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Why The Fear Of Low Back Pain Causes Low Back Pain

By Coach Joe Zambito


Back pain is a widespread epidemic that will affect nearly everyone at some point in their lives. What makes matters worse is that back pain is a complicated diagnosis, and oftentimes requires a very skilled coach or doctor to actually figure out what is going on. Unfortunately, most people who go to their general practitioner for their back pain will just get an MRI, be given pain meds, be told not to lift anything over 20 pounds, and to rest until symptoms go away. This treatment plan more often than not just provides a Band-Aid for the problem.

Soon after the individual returns to work, or the athlete returns to activity, the symptoms they were dealing with will come right back, because they did not actually get to the root of the problem. This leads to a vicious cycle of doctors’ visits and misinformation. Your back has the ability to be an amazingly strong and durable structure if trained properly, but if you treat your back like a delicate structure that can break at any moment, then that is exactly what it will be.





Your spine is divided into three main sections of vertebrae. Your cervical spine makes up the top seven vertebrae of your neck. Your middle back, also called your thoracic spine, consists of the twelve vertebrae that connect to your ribs. The lumbar section includes the lowest five vertebrae in your spine, which are not fused together. In between each of these bones are shock absorbing discs made of collagen called your intervertebral discs. Holding this all together are muscles, tendons, and ligaments that attach your vertebrae to each other and to different areas of the body. Finally, you have nerves and blood vessels that run through and around the spine that act as information centers and provide nutrients to the different structures of the spine. While this is a very simplistic description of the structures in your spine, it will be sufficient enough for this article.


People often worry about injuring their backs while performing certain movements in the gym, such as heavy deadlifts for squats, because they place a great stress on the back. However, this type of stress is not one that should be avoided at all costs. Stress is how structures in your body grow and get stronger. All of the structures in your spine have the ability to adapt and get stronger with training. Placing heavy loads on your spine will cause microfractures to happen in the vertebrae that make up your spine (Horschig, Sonthana, 2016). While this may sound like a bad thing, what actually happens is this stress tells your bone to become thicker and stronger. This is actually the reason why weightlifting can reduce or even reverse symptoms of osteoporosis because this happens with all of the bones in your body, not just your spine. The outer portion of your intervertebral discs in your spine are made of collagen which is the same structure that makes up your tendons and ligaments throughout your body (Horschig, Sonthana, 2016). The stress of exercise can also cause all of these structures to become stronger.Just like sprinting and other plyometric training can stress the tendons and ligaments in your ankles, knees and hips, heavy weight training can do the same thing for the connective tissue in your back. This stress will cause them to adapt and become more resilient over time. As a very strong man named Louie Simmons once said, “Weak things break.” I have never seen a situation where having a weak structure in the body has led to less pain and better function.


Having weak bones or weak collagen in your back are not the only things that can cause back pain. Movement dysfunction and instability are two common areas that often cause pain, and could even be doing so without any evidence of structural damage in your back. Movement dysfunction often happens because people have not learned how to actually load their hips and perform proper hip hinging motion. So instead of bending at their hips and loading their hamstrings and glutes to pick something up off the ground, they perform hundreds to thousands of flexion movements at their back. Your back has only a certain amount of tolerance for this rounding before it starts to cause pain, and doing it under load can decrease the amount that you can tolerate. Over time, it can wear away at the collagen discs in your spine and cause a bulging disc, but pain can start long before that happens. The inability to actively stabilize your body during movement also has the ability to cause pain. If your body is not stable within a specific range of motion it will either make you too tight or stiff to get into that range of motion, or will cause you pain to make sure you stay out of that range. This is why learning how to properly brace and create maximum stiffness while your spine is under load is very important. Over time this poor stiffness can lead to joint degradation, but pain can start before any structural damage is present. Pain does not automatically mean that there is structural damage in your back, or in other places in your body. We have to redefine our relationship with pain, and realize that your body is trying to tell you something through pain. It could be improper movement, a lack of stiffness or mobility in a joint, or possibly structural damage.


While structural damage can cause pain, there is evidence to show that it does not have too. In fact, people can have a bulging or herniated disc in their back and never know it. It has been shown that about a third of 20 year olds have a bulging disc in their spine (Horschig, 2016). That percentage can increase by ten percent for every decade older the individual is, so almost half the population between ages 40-50 have a bulging disc without any symptoms of pain (Horschig, 2016). The opposite end of the spectrum is also true in the sense that you can develop symptoms without any evidence of structural damage. In a study from 2006 that followed 200 people for five years through MRIs, a whopping 84 percent of those who developed low back pain over the course of the study had no structural difference shown in their MRIs (Carragee, Alamin, Cheng, Franklin,van den Haak, Hurwitz). Over time, herniated discs can become asymptomatic on their own through your body's natural immune response, or the reabsorption of the water that is in the disc (Health). So, having a herniated disc is not a kiss of death like it is made out to be.


I have worked with athletes who get worried when their back gets sore after training. No one wants to be on the sideline because they hurt their back in the weight room, especially an athlete whose real love is playing their sport and not lifting. The idea of a low back injury can be a scary one. However, if you went through a really hard upper body workout and your shoulders were sore, or you did a tough lower body workout and you came back the next day and your quads and hamstrings were sore, no one would bat an eye, because it seems acceptable for these areas to be sore. While making the athlete sore is not the main goal of our workouts, it is a natural part of the process on the road to adaptation and growth. Putting the body through something it's never done before in order to elicit adaptation to the structure of the body does not come for free. Yet it seems like when this happens with someone's low back they freak out thinking they are hurt. It is believed that the muscular soreness that you feel is generally caused by damage done to the muscle and connective tissues of the body. We already discussed how this damage forces the athlete’s body to get stronger through proper recovery. Soreness is not the end of the world. It is a good indication that that area of the body is not one hundred percent recovered yet, and it should be monitored. If your low back is sore after a deadlift workout that is a sign that it is healing and adapting and getting stronger. This doesn’t mean you should crush yourself with another hard deadlift workout while your back is still sore, but it's not a reason to never deadlift again. If you don’t, then there is a high chance that you are leaving potential athleticism on the table. Recently, there has been a movement in the personal training world to never make a client or athlete sore. While, the goal should not be to put an individual through such a brutal workout that they cannot walk for a week, avoidance of muscle soreness at all costs probably means you are not pushing hard enough in the gym to get stronger and more fit. Soreness and discomfort is different from pain. If your back is in pain that is a different story. Then we need to look at your movement quality to figure out what is going wrong. The problem is most people don’t know how to distinguish the difference.


Low back pain is a complicated subject, and it does not have a one size fits all answer. However, a lot can be done in order to reduce the possibility of having pain or to reduce the intensity of it if injury does happen. The best place to do this is the gym with a qualified professional watching you. Weight training can develop the structural changes in your back in order to develop its resilience. Learning how to perform compound movements correctly, like the squat and deadlift, will provide you with movement competency that you need for your life, and to maximally develop your athletic potential. Part of this process is going to be for you to learn how to distinguish between the pain of injury and the pain of effort. Making yourself sore should not be the goal of a workout. Soreness does not directly correlate to an effective workout. However, it is going to be a natural part of the training process no matter what sport you do, or whatever your goals happen to be. Weight training is hard, and it is not all sunshine and roses, but avoidance of it altogether is not the answer. Learning how to lift correctly, and adapting is.



























References

Horschig, Aaron, and Kevin Sonthana. “What Causes Low Back Pain?” Squat University, 22 Aug. 2020, squatuniversity.com/2016/10/14/common-squat-injuries-low-back-pain-pt-2/.

Carragee E, Alamin T, Cheng I, Franklin T, van den Haak E, Hurwitz E. Are first-time episodes of serious LBP associated with new MRI findings? Spine J. 2006 Nov-Dec;6(6):624-35. doi: 10.1016/j.spinee.2006.03.005. Epub 2006 Oct 11. PMID: 17088193..

Health, Veritas. “Video: Can Herniated Discs Heal on Their Own?” Spine, www.spine-health.com/video/video-can-herniated-discs-heal-their-own.

Horschig, Aaron. “The Low Back Pain Epidemic.” Squat University, 22 Aug. 2020, squatuniversity.com/2016/10/07/common-squat-injuries-low-back-pain/.


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