How I Used Strength and Conditioning To Rehab My Back
I’m a Brazilian Jiu-Jitsu athlete. I’m not great at it yet ... but I show up.
I started in my late 20's after spending my early 20's getting unfit.
Like many people who train and compete in the grappling arts, I have to manage what some might call a ‘bad back'. It's just that I've got a fairly unique approach to it.
By way of background, I’m an Osteopath. I have undergraduate and Masters level studies in Osteopathy. I also have a Graduate Certificate in Higher Education (Teaching and Learning). Even though I’ve consulted over 10,000 times as an Osteopath. This is consulting with people about their pain. As I found out, there is NOTHING like having to fix your own back pain.
In this post I’ll share my story, I'll show you how you might be able to manage your back pain. Perhaps like me, use Strength and Conditioning to rehab your back. [Make sure you see my Big, Fat Disclaimer at the end of this post]
BRIEFLY ABOUT ME:
I went from a fit World Championship competitor in Karate and State level Soccer goal keeper, to become a sedentary full-time student. This study culminated in ending up as an over-worked Osteopathic manual therapist. A passionate one, none the less.
I first hurt my back as a teenager tearing a hamstring (grade 2 tear). This was not resolved by the well intentioned physiotherapist. He did no more than apply ultrasound at 6 follow up appointments. So on I went chasing my dream of playing ‘soccer’ (Football) in England. Season after season I would end up the same. In a steaming hot bath of epsom salts after every game. This was the only pain relief I could manage with my then limited knowledge of pain. The hamstring was “ok”, but that gnarly back pain coincided from that day forward.
Fast forward 17 years and into more back pain. I was the sole income provider for a young and growing family. My beautiful wife was running an amazing household for which I am still grateful for everyday. The household was reliant on me turning up to work. I work for myself and if I don’t turn up, I don’t get paid!
I took up Brazilian Jiu-Jitsu (BJJ) despite having back pain, a long history in other forms of martial arts. BJJ is a robust form of grappling. A martial art which requires entire body form and function at the highest level. This, after being a sedentary full time student for six years I was now full tilt back in training. BJJ is one of the few grappling arts in which you can train at 100% intensity every session as there is no striking. This means there is less bruising and thus less recovery time than a lot of impact based martial arts. Most Combative arts (Karate, Muay Thai, Boxing or MMA) often require their athletes to spar at sub optimal intensities. This is due to higher risks of impact injuries that lead to time off training.
ZING! Lightening bolt like sensations across my back woke me up at 2am. I had trained hard earlier that night at BJJ, nothing out of the ordinary. My back “spasmed”. It was a Tuesday, my longest consultation day at work back then. Panic set in. I couldn't move. I literally couldn't even roll over in bed. It was amazing at how many doomsday thoughts rushed through my mind. I can’t work, I can’t earn money, hell I can’t move! I’m useless. I can’t do this job, today or ever. How can I bend over the table at work all day treating people? Permanent, long term pictures of my life changing before my eyes. It was full on.
After a few minutes my rational brain kicked back in to gear. “A-Ha” I thought. This is what they mean when they describe acute low back pain at my consultations at the clinic.
I had experienced HEAPS of back pain (aches), but not THIS type of back pain. This was new, this was lighting my brain up like a christmas tree. This was intense!
I treat back pain for a living. I am an osteopath. Thats what we do.
I guess you could say that being sedentary and going straight into intense exercise isn't a great idea for your back’s integrity!
It turns out I had what's called ‘Internal Disc Disruption’ (IDD). This is one of the most common reasons for low back pain. Not disc ‘bulges’ or ‘pinched nerves’ as I explain in this other post (READ IT HERE).
Needless to say I called the local osteopath as soon as 8am rolled around. I half crawled and half crab walked to the car to get to the first available appointment. Three osteopaths, five consults over two weeks and I was upright, certainly not capable of running, grappling or working yet.
These fantastic manual therapists gave their all in the appointments. They were and still are my friends and colleagues. Beautiful, well intentioned, best care providers. But something was missing. All day, every day at home, not earning money, severe pain with minimal ‘homework’ from the osteopaths sent me around the twist. I still believe they thought because I was an osteopath I knew what, where and how of MY back pain. It’s different when its your own. I needed guidance and I wasn’t receiving it. It sent me back to my osteopathic training. Back to research. There had to be more we could offer as a profession.
And so I had to re-think everything about the way I moved. Re-think about the way I performed exercises and re-think about my advice to people in the clinic.
I went on a massive hunt for the best information. That hunt took me on a journey to the other side of the world (Thank you scientific literature and Google!). I studied many different approaches.
The good news is that not only did I learn how to manage my own back pain. I was also able to get my back stronger than before…and that’s what I’m here to help you with.
Here’s the no BS reality check. I still get some mild back pain from time to time. Infrequently. In fact, the last 2 episodes happened during Brazilian Jiu-Jitsu. Deadlifting, hang cleans, kettle bells and Brazilian Jiu-Jitsu are rotating on the daily agenda. Just to name a few crazy things, but none of these create pain anymore.
But before we do a ‘knee-jerk’ reaction and blame Brazilian Jiu-Jitsu for that intense back pain, (which even some experts will do), we have to ask smarter questions than that.
Here’s what happened real quick.
That night the pain set in, I was (yes back then as a blue belt in jiu jitsu) playing what we ‘Jiu-Jitero’ call “spider guard”. A position that, if not done correctly, can load the lumber spine into an enormous amount of flexion. Loading the discs in the low back and causing an insult to their internal integrity.
Over the next 24 hours the pain got worse. It moved from central back pain to radiating into my buttock. Fortunately for me, no further down the leg.
Based on my upgraded understanding of back pain, I was able to continue with Strength workouts without stopping. I actually used my weight lifting workouts to help rehab my back. This is once I had re organised my own approach to back pain. A few weeks in to my own terrifying experience.
Key Point 1
It wasn’t ‘Brazilian Jiu-Jitsu’ that caused the injury, it was me. It was poor form during a position I had entered in to by choice. This could’ve happened anywhere, in many different positions. Lot's of people blame exercise for injuries or pain because of the high repetition and volume of work. Which not only fatigues the person, but can also fatigue tendons, ligaments and bones. This can leave them more vulnerable to injury (e.g. fatigue fracture). The most interesting point here is that I was only using ‘spider guard’ in my second roll (bout) of the night. We often do 6 or 7 bouts. So it wasn't fatigue. It was form.
Key Point 2
I used more exercise (strength training) to eventually learn how to manage this episode. Over the following 3 weeks it all came good.
I know there will be those who’ll say, “You should have just opted out, you’re stupid for putting yourself at risk”. To which I would say, I would have also been at risk by resting and opting out … as I explain in another post here (READ IT HERE).
Does Strength and Conditioning training, including things like CrossFit Cause Injuries?
I understand why people ask this question, and yet I don’t think it’s a great question to ask. There are so many variables in Strength training and also CrossFit. So many variables within any given person, that the question doesn’t even make sense.
Maybe a more useful question is, ‘Do deadlifts cause back pain?’ or 'Do squats cause back pain?'…but even then, the answer starts with, ‘Well, it depends’…
The most sensible article I’ve read on this is with Dr. Stuart McGill…an expert worth paying attention too (Read that article here). The main point is that with any form of exercise, including CrossFit and Brazilian Jiu-Jitsu, when you are fatigued, your risk of injury is increased, and this leads to the one of the key messages of this post.
It’s the SPECIFIC way that you use your body that can lead to pain and injury, and the solution is to understand this pain message and modify how you move for pain-free, functional movement.
There has been a lot of talk about the incidence of injury in CrossFit, prompted partly by claims made by the National Strength and Conditioning Association (USA) in it's scientific journal. This controversy culminated in late 2015 with the NSCA publishing an erratum in their journal admitting that the injury rates that they'd published were falsely reported, (Read that article here)...there were actually less injuries.
The Difference Between Pain and Injury
Injury is damage. Muscle tears, ligament sprains and broken bones.
Pain is different. Pain is a sensation. Pain is produced by your brain in response to the “threat of damage”.
Most people don’t think about the last 2 points. Most think that injury and pain always go together.
That’s why, if they have pain they just assume that they’ve got an injury. This freaks them out, (it freaked me out!)...and they often stop training altogether...which can appear to be a wise action...but might not be.
I’d like you to think of pain differently. I want you to think of pain as a home alarm system. That alarm system is there to WARN you. An alarm system is useless if it only goes off AFTER you’ve been burgled.
The point of the alarm system is to get you to INVESTIGATE the problem so that you can PREVENT the burglary from happening.
It would be an under-reaction to hear the alarm and ignore it. That would be like having pain … even a niggle … and ignoring it, hoping it will go away.
On the other hand, it would be an overreaction to hear the alarm, freak out, sell the house and move away from the area. That would be like noticing some pain, freaking out and stopping your training.
The point of the pain is to cause you to INVESTIGATE the pain … to find out exactly what it’s trying to tell you. And one of the BEST places to investigate that pain is at training, in exercise, at CrossFit, at the gym or the academy, especially if that’s where the pain alarm gets triggered.
For example, if you only get pain when you squat with more than 80KG on the bar … then that’s one of the contexts in which your pain should be investigated. If you don't investigate the pain in context, you can miss the most important messages it has to offer.
Now, about your back pain at Strength work outs, even CrossFit.
Before we get to back pain, I need to tell you briefly about ‘sciatica’, because people get this confused all the time (even doctors).
If you have an electric-like pain zinging or shooting down your leg … on and off like an electric current … then that’s a type of nerve pain … and its name is Sciatica. But it has to be electric, on and off, like you’ve hit your funny bone, but much much worse.
If it’s not like this, if it’s aching and constant, then it’s not sciatica. It is called referred pain … and that is a different story.
If you have numbness (you can’t feel it when someone touches your skin) or you have weakness (you can’t lift your foot, or bend your hip or knee) … then that’s a loss of nerve function and you need to get this diagnosed ASAP. You don’t wanna muck around when it comes to nerve problems.
The Most Common Source of Back Pain?
As much as we can tell from the many studies available, the most common source of back pain is the intervertebral disc. I want you to think of this like a ‘ligament sprain’. These discs - or specialised ligaments - are what sit between each of your vertebrae and hold them together.
Now, when I say ‘disc’ I’m not talking about bulging discs or slipped discs. I’m talking about a specialised type of sprain on the inside of the disc, called 'Internal Disc Disruption', and it can become very painful when it's inflamed. The internal mechanism somewhat blows up like a puffer fish when its angry. This increase in size (often caused by inflammation) can change the mechanical loading pattern through that vertebral segment. Making you move funny.
Question: What happens when you squash a disc that is sprained and inflamed?
Answer: Your brain creates an alarming pain signal for you.
Question: What squashes your discs the most?
Answer: Loading your spine when it’s in a FLEXED position (e.g. when your lumbar spine - Lower back- is curved forward).
Question: What movements at CrossFit, weight lifting or Jiu-Jitsu load your lumbar spine in a flexed position?
Answer: It’s all about how YOU use your spine during those activities.
Here are some examples that I’ve experienced:
1. Deadlift
You should keep your back in a fixed neutral position during the lift, while you bend and straighten from your hips and knees. If you allow your lumbar spine to curve forward during the lift, you are loading it in a flexed position. This requires having hamstrings that allow you to tilt maintaining that neutral spine.
2. Squat
At the bottom of the squat, well past 90 deg, it’s common to see a person's pelvis tuck under (rotate backward), which pulls their lumbar spine into flexion … and of course, this is under the load of the squat. This is often referred to as a ‘butt-wink’. This is a movement fault. It needs correcting immediately.
If you’ve got a “butt-wink” when you squat, have someone teach you how to squat without it. It will require significant concentration to begin with, but is well worth the effort in the long run.
3. Hollow Rock
You’re lying on your back, curling into a sit-up, and reaching forward with both arms at the same time as you’re lifting both legs, rotating your pelvis backwards … all leading to a flexed lumbar spine that is loaded with the weight of your legs and upper body, and the compression caused by the contraction of your hip flexors.
Note: Some people have the opposite occur during this exercise. The pelvis rotates forward, and their lumbar spine arches. This can cause an ache too ... which is why you need to INVESTIGATE the pain in the context of your exercise so you can assess what's really going on.
It can be very helpful to have someone investigate this with you.
In each of these cases, a simple solution might be teaching the athlete to maintain their lumbar spine in a neutral position during the exercise, not letting their spine arch or curve forward, and then using these VERY EXERCISES to rehabilitate the athletes pain - as long as the movement pattern is corrected and is pain-free.
And that's one way to use strength training and or CrossFit for rehab.
Here’s a specific example.
I have, more than once, finished work as an osteopath, with back pain. Usually a result of bending all day lifting body parts as part of my manual therapy (often loading the lumber spine in flexion). I drive to the Jiu-Jitsu academy (sitting in fixed lumber flexion). As I get out of the car (loading into flexion) I think, here we go again! I used to panic. Now, armed with my pre-workout routine often wrestle at full speed or lift at full loads and feel WAY better when I finish then when I was on route to the gym. In all honesty I am still improving my daily habitual use of neutral spine in the workplace.
Before I start the workouts, I am usually able to eliminate the pain using a process known as 'centralisation', which you can read about in this post here (READ IT HERE).
After I centralize my pain, I then do the workout ... 3, 2, 1, GO!
Guess what happens when you do a deadlift while keeping your back in neutral? You’re not loading your spine in a flexed position.
And what happens if you squat while keeping your back in neutral? You’re not loading your spine in a flexed position.
And what happens when you clean the bar while keeping your back in neutral? You’re not loading your spine in a flexed position.
So, let’s go over this unusual situation:
1. I had pain at work.
2. I had pain sitting in the car.
3. I had pain getting out of the car.
4. I had pain tying or untying my shoes.
5. But I had no pain doing squat cleans, and
6. My pain was improved after the workouts.
This happened because the thing that aggravated the pain wasn't weight lifting or ‘CrossFit' or Jiu-Jitsu, it was loading my spine in a flexed position ... and this happened with simple sitting and bending movements, not squat cleans, when done properly.
The fact that I used the opportunity to centralise my pain was also a key contributor.
This post, therefore, is in NO WAY a substitute for thorough diagnosis and assessment by a qualified health professional.
I've taught you to think about pain a bit differently.
I’ve encouraged you to LISTEN to your pain and INVESTIGATE it’s message, rather than ignoring or fearing it.
Maybe, like me, you'll find that you can use the workouts at the gym or CrossFit box to rehab your back and get it fitter and more functional than before.
Exercises in Strength and Conditioning training, Brazilian Jiu-Jitsu or CrossFit don’t cause injuries … it’s the specific way people use their bodies that can lead to pain and injury. It can also happen at the at yoga, at Pilates, gardening, or just picking up a pen from the ground.
Pain and injury are not the same. You can have one without the other. The point is to INVESTIGATE your pain alarm to understand what you're doing to trigger it and learn how to improve how you move.
One of the most common sources of low back pain is the disc, likely caused by a sprain on the inside called ‘Internal Disc Disruption’.
Flexing and loading your lumbar spine squashes your discs … and if a disc is sprained or inflamed, this can trigger your brain to create pain.
Investigate how you are performing the lifts, gymnastics and MetCon at CrossFit and be on the lookout for a curved (flexed) lumbar spine (e.g. during squat, deadlift, burpee, hollow rock etc). Hint, in your case it might not be flexion ... it might be extension or rotation.
When you discover what you’re doing to trigger the pain, see if you can modify the way you move so that it becomes pain-free.
If you can’t figure this out for yourself (and I admit, it takes a trained eye to notice what’s happening), then see someone who knows what to look for and who is experienced at Strength training, at Jiu Jitsu or at CrossFit … so that they know the kind of crazy stuff you get up to :-)
Adam Thomas
(Contributions for the geek speak part of this from Dr Nic Lucas)
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