Help with Back Pain...Coach, Ido, Dr.G and others

[Scott Kane]

1. Should I take a break from static holds?

2. Should I do even more prehab/rehab/stretching?

3. Is 5 minutes daily of inversion therapy enough?

4. Are there exercises I should be doing when inverted?

5. What have you found to be beneficial for gymnasts (or other athletes) with back pain?

6. What else can I do?

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Stats:

Age: 30

Height: 5'9"

Weight: ~175

Body fat: 7-8%

Strength level:

-Adv Tuck Planche (2 sec Straddle)

-Straddle Front Lever

-Full Back Lever

-Dip BW + ~150lb

-Pull up BW + ~100lb

-Squat 315 (~ 1yr ago)

-Deadlift 425 (~1yr ago)

I haven't been doing much weighted leg work recently to avoid spinal compression. Though I believe the shear stress from straight/extended body static work may be causing my current problems. I am having some disc flare ups. My back "catches" when I rise from prolonged sitting, usually at the point where the knees are fully extended and the trunk is extending at the hips to an upright posture (think top of deadlift). I wake up quite stiff. I'm afraid to sneeze. If I take a misstep (like from walking in the dark) the jarring causes pain. Oddly enough, I don't tend to have much pain during my workouts. I guess this could be attributed to better body awareness and bracing, maybe even endorphins to an extent. Anyway, I'm pretty fed up...if you haven't figured that out already.

Background:

In 2004 I suffered a vertebral fracture at the pars (spondylolysis). For obvious reasons, my back has never been 100% since. I have invested quite a bit of time and money trying to keep my back as healthy and stable as possible. This is what eventually led me to Gymnastic Bodies through CrossFit.

I have been performing a basic strength routine 3-4x per week as outlined in "Building the Gymnastic Body" for the past year or so, which is very similar to that of ortprod. Prior to the release of Coach Sommer's book, I was still doing mainly bodyweight workouts with some weight training for legs (squat, deadlift, etc.) and some CrossFit thrown in for variety. I have been working the static holds for the past 2 yrs on and off, and consistently for the about the last year.

This brings me to my dilemma. It seems that I am developing some disc issues in my lower back. This is to be expected given my spondylolisthesis (slipping of one vertebrae over another) at the level of L5-S1. On X-rays and MRI's taken ~4-5 yrs ago disc dessication with associated narrowing of the intervertebral space was noted. Lots of this I believe is an inflammatory response to the stresses I put on my spine.

I am very careful to perform a thorough warm up prior to any exercise with particular attention to my spine, hips, and hamstrings. I usually warm up with the following yoga inspired series:

-Cat>Cow x10:not really pushing the limits of my flexibility, just trying to floss the nerves through the foramens

-Prayer pose>Downward facing dog x5:hold each pose for 5 breaths

Sometimes I follow this up with:

-DB swings (KB swings) ~1-2min to loosen up my hips

I then move on to basic mobility drills:

-Neck, arm, shoulder, wrist, feet, hip, etc circles

-Leg swings (being sure to use my active flexibility rather than just flailing around)

Finally I'll get into a basic pre-strength warm up:

-Push x10

-Pull x10

-Overhead squat x10

-Stiff legged deadlift x10

At the end of my workouts I perform one of the following prehab/rehab routines:

-2x10 Jefferson curls (for back strength/flexibility)

-3x10 Hip extensions (for hip strength/flexibility)

-2x30s Weighted pike stretches (for hamstring flexibility)

Then I finish up with:

-5 minutes of inversion (antigravity boots hooked to pull up bar)

I take 2 Tbsp Carlson fish oil religiously (to help fight inflammation and for overall health benefits)

-4800mg DHA

-3000mg EPA

I also take Utrition Liquid Joint Repair:

-60mg Vit C

-2000mg Glucosamine Sulfate

-1200mg Chondroitin Sulfate

-500mg MSM

-50mg Collagen

I have even purchased a Sealy Posturepedic mattress just to be sure my back is well supported when I sleep.

[Coach Sommer]

Anything that causes pain should be discontinued; immediately.

If this includes lever and planche variations, then so be it. The reality of the situation is that your back has been severely injured and may or may not ever regain full functionality. In my opinion, you may also want to consider drastically reducing the the weight you use for overhead squats, squats and deadlifts or even discontinuing them altogether as these movements directly compress the spine.

My recommendation is that until you are able to resolve the lower back issues, continue make increasing upper body strength your primary focus and broaden your repetoire beyond simple pullups and dips. Gymnastics strength elements may be particularly advantageous for you in this regard as many of them actively decompress the spine.

Yours in Fitness,

Coach Sommer

[Blairbob]

I like to do these in my WU and at the start of my day when I get into the gym.

I get up on my rings and do straddle swings which loosen up my lower back as well as my hips. If I don't have enough clearance, I tuck my legs and I look some sort of monkey on the rings. Looks funny, but loosens my back up.

Besides those, I do hip circle similar to the action of doing bucket circles. Quite often this pops and loosens a lot of things in my lower back. I do these in both directions. It's also good for loosening up my shoulder girdle and neck.

Bring out the foam roller besides doing lying windshield wipers. I do many of the movements that are in the PM warmup video on PerformanceMenu about a month ago. This also includes deck squat to candlestick to basket to loosen up what I think are the extensors and erectors in my back. I do seal stretch but many people with lower back issues opt to skip this stretch which makes sense.

As for me, I'm just tight period. Chiropractors notice that I'm just wound up tight in general and I've been this way a long time, probably from strength training. It takes a bit to loosen me up but it all depends on how active I've been.

I try to do my loosening back stuff before I coach and periodically since while spotting the little guys and kids is easy, it's spotting the tweenagers and high schoolers and adults that can put a lot of load on my back ( typically tumbling classes though spotting on bars gets to it as well ).

[Jason Stein]

Scott,

Back pain is the worst.

It might be helpful to include with your joint drills a direct hip flexor stretch, perhaps after the hip extensions. Specifically, tight psoas muscles can exert a tremendous pull on the vertebrae.

regards,

jason

[Joshua Naterman]

All of these are good suggestions. There is one thing that no one is thinking of, and that is forcing relaxation of the vertebral musculature. Nothing suggested here, from inversion to the variety of excellent and useful exercises, accomplishes this, and you are going to need to force relaxation if you want to get rid of the pain. More than inflammation, what is happening is microcramps. Your body recognizes it has an injury and is seizing up to prevent vertebral movement. It's a safety mechanism that causes a lot of people a lot of pain. In the moment, your body has two choices. It either relaxes and lets your spine slip, which will obviously screw you up permanently, or it seizes up, holding the bones rigidly in place and placing all stress on the small soft-tissue support structures around the bones. This is a survival mechanism, and it usually happens in a single moment when your body thinks it is going to suffer severe injury if it doesn't seize up. It can start off small and progressively become more painful as the seized tissue responds to the increased stress by becoming inflamed. What you need to do is tell it that it is ok to relax, so your body can go back to functioning normally. Here's how you do this.

Step 1: find a chair, couch, or other object/stack of objects that keeps your tibia at a 90 degree angle to your femur when you are lying on your back. It needs to support your lower leg from the knee joint down to the heels.

Step 2: Lay on the floor, face up, arms at a 45 degree angle from your body like a wide ring support, palms up. Lift your legs and place your lower legs onto the object from step 1. You should now be flat on your back, upper legs perpendicular to the floor, lower legs parallel to the floor. ALL the weight from your legs should be supported by the object from step 1. If you are using your leg muscles to maintain the leg position, this will not work. Stack more stuff up until you can completely relax. This is going to feel a bit weird, but good. You may want to fold a small towel under your lower back if you cannot flatten it out on the ground. COngratulations, you are in position!

Step 3: Breathe in deeply, stomach first and then chest. Hold it for a few seconds, focusing on relaxing your lower back into the ground. Your hip bones, and your entire spinal column all the way up to the neck, should be on the ground. This may not happen right away, so be patient. Let your breath out slowly, and concentrate on sinking to the floor. If that is too much, put the towel under your back and sink into it. When you can do that no problem and it doesn't feel funny, make the towel smaller, and eventually take it away so you are down on the floor. It may be a progressive thing for you, I don't know. It was for me.

Hold for up to 5 minutes, 1-3 times a day. More than 5 minutes at a time won't do anything for you. You may also want to follow this up with a similar maneuver, where yo have one leg supported at a time, with the unsupported leg on the ground. This helps release hip flexor tension. These are NOT stretches in the classical sense, these are to teach your body that it is safe and ok to relax again. This is the key to getting rid of pain. All the drugs and stretching in the world can't do this. Having said that, there are a lot of really good stretches and exercises that have been mentioned. Please take advantage of them! Let the pain guide you. You should do these relaxation techniques for at least a month, preferably forever. It's not much time out of your day, maybe 10-20 minutes, and while at first the relief will be temporary it will quickly turn into permanent pain relief. In the meantime, don't be afraid of the ibuprofin, it can only help the inflammation that is there. You can fix this my man, don't worry! There is a book that goes into more detail on this, it is called Pain Free, and it is by Pete Egoscue. I used this book to permanently fix a huge, huge, huge number of issues that I had. He has physical therapy clinics using his methods all over the country, and they have a 95% success ratio. The people who don't get rid of the pain are people who didn't stick to the plan. It's really simple, makes a lot of sense, and it works.

When I found this I had horrible back pain from an old back injury, compression fracture t6-t7. And then I started getting foot and knee pain. i was getting ready for buds, navy seal training, and my body just started breaking down. 3 weeks later I felt like a new man. I never would have made it without that book, and I wholeheartedly recommend that everyone here who has pain check it out. It explains a lot of chronic injuries that are hard to diagnose, from how they happen to how you fix them. It is easy and fun to read, and you'll learn a lot about how injuries in one place affect the function of completely different body parts. For example, why knee and back pain tends to start with an ankle injury. It's fascinating, and it will really change the way you view injury and treatment. I haven't had an injury in years that I haven't been able to take care of in a few weeks time, and this stuff helped me recover from nerve damage and I am currently making steady progress with my right shoulder problems as well.

I wish you the best, and I hope you have as much success with this as I have. I really would read the book, you may realize that something as simple as your walking gait is what is causing the pain, and the book will teach you how to retrain your body to use the right muscles for what it does, and to relax chronically seized muscles. That's what happened to me. It took about three weeks to retrain my muscles, and I didn't have to stop my workouts to do it. I got better on an almost daily basis. Don't give up hope man! I was lucky to get better so fast, but trust me, you will be feel lot better than you are feeling now!

Here is a link : http://www.amazon.com/Pain-Free-Revolutionary-Stopping-Chronic/dp/0553379887/ref=sr_1_1?ie=UTF8&s=books&qid=1245545603&sr=8-1

and here is the newest testimonial on Amazon from a buyer:

I must add my endorsement to those of others. Last summer, after two back operations, and hundreds of hours of physical therapy, and facing the prospect of beginning school in chronic pain that required me to lie down for several hours a day, I saw Mr. Egoscue's book. I tried the exercises, doing them exactly as he instructs. Within a few weeks, I noticed significant improvement, and not only in my back, but in chronic knee and shoulder problems. I kept up with the exercises, and, after about six months, I found I could do things I hadn 't been able to do for over ten years--like swim, lift weights, ride a bike. . . I'm not completely pain-free, but I credit the exercises in this book for returning me to about 80% normal. I continue to do the maintenance exercises daily. I'm completely convinced by Mr. Egoscue, and this is after trying conventional medicine and every alternative in the books and quite a few not in the books. His approach works far more effectively than anything else I've tried, from surgery to herbs. I recommended it to a friend who called me one morning in severe back pain--two weeks later she, too, was calling it a miracle. I'm in danger of becoming a bore at parties, because whenever I hear anyone with any kind of chronic musculoskeletal problem I spend about half an hour extolling the virtues of Mr. Egoscue's method. It works!

[Joshua Naterman]

The forward to the book is by Jack Nicklaus, the PGA golfing legend. Check it out. This isn't a quack book.

[Jason Stein]

Friend,

Regarding "forced relaxation," please see my post immediately preceding yours. There is an astounding depth and breadth of postures designed to encourage relaxation. Scott can select and incorporate one most intelligently with his current practices.

best,

jason

[Scott Kane]

Anyone else aggravate back problems with the levers? Planche?

Scott,

Back pain is the worst.

It might be helpful to include with your joint drills a direct hip flexor stretch, perhaps after the hip extensions. Specifically, tight psoas muscles can exert a tremendous pull on the vertebrae.

regards,

jason

I actually do a deep lunge/warrior pose following the yoga warm up. Forgot to mention that. I also do some holds at the bottom of a squat and lateral lunges during the mobility phase.

I like to do these in my WU and at the start of my day when I get into the gym.

I get up on my rings and do straddle swings which loosen up my lower back as well as my hips. If I don't have enough clearance, I tuck my legs and I look some sort of monkey on the rings. Looks funny, but loosens my back up.

Besides those, I do hip circle similar to the action of doing bucket circles. Quite often this pops and loosens a lot of things in my lower back. I do these in both directions. It's also good for loosening up my shoulder girdle and neck.

Could you provide more detail on these two movements? For the straddle swing, is it like pumping your legs on a swing set but in straddle or is it like a straddle kip? For the hip circles, do you just hang and do a hula type movement to get your legs/feet going in circles?

Anything that causes pain should be discontinued; immediately.

If this includes lever and planche variations, then so be it. The reality of the situation is that your back has been severely injured and may or may not ever regain full functionality. In my opinion, you may also want to consider drastically reducing the the weight you use for overhead squats, squats and deadlifts or even discontinuing them altogether as these movements directly compress the spine.

My recommendation is that until you are able to resolve the lower back issues, continue make increasing upper body strength your primary focus and broaden your repetoire beyond simple pullups and dips. Gymnastics strength elements may be particularly advantageous for you in this regard as many of them actively decompress the spine.

Yours in Fitness,

Coach Sommer

Just for clarity, I do not currently do any heavily loaded leg work. The most recent loads have been 95lb overhead squats and 158lb thick bar deadlifts. I have been doing inverted squats (using the inversion boots), deck squats, and single leg squats. For upper body, I do things like Elevated (2-3") HeSPU, Bulgarian Dips, XR Pseudo Planch Push Ups (lifting feet up at bottom of movement), L-sit Chin Ups, Adv Tuck Front Lever Rows, Inverted Chins, Tick Tocks, HeS Reverse Leg Lifts. I also do L-sits, and Straddle L-sits. I can also perform Tuck Press HS and Straddle Press HS both with slightly bent arms.

What exercises and/or static holds do you have your athletes avoid if they are having back issues similar to mine? Which exercises would you suggest I try to "actively decompress the spine"?

slizzardman thanks for the recommendations. I'll definitely check out that book.

[JaredLLL]

One thing to note when dealing with joint pain and muscle cramping at the same time is that you will often find that its never just a single muscle that is doing all the work ( damage). An effective ART guy can help pick apart all your little problems which are helping to contribute to your condition. They are extremely useful in letting your muscles relax to where you can be successful with your own self treatment (stretching and such).

That said, work on stretching virtually every muscle about your hip/spine/neck, rather then looking for a single tight muscle. Do not however confuse what Im saying with dealing with an individual muscle that is could be injured and is causing the protective tightening response. Tennis balls and foam rollers help with that in particular.

You can pretty much expect that EVERY muscle be responsible in some way shape or form for your problem. With that I offer you a useful stretch for your obliques and quadratus lumborum. This is for the Left side:Sit in a char with your legs spread apart for a solid base. With your right arm reach and grab the front left corner of the chair. Lean your body directly to the right while pulling your left arm up over your head. you should feel a very strong stretch from your LEFT obliques. Raising the arm will stretch your lats. If you lean forward a little from that position you will move the stretch towards your back, that will be your quadratus lumborum, as well as a little of your spinal erectors on the left side as well. To get out of the stretch use your left arm as a support on your right leg to put you upright. Resist using your stretched muscles directly if possible. Reverse for the right side.

Anyway, quadratus lumborum attaches along the back of your ribs to the back of your pelvis, and if its tight it will roll your pelvis forward, giving you an exaggerated lumbar curve, which can cause pain under under a variety of conditions. Coupled with a tight psoas ( hip flexor) and rectus femorus (quad muscle) can all help to roll that pelvis forward.

Good luck, and i hope this is helpful.

[Joshua Naterman]

I like this stretch! Thanks

[Jason Stein]

Scott,

There are tons of active, passive, PNF, forced relaxation, and isometric stretches for your QL, your psoas and your hip flexors, as well as the muscles in and around your back.

What's helpful about all the suggestions above are the principles behind them: as Coach Sommer said, the first priority is "Do no harm," meaning cease any activity that aggravates your back.

Second, my experience with back stuff has been that almost all of it works --- ALL of it, from passive stretching and acupuncture to ART and Rolfing/structural integration --- but only if you follow it consistently.

You seem to be pretty dialed as far as the structure and discipline of your practice goes --- those skills will help you sort out a routine for your back.

I won't bore you with the specifics of what worked for my back pain, but my strategy was consistent (in my case, daily), structured intelligently, and also had about 10 minutes built in for experimentation or "play." If anything, anything at all aggravated my back, I stopped immediately.

So I had a regimen I followed, but then I had time built in to mess around with anything I'd heard, read, or been told about. If a technique worked well, or better than something else I was doing, I adopted it.

I wish you the best. Back injuries are the worst.

best,

jason

[braindx]

Most lifters have some degree of herniation or bulging disks with 0 pain.

Thus, your goal is to make your body as strong as possible so the muscles take over instead of pressure on your joints. Given your history it's probably a good idea to stick with bodyweight exercises for now + the other stuff in this thread about loosening everything up then making everything stronger.

As Coach Sommer said... pain is a no-no. Don't do anything with pain.

[Scott Kane]

Scott,

I won't bore you with the specifics of what worked for my back pain, but my strategy was consistent (in my case, daily), structured intelligently, and also had about 10 minutes built in for experimentation or "play." If anything, anything at all aggravated my back, I stopped immediately.

Actually, I'd like to be "bored"... What was the cause of your back pain? What did you do specifically? How long before you saw results?

What is everyone's thought of the levers? I will discontinue them for a month or so to see if there are noticeable improvements in my back pain. I'm thinking since the spine is built mainly for handling compressive forces, the extreme amount of shear force on my lower back coupled with the fact that my lower back is intrinsically unstable doesn't sound like a good combination.

Most lifters have some degree of herniation or bulging disks with 0 pain.

Thus, your goal is to make your body as strong as possible so the muscles take over instead of pressure on your joints. Given your history it's probably a good idea to stick with bodyweight exercises for now + the other stuff in this thread about loosening everything up then making everything stronger.

As Coach Sommer said... pain is a no-no. Don't do anything with pain.

That's the frustrating thing, I turned to gymnastics and bodyweight training in an attempt to bulletproof my core. It seemed to me that the levers were just much harder variations of the planks and side planks done as physical therapy. Any suggestions on a compromise between the floor planks and levers for building straight body strength. Should I just do prolonged plank holds? Afterall, shouldn't stabilizing my lower back be a priority? Stuart McGill claims that endurance is more important to long term spine health than is absolute strength. Agree? Disagree?

[braindx]

That's the frustrating thing, I turned to gymnastics and bodyweight training in an attempt to bulletproof my core. It seemed to me that the levers were just much harder variations of the planks and side planks done as physical therapy. Any suggestions on a compromise between the floor planks and levers for building straight body strength. Should I just do prolonged plank holds? Afterall, shouldn't stabilizing my lower back be a priority? Stuart McGill claims that endurance is more important to long term spine health than is absolute strength. Agree? Disagree?

I definitely agree but the fact of the matter is that high strength increases the ability for high endurance with a bit of work.

Like the powerlifters example... if you can deadlift 600+ lbs you obviously have the core stability to support your own body.

Then again, your problems may be beyond this so I don't know.

[Joshua Naterman]

I would personally do the hardest things that don't make me hurt. It's not worth it if it decreases the quality of your life. It doesn't take THAT much strength to stabilize your spine, but between the planks and the levers you should be fine. You may want to stick with flat tucks to keep the stress off of your lower back.

[Garrett Smith]

Work on your posture:

http://www.egwellness.com

Start doing these exercises once a day, maybe in the morning after you've been awake and moving around 30+ min.:

http://www.menshealth.com/cda/article.do?site=MensHealth&channel=fitness&category=muscle.building&topic=back&conitem=d6f999edbbbd201099edbbbd2010cfe793cd____

[Joshua Naterman]

The book under the posture link looks really good, you may want to check that out. I'm pretty sure you're already doing everything from the men's health page, but check it anyways.

[Jason Stein]

Scott,

Fortunately, I didn't suffer trauma; rather, my injury (as with most non-traumatic performance injuries) was the result of two confounding minor injuries, and then one catastrophic.

None of them alone would normally have been enough to cause any serious injury, but together ...

In my case, it was an advanced yoga backbending posture, an advanced yoga forward bending posture --- so extreme flexion, extreme extension --- and then I had embarked on a high-frequency deadlifting program.

The weight of the DLs wasn't a problem --- but coupled with the other stuff, I had a DL session and my back felt tweaky. I ignored it, and then after the next DL session, I could no longer fold forward, get in and out of a car, or even look down.

As we say in yoga, in this instance my ambition overtook my perception, and I suffered the consequences.

Unlike what Kelly Starrett at Xfit would have you believe, for back injuries, I believe it's ideal to take a chunk of time off for total rest.

I took 7 days completely off anything and everything. Total rest.

My experience is that if one is practicing sequences of weighted, full-body, multi-joint, complex movements --- often for time or AMRAP --- it's incredibly difficult to isolate the specific and unique movements that may be traumatizing your back. Especially in a blaze of competitive endorphins.

In fact, continued activation of certain muscle groups in some of the movements may not be injuring your back --- they may simply prevent the healing process.

I personally found squatting, even unweighted, made my back feel like shit. That said, for some reason (black box, here we go) pistols and KB swings made my back feel great. I also did the "death stretch," which is like warrior pose, one leg forward, back shin up the wall.

Maybe 6 to 8 weeks total recovery time?

Don't know if this is helpful. You already have the tools to figure out a routine, you have the discipline to stick to it. Resources permitting, you might try a two-pronged approach, with a daily sequence of postures/exercises coupled with acupuncture, ART, or structural integration/Rolfing sessions. Any and all of them work --- as long as you do them.

best,

jason

[Scott Kane]

Start doing these exercises once a day, maybe in the morning after you've been awake and moving around 30+ min.:

http://www.menshealth.com/cda/article.do?site=MensHealth&channel=fitness&category=muscle.building&topic=back&conitem=d6f999edbbbd201099edbbbd2010cfe793cd____

These are straight from Stuart McGill's work. He calls the curl, bird dog, and side plank the Big Three. The cat-cow is used to loosen up the spine and "floss" the nerve roots as he says. I perform them before every workout with the addition of a front and reverse plank and the subtraction of the abdominal curl/crunch. I figured the front plank was the same as the abdominal curl/crunch so I just switched them out. I guess I should do these every day and not just on workout days 3-4/week.

I have seen that book, checked it out actually. I never did read it all because most of the stuff seemed self-explanatory. Maybe worth checking out again and actually reading it this time.

[Joshua Naterman]

I should check it out too, I haven't read it. Always good to keep up! Don't go for too much volume with your rehab work, remember that you're making yourself healthy, not working out It's hard not to go all out when you exercise if you're used to going all out, at least for me.

[Blairbob]

Scott, the straddle swings on rings look like a straddle swing on pommel horse except that you are in a hang and not a support.

http://drillsandskills.com/images/display?path=phz001a.mpg

Hip circles from a hang are much like doing hip circles in hula-hooping or standing hip circles where you circle your hips around similar to hula hooping. This can loosen up my spine a bit, but not like foam rolling and the straddle swings and hip circles on rings.

There are a few stretches in the PerformanceMenu warmup http://performancemenu.com/wod/video/CAStandardWarmup.mov

I also do some yoga snaking in my back. It looks pretty funny so I do it when no one is around as it looks like I'm humping the floor. It's worth a few pops in my back though that feel splendid.