Countless people suffer unnecessarily with lower back pain.
I’m not going to recount endless statistics about it, because for one – you’ve already heard them. Two, if you’re suffering with back pain it often feels pretty lonely. There’s no real comfort in numbers or in being a statistic.
As personal trainers, or coaches, or however we’re perceived by the wider public, we very often meet with resistance to that opening line. A shake of the head. An exhortation that the person has tried EVERYTHING. A resenting of the implication that maybe they haven’t tried everything, and that they could be pain free had they looked a little deeper.
But, sadly, that last point rings so, so true.
We’ve seen well over 500 clients at Real World Fitness over the last 6 or 7 years. Most people come to us with issues about their body image, their movement ability, or pain/discomfort. By the time they get to us, especially regarding pain management, we’re their last resort.
The thing is, strengthening your body and improving your flexibility shouldn’t be the last resort. It should often be the first or second thing you try (once you’ve ruled out, or taken advice on, damaged body parts!).
Regardless of why people come to us, guess what we hear in 9/10 new client consultations?
Some version of: “Oh, by the way, I should tell you that I have a bad lower back and my knees aren’t great either”.
There are some very obvious things that contribute to back pain. Being significantly overweight. Adding a significant amount of weight in a short timescale, before your body has had a chance to ‘catch-up’. Which, incidentally, amongst other reasons, is why many pregnant women get bad backs.
Time and time again, though, we manage to eradicate the ‘bad back’ within weeks.
I know that is a bold statement.
But it’s true. I can give you countless examples. Weeks into a new training scheme and some simple changes to movement patterns, we often get the “do you know what? My back hasn’t twinged in ages”. Or, “I can do my shoelaces up now and it took me by surprise”.
One client we worked with was a little more chronic than most, but he saw drastic improvement –despite being a sceptic! – in weeks. He went from struggling to get involved with his kids activities, to taking up karate in just over a year.
Another recent example is a woman who was at the point of accepting an operation to fuse two discs. It was her last resort, until a friend of hers said to come and see us. She was nervous, didn’t hold out any hope and was polite but sceptical.
She was a tough case. We helped build her strength up from such a low base, it was a wonder she didn’t have a myriad of issues – let alone a painful back. She was living on painkillers. Proper, prescribed painkillers. Taking days off work with agonising pain.
Now, her change didn’t happen overnight. But it did happen in just six months. She ended up being able to stick a backpack on her back, and trek in Peru for a week. Pain and painkiller free.
So, how and why does this happen?
It’s a symptom of wider societal attitudes to exercise, strength and movement.
We just don’t move anymore.
We sit at home, we sit in cars, then we sit at desks. Then we go home and sit some more.
It’s not just the sitting that causes it all. It’s the lack of movement in general, and the lack of the need to do any strenuous activity at all. When you don’t move, and you don’t actively target muscles that in a modern society don’t NEED to be exercised, you get problems.
Glutes. Hamstrings. Spinal erectors. They don’t strengthen by accident. Ever. They just get weaker, and weaker and weaker. Past the age of 30, you lose roughly 5% of your muscle mass per year – unless you do something to prevent it.
The loads that these muscles are supposed to support get transferred to smaller, far less capable muscles – and, in worse cases, the spine. The spine isn’t supposed to take your entire bodyweight. It’s supposed to give structure to your body, and be supported by an effective muscular system.
Time and time again, what we see is a body being forced to rely on small, ineffective muscles and joints that aren’t designed for that purpose. Eventually they pull, strain or spasm. When that happens, even MORE workload gets transferred to the remaining muscles, and adds to the unnecessary loads on overworked, under-supported joints. You can even create problems in areas of your body previously unaffected, as more distant resources are pulled into the battle.
We try to work closely with the client, with their medical team if appropriate, and pay attention to everything they tell us. The biggest thing is to inspire confidence that trying to strengthen the area, and loosen areas that are too tight, won’t make anything worse. That’s a big battle to overcome with any new client, let alone someone coming from a history of debilitating back pain.
Many times, we have to work with competing advice – many occasions we’ve seen clients who ABSOLUTELY need to strengthen, yet have been told by GPs to just rest. Given that most rest is in a seated position – you can see how this just adds to the problem.
So how DO you tackle the issue? It’s far too complicated, and far too individual, to give a blanket fix-all solution. Same with a length of time to see improvement. But, we’ve yet to fail at helping anyone who’s come through our door with back pain. We’ve yet to take longer than 3 or 4 months to see a marked improvement.
We target, typically, the glutes and hamstrings. By far the biggest cause of lower back pain, that we see, is the result of glutes that simply do not successfully load bear, and hamstrings that are incredibly weak compared to quads. This means that the natural tendency to rely on your anterior chain, rather than your posterior chain, simply becomes exaggerated and adds to the problem. We aim to at least introduce parity of strength; ideally, to eventually make the posterior chain STRONGER than the rest of the body – and this is what gets the results.
The difficulty with this solution is it’s, well, difficult! Not in theory, but in practice. The client has to actually work their socks off, and it requires more than 15 minutes a week, and takes longer than a couple of months. Is this why a physical solution, despite being so effective, is so frequently ignored and dismissed? In my experience, yes – it’s the necessity of instant results and instant relief that means many people just won’t stick at a proven solution long enough to see the outcome that they are so desperate for.
If any of this rings true with you, get in touch with us. We can help.