always better to consult a specialist. Self-diagnosis can lead to more serious problems.

Exercises to Avoid and Modifications for Back Pain

When suffering from back pain, some exercises can worsen the condition or provoke re-injury. It is important to know which movements to avoid and how to modify your training program.

Exercises That Often Provoke Back Pain:

• Deadlift: Although excellent for building strength, deadlifts, especially with heavy weights and improper form, put immense pressure on the lumbar spine. Research shows that even small deviations in technique can drastically increase the risk.
• Barbell Squat: Similar to deadlifts, heavy squats can strain the spine if the core and back are not well braced.
• Good Mornings: Require strong control of the lower back and hips. With pain, the risk of excessive strain is high.
• Crunches: Traditional crunches can compress the vertebrae and put pressure on the discs, especially if performed aggressively.
• Torso Twists with Weights: These exercises can create harmful twisting forces on the lumbar spine.
• Back Extensions: If not performed with control and you hyperextend the lower back, you can increase compression.

Modifications and Alternatives:

• Deadlifts and Squats: Drastically reduce the weight or use lighter alternatives like Romanian deadlifts with light weight, bodyweight squats, or box squats. Focus on glute and core activation.
• Crunches: Replace them with core stabilization exercises like plank, side plank, bird-dog, and dead bug. These activate the deep stabilizing muscles without harmful spinal flexion.
• Torso Twists: Avoid altogether. Instead, work on rotational core stability with exercises like the Pallof Press.
• Weight Training: Use lighter loads, increase repetitions. Choose machines that provide better back support (e.g., leg press instead of heavy squats).

McGill's Big 3: The Path to Recovery and Prevention

Dr. Stuart McGill, one of the world's leading experts in spine biomechanics, has developed a set of three key exercises known as "McGill's Big 3." These exercises are proven effective for building core muscle endurance and reducing back pain, as they stabilize the spine without unnecessary strain.

How to Perform McGill's Big 3:

1. The Curl-up (Modified Crunch)

Goal: Build abdominal muscle endurance without straining the lumbar spine.

1. Lie on your back on the floor. One leg is extended, the other is bent at the knee with the foot flat on the floor.
2. Place your hands under your lower back to support its natural curve – this will help you feel if you start pressing your spine into the floor.
3. Brace your abdominal muscles as if preparing for a punch. Lift your head and shoulders off the floor, keeping your neck straight and looking at the ceiling. Keep your lower back stable.
4. Hold for 10 seconds, then slowly return to the starting position. Repeat 5-10 times.

2. The Bird-Dog

Goal: Improve pelvic and spinal stability, as well as limb-core coordination.

1. Start on all fours, with hands directly under shoulders and knees under hips. Your back should be in a neutral position.
2. Engage your core to stabilize your spine.
3. Simultaneously extend one arm forward and the opposite leg backward, keeping them level with your body without lifting your hips or changing your back's curve.
4. Hold for 10 seconds, then slowly return to the starting position. Alternate sides. Repeat 5-10 times per side.

3. The Side Plank

Goal: Strengthen the oblique abdominal muscles and spine stabilizers.

1. Lie on your side, supporting yourself on your elbow, which is directly under your shoulder. Your legs should be straight and stacked.
2. Lift your hips off the floor so your body forms a straight line from head to heels. Engage your core and glutes.
3. Hold for 10 seconds. Slowly return to the starting position. Repeat 5-10 times per side.

Progression: Start with shorter holds (a few seconds) and gradually increase the duration up to 10 seconds. When 10 seconds becomes easy, you can increase the number of sets or repetitions, but do not hold for longer than 10 seconds in these exercises. McGill recommends a scheme of 3 sets of 5-10 repetitions or holds, where assuming the position, holding, and returning count as one cycle. Frequency can be daily or every other day, depending on your pain and recovery.

Other Safety and Recovery Strategies

Besides the right exercises, there are other key factors for successfully managing back pain and recovering:

1. Optimizing Lifestyle:

• Postural Hygiene: Pay attention to your posture throughout the day – while sitting, standing, lifting objects. Avoid long periods of sitting in the same position. Use an ergonomic chair and desk if you work in an office.
• Lifting Weights: Always squat to pick something up from the floor, keeping your back straight and the load close to your body. Do not twist your torso while lifting.
• Sleep Quality: Adequate and quality sleep is essential for tissue repair and reducing inflammation.
• Hydration and Nutrition: Maintaining good hydration and a balanced diet rich in anti-inflammatory foods can aid recovery.

2. Stretching and Mobility (Carefully):

While excessive lumbar spine stretching can be harmful, improving hip and upper back (thoracic spine) mobility can relieve pressure on the lower back.

Important: If a stretch causes pain, stop immediately. The goal is a gentle stretch, not a painful one. Avoid aggressive stretching with lumbar spine flexion.

3. Professional Help:

Do not hesitate to seek help from a qualified physical therapist, kinesiotherapist, or doctor. They can provide an accurate diagnosis and create an individualized treatment and recovery plan. A good specialist can show you the correct exercise form and guide you on how to safely integrate training back into your daily life.

Psychological Aspects of Back Pain

Back pain is not just a physical condition; it has significant psychological aspects. Fear of movement (kinesiophobia) is common in people with chronic back pain and can delay recovery. Avoiding all physical activity can lead to muscle deconditioning, which in turn worsens the problem.

• Awareness and Patience: Be patient with yourself and the recovery process. Pain reduction takes time and consistency.
• Gradual Loading: Avoid aiming for quick results. Gradual and controlled increases in load are crucial.
• Positive Mindset: Focus on what you can do, not on what you cannot. Small victories contribute to greater confidence.
• Stress Management: Stress can increase muscle tension and contribute to back pain. Relaxation techniques like deep breathing, meditation, or yoga can be beneficial.

See more in the fitness guides of Sport Zona Academy.

See more in the fitness guides of Sport Zona Academy.