I’m a mega-proponent of strength training. It’s a major part of my life and it’s something I’ve always encouraged for my patients, family, and friends as a way to dramatically improve someone’s life.
That being said, strength training is an integral part of the treatment and prevention of musculoskeletal pain. There’s probably no condition in the world that has been widely attributed to a strength deficiency than lower back pain.
Got back pain? Must be those
- Weak glutes
- Weak transverse abdominus
- Weak multifidi
- Etc, etc
So now we have an entire world of fitness focused on preventing lower back pain by developing really intricate exercises to strengthen an unending list of muscles connected to the back.
Are Weak Back Muscles Really The Cause of So Much Back Pain?
I do believe that being sedentary, and the general weakness and de-conditioning associated with a lack of movement does put people at risk for low back issues. After all, being sedentary and de-conditioned is basically a risk for just about everything.
However, I do think that we need to re-evaluate why so many active and relatively strong people throw their backs out doing really slight movements.
What do I mean by that?
For many of the patients that have come to my office for chronic back pain, their stories don’t usually feature an attempt to lift something that was extraordinarily heavy. It’s generally things like:
- I was reaching to grab my phone when I heard a pop
- I was rolling out of bed when I felt something seize up
- I was bending over to pick up a pillow when my back went out
Plus these people aren’t necessarily weak. These are people who can deadlift 400+ lbs or spend their day as construction workers lifting heavy things every day. I can promise you that these individuals did not have weak glutes.
So what might have happened?
The Principle of Coordination
All of the strength in the world is useless when the body is not prepared to make use of it.
Have you ever been to a bowling alley and picked up the wrong ball by accident? It’s a strange feeling. You may be accustomed to picking up a 9 lb ball, but the ball next to it was the same same color and shape but it weighed 14 lbs.
So you went to pick the ball up with the amount of force that you expected to easily lift the 9 lb ball, but your arm moves slower and you have to catch yourself for a second before reaching down and grabbing the correct ball.
Even though you are plenty strong enough to lift a 15 lb object without any problems, you were thrown off because your brain made a calculation wasn’t appropriate for the lift it was about to perform.
This takes a coordinated effort for your brain to tell your muscles to use the correct amount of force with the right timing in order to make lifting an object feel more effortless. It’s a really neat system when it works properly!
But if you didn’t know how much something weighed, and you went in without expectation, you would probably take a conscious effort to over-prepare your body to lift an object up so you wouldn’t be caught off guard. Your brain has plans and contingency plans for when it encouters an unknown situation.
So what does this have to do with your bad back? Your back is different from most of the other muscles in your body in that it is a muscle group that is almost always on. Your arm and shoulders don’t get used unless you need to perform a task. Your legs are always on when you’re standing, but they can be rested when you are sitting. Your spinal muscles only get a rest if you are laying down, which is a small chunk of the day for most.
This is an important concept because our spine has to move for just about everything. Even when you are lifting your arm or your leg, your brain is sending messages to your spinal muscles on how to move your spine to accurately perform an arm/leg movement.
When Coordination Fails
So we know that the spine is always on, and even when you are just trying to move any body part alone, your brain is still getting your spine prepared to brace or move in concert with other limb movements.
There is a lot of coordination that has to happen with this, and sometimes there are just moments in time where coordination will fail, and injury can occur in those small windows.
It wasn’t just an issue of being weak. It was an issue of timing that one part of your muscular system didn’t create a good enough response to protect the parts of your spine that may generate pain.
This doesn’t mean that you’re broken. It doesn’t mean that you need fixing. It means that when you’re active and putting your body under a steady dose of mechanical stress through exercise, sometimes things may get hurt.
It’s okay! Your body can heal, get better, and improve with time, especially when you have good alignment, flexibility, mobility, and appropriate rest.
Can Coordination Improve?
There are a number of things people can do to improve the coordination of your spine and nervous system. It involves making your spine more adaptable. So how can we improve our adaptability?
- Respect your alignment and biomechanics. You don’t have to be obsessed about it, but dysfunctional spinal joints from structural shifting of the spine can decrease neurological coordination
- Expose your body to different loading patterns. Perfect form in the gym is great, but your brain needs exposure to variation in movement so it knows how to deal with it in the future. Mix up your lifting and movement strategies
- Train on different surfaces – You won’t always be on a nice flat gym surface when you have to lift something up. Perform movements and exercise on different surfaces to allow for your nervous system to adapt
- Do reaction time training – reaction time training or rhythmic movements can train your body to work in different patterns and rhythms.