Hey guys, Sal here and welcome to our podcast. It’s a little bit late this week because today I want to talk about back pain, and last week I hurt my back. So I was interested to see when I wrote the plan for this podcast, whether or not I would change my views or what I said to you based on the fact that I’m actually going through some mild discomfort as it is.
So I think if you’re going to get one thing from this podcast, the important thing to note is that everybody listening to this podcast at some point is going to have some form of back pain. Because we are bipeds and we are subject to what’s called axial loading, which is where the weight of gravity travels from the top of our head through our spine down to the base of our feet, so we continually have downward compression on our spine. And obviously over time that structure, our spine, will deteriorate. And when we hurt our back, how quickly we recover and the severity of the injury all comes down to how strong your back is before you hurt yourself.
Now, one of the biggest fears that people have is about slipped discs or prolapsed discs. Now, if you’re a guy over 40, more likely than not, you are going to have some form of disc degeneration or arthritis in your spine. If you MRI it, it is not going to look perfect. Now if you see the scan and you’re feeling pain, most likely you’re going to freak out and you’re going to go to a surgeon and you’re going to say, “Okay, what do I need to do about my back?”
They are going to want to do two things. One is to inject, and two have an operation because that’s what surgeons get paid for. But the reality is a prolapsed disc is a red herring. There are people that have back pain because of a prolapsed disc, as in a slipped disc as you may call it, where that spongy tissue touched the nerve and gives you sciatica, and there are people who have prolapsed discs and have no symptoms. It is a bit of a red herring. In my time as a coach, I’ve had many people who have had back pain surgery, so quite serious invasive surgery and all of them still have back problems. They did not resolve what the root cause is. Ultimately all they did was they bought their surgeon’s wife a new pair of diamond earrings.
Back pain is normally a symptom something else is going wrong structurally. And once you have an operation, there’s no turning back. You may have the best surgeon in the world, but he may slip with his scalpel and you’re fucked. There’s no going back. You need to rehab the shit out of your back, especially if you’re a young man before you decide to have injections before you decide to have surgery.
Now, in my experience, there are two types of people. The first type has already turned off this podcast. They’re the sort of people who just give up. They have a back episode, it’s traumatic for them, and they just say, “Okay, this is how my life is.” They stopped playing sports. They stopped interacting with their kids in a certain way. They just accept it. Generally, these people are generally older and they say, “Okay, that’s just part of life.” But they downgrade their life because of this episode. They’re those really annoying people in a movie when the shit goes down and the machines are going off and there are explosions, they are that dweeb that’s hiding under the table, crying, waiting for it all to be over rather than taking control of their lives, grabbing that gun or just making a bolt for the door.
The second type of person is someone who is a fighter, someone who does not accept that their life is now going to be shitty because they suffered some form of freak accident. Those are the type of people you see on the news who are told by the surgeon or the doctor they’ll never be able to walk again, and not only do they prove them wrong, they do something wild like successfully complete the London Marathon. If you experience trauma like back pain and it pushes against you, you need to push back harder. Because I assure you, if you put the work in, you will get your life back to where it was before, if not better.
Now, the way that you recover from back pain and be stronger and more resilient than you were before is taking advantage of the stress, recovery, adaptation process. And what that means is first off you’re going to have to stress the injury, and this is where people get really afraid. They avoid bending, twisting, moving, lifting anything heavy or even anything off the floor. Those are the sorts of things that you need to do to get blood to the area, stress it and get a reaction. And that reaction is going to be painful, and this is where people just freak out because that injury may feel worse for a couple of days. It might feel tender or it’s going to feel sore. And when people feel that, they think, “Okay, well what I did was obviously wrong,” or “I don’t want to go through that episode again.” And they stop at that point. That stress will lead to recovery. Rest is not a recovery strategy. It’s ultimately a way that you can feel sorry for yourself and be lazy.
So I’m sure you’re asking yourself, “What do I suggest.” The thing is the more you move, the better you’re going to feel. Just putting your feet up on the sofa and being in the fetal for a few hours or even a few days is not going to help you. The body does not understand what you’re trying to do. The inflammation, the spasm is just not going to go away. But when you have a back problem and you don’t move, those muscles start to cramp and they start to tighten and you get tighter and tighter because you just move less and less. You make the problem even worse because your muscles then become like a wound tight coil and when you do move, that coil can go spring and then you’re in a horrendous amount of pain.
When your back has a spasm, it creates knotting and scar tissue. And you can think of this knot as if you had a shoelace and you put an actual physical knot in it, that shoelace is a muscle and now that muscle is shorter because you put the knot in it. If you just decide to stretch that shoelace, that knot just gets tighter and tighter and you may cause the body to react with greater severity.
What you need to happen is someone to release that through manual therapy, get rid of that knot and then stretch, and that’s really only if it’s muscular. If it’s like a nerve, so if you’ve trapped the nerve somewhere and you start just stretching your hamstrings or back randomly, then you’re in for some shit. Muscles can stretch, but nerves do not stretch. And if you pull a nerve, it’ll yank itself back to where it was before, and that will be increasingly painful for you. Stretching is the equivalent of if your computer crashes, just hitting random keys on the keyboard, hoping that it’s somehow going to fix itself. No, what you need is a technician to open it up, have a look, fix it and give you a plan so that doesn’t happen again.
The second thing you need to do is train around the injury. If you can’t directly train your back, you need to train the rest of your body. And that might just be something as simple as upper body, your arms, your chest. Because whenever you do some form of strength training, you are creating an environment of growth, and the chemicals that get released by the body not only will cause growth and repair, let’s say in your chest if you’re doing bench press, but also some of those chemicals will go to the injured area. And some of the stress hormones like cortisol that has been released by the body will also get utilized and taken out of the bloodstream. So it’s a win-win for you. You may not feel like it, but get off your ass and get lifting some weights.
Now, once you’re past the acute phase, you’re going to have to start to lift some relatively heavyweights. I’m not saying you’re going to jump from never having lifted a weight in your life to 100 kilos, but you’re going to have to add progressive overload where each time you go to the gym you are loading your back a little bit more, a little bit more with an exercise like a deadlift. Now if you do something with a barbell, you can micro load, so you can go from, let’s say if you’re doing 20 kilos, you can load the bar to 22 kilos or even less. You can go from 20 kilos to 20.5, you can get a special plate to do that. So you’re not in any danger of actually overshooting and hurting yourself.
Now, so many people are afraid of doing lifting to help their back. They want to do something like a bodyweight exercise. Yes, okay, possibly right at the beginning of bodyweight exercise may help. But if you think about what I said before, the stress, recovery, adaptation, there’s not enough stress from lifting your legs off the floor doing pilates to give you substantial stress and then recovery. And as I said, each time you train, you need to increase the stress. Your legs don’t suddenly get heavier every single week. Reaction and then recovery. You need to be, as I said, pushing the envelope day after day, week after week, and it’s up to you how much you increase it by each time you attend.
Now, there is a thought that if you lift at all, really you’re going to hurt your back. But if you think about it, most of the people that you know that have hurt their backs, they have not hurt their backs by doing something like a squat or a deadlift. Nine times out of 10, they have done something like put on a coat, tie their shoe, fall over, be in an accident. Because if you don’t train your back, it is weak. You don’t have some sort of magical man or magical woman’s strength that you have a strong back. If you don’t do anything with it, it’s shitty. It’s weak and weak things break.
Just the same way that you might have learned French when you’re at school to GCSE, you are not good at French. Everyone might say, “Oh yeah, I learned French.” You aren’t good at French, you know no French. If I put you in France, you cannot have a conversation with anybody. You might be able to ask for some bread maybe. And the same with your back. If you haven’t been training your back consistently to get stronger, it is paper week. And this is going to cause you an issue because as we get older, things get weaker and weaker. Your back is your foundation and if you think about the foundation of a building, what you’re doing by lifting weight is putting more concrete into that foundation. And what you’re saying to me if you don’t want to lift is, “Oh, I don’t want to put any more concrete in the foundation of my building because something might go wrong.”
Well, I’m telling you this, if you don’t have a stronger back, something will go wrong. If you hurt your back doing something like a deadlift, and I’ve worked with many people who have come to me and said, “Oh, I don’t want to do deadlift because it’s going to hurt my back.” It’s because you did something stupid. The deadlift didn’t do anything. The deadlift is simply lifting a bar off the floor. If you lift the bar off like a moron because you haven’t taken the time to learn the technique or employed a coach, that’s your fault. That’s not the fault of the lift. The same way if you drive a car and you crash that car, you can’t just say, “Oh well the car made me crash.” No, you don’t know how to drive the car. You were speeding or you were texting.
Back exercises that you do at the gym with a barbell are safe. It’s the human element that makes a problem. A weight just sits there on the floor. It does nothing until we come along and move it, and if we move it with a poor movement pattern, we will hurt ourselves, fact. It doesn’t matter how heavy that bar is. There are people that can squat, let’s say 250 kilos because that weight is relatively heavy for them. They have done the work to get to that weight and they have a straight back and they have optimal mobility to do that. However, there are people that squat 40 kilos and fuck their back because they have a weak back and they just jumped in at that weight. They thought about, “When I was at school, I did X weight, I should be able to do that.”
To summarize, when it comes to rehab, the treatment and the stretching is to soothe the discomfort and the pain, but the strength training, the building of your back is there to stop you from hurting yourself again. If you only have the therapy, you may not have any symptoms but you still have that weakness. And I’m telling you now this, if you have had a back episode in the past and you haven’t done anything to resolve this, you might have seen a bit of the physio, you might have had some painkillers and now be asymptomatic. You are in for a rude awakening because you are going to have another back episode, and it may well be even worse than the first one you had, and if you’re over 50 you may never recover from that back injury. You may have a stick. You may, for the rest of your days, be on painkillers.