Working around Low Back Injuries in the Gym Part 2; Maryland Personal Trainer

In the previous installment of this four part series, we talked about what exercises were and were not appropriate for training around a lower back muscle strain. In part 2 of this series, I will discuss working around back pain in flexion.

One of the primary causes for back pain in flexion (bending forward) is a herniated or bulging disc. The main risk factor for a herniated disc is poor lifting technique, age (being older) and sitting a lot (the more you sit, the more likely you have a herniated disc). These are rare in children and young adults - these populations typically have pain in extension rather than flexion.

In the picture above, the left side of the picture is a depiction of the front of the spine. When flexing the spine (by rounding the back), the herniation is excacerbated as more fluid is forced out of the disc. However, disc herniations are not the end of the world. Studies have estimated that 70% of the population in the United States has an asymptomatic (pain free) disc bulge or herniation. As a result, disc pain can be a tricky thing. However, there are three main things you want to minimize avoid: flexion (as we already discussed), shearing force, and compressive force. The less we make the disc work, the better off it fares.

Before working out with any sort of disc injury, make sure your doctor has cleared you for exercise. 

Minimizing Back Flexion, Shearing and Compressive Forces

Take a look at the picture of the spine above. This is the neutral alignment of the spine. When weight training, especially if you have a herniated or bulging disc, it is of utmost importance to avoid leaving neutral spine under load. If you are working with a physical therapist or other professional, he may mobilize the spine at some point. However, spinal stability is always the first priority for anyone with a recent disc injury; so flexion under load (i.e. while lifting) should be avoided at all costs.

The spine is great at handling compressive force (force travelling from the top of the discs to the bottom) but it can not handle much shearing force (force moving posterior to anterior or vice versa; across the bone). Shearing forces are very high a flexed spine as the erector spinae do not have the appropriate angle of pull to counteract it, so again, avoid flexing the spine while lifting.

Additionally, movements that involve rotation, lateral bending, flexing at the hip can produce shearing forces. As a result, at least while under load, try to avoid movements that involve bending forward or involve twisting or bending of the spine.

Any movement that hip flexion and significant erector spinae involvement is capable of creating high levels of compressive force. Back squats and traditional deadlifts can be very troublesome for people with a history of back pain in flexion.

Appropriate Exercises

Lower body: Someone with a history of back pain in flexion should make ample use of single leg movements. For adding weight, dumbbells are always the preferred method for adding weight. Reverse Lunges, Bulgarian Squats, Split Squats, Single Leg Squats are all great ways to work the legs when working around this type of back pain. 

For someone further along in the recovery process, front squats and trap-bar deadlifts are great ways to use more weight while minimizing compressive forces in the spine.

Core: When working with this type of back pain, exercises such as the plank, side plank, cable hold, and any exercises which emphasizes resisting movement rather than creating it will result in much less compressive force than a traditional abdominal movement like a sit-up or crunch.

Upper Body: Just like with the erector strain, bent over rows and seated rows can potentially be problematic. Use dumbbells and chest-supported versions to reduce stress on the injured areas.

That is it for part 2. For the younger audience, I will cover pain in extension in part 3, which will be up tomorrow.