Debunking the 12 Myths of Back Pain so you can get back to Living
Did you know a large majority of athletes and spectators alike will experience low back pain on any given day?
Many of those who do will actually experience pain off and on for decades after the onset of their back pain.
It doesn’t have to be this way.
If you are one of these people, the first thing you have to do is unlearn what you think you know about low back pain.
I know this will sound harsh, but what you have been doing for the past decade apparently is not working, correct?
You’re probably thinking, “Who is this guy and why does he think he knows so much?”
I’m Dr. Sebastian Gonzales and I spent 10 hours of my life writing this guide so you can learn how to feel better.
The first year I was in pain, I lost an entire high school baseball season. I tried PT, meds, rest, imaging, chiropractic, acupuncture, reflexology, Active Release, physiotherapy, strength training, massage and much more.
Looking back, I saw how much time I wasted and continue to waste today when I encounter a new injury and default back to what I “thought I knew.”
I followed what my parents and friends told me:
- Surgical consultations
- Consideration of dropping my sport
Many peers told me I would have a “bad back” for the rest of my life.
They were wrong, and after becoming the director of care at a sports injury clinic, I now know that 90% of what they’d advised me to do was wrong.
I encounter back pain patients everyday and see they are where I was back at 16… hence this article.
The intent of this article is to bring you up to speed on the current research and methods surrounding resolving low back pain.
After finishing this article, you will know all of the current TRUTHS about back pain therapy and treatment. We will start by discrediting the most common “truths” that you have probably heard.
This is why I am calling this article:
THE 12 MYTHS OF BACK PAIN
Preface: The Red Flags of Back Pain
In this section, you’ll learn the signs that merit a visit to the emergency room right now.
Myth 1: Rest is the key to recovering from back pain
In this section, you’ll learn why rest can set back your recovery in the long run.
Myth 2: Back tightness should always be stretched
In this section, you’ll learn when stretch is actually harmful and the theory.
Myth 3: Core training is just a Fad
In this section, you’ll learn why core training for back pain is the real deal.
Myth 4: Once back pain is gone, it is gone forever
In this section, you’ll learn what can increase your probably of having back pain come back.
Myth 5: Deadlifting is bad for your back
In this section, you’ll learn how deadlifting can actually be helpful and how to do it!
Myth 6: How you use your back has nothing to do with an injury
In this section, you’ll learn how your movements can create back pain, even without a positive MRI finding.
Myth 7: “My back is weak” or “I have a bad back”
In this section, you’ll learn the logic of why this mental mindset is harmful.
Myth 8: “My mom/dad has a bad back so I will too”
In this section, you’ll learn why most back pain is a result of an individual’s life choices, not genetics.
Myth 9: An X-ray and MRI are needed for diagnosing the cause of back pain
Myth 10: “My X-ray, CT and MRI imaging findings can’t be “cured” so there is no hope for me”
In this section, you’ll learn why we don’t need to “cure” imaging findings to feel better.
Myth 11: Poor posture while sitting has no effect on back pain
In this section, you’ll learn how to sit properly. Video Section.
Myth 12: The way you breath has no effect on back pain
In this section, you’ll learn how breathing can improve back pain within minutes. Video Section.
PREFACE: THE “RED FLAGS” OF BACK PAIN
Before we start, you should know we group back pain into three categories:
- Category 1: Non-specific low back pain
- Category 2: Back pain associated with radiculopathy or spinal stenosis
- Category 3: Back pain associated with another specific cause
Your treatment plan is dictated by what category your back pain falls into.
For Category 1 and 2, we normally recommend going with conservative care for a month or so and see if there is improvement.
With Category 1, we have an extremely high success rate.
With Category 2, we have a little less depending on the severity of some of the underlying issues.
With Category 3, we normally refer out to a specialist. Your back pain could be caused by other odd conditions such as infection, cancer, referred pain from other organs such as gallstones and more. A doctor in another specialty can assist in these cases.
The “red flags” of low back pain are really the only reasons we should attribute pain to a structural cause.
The “red flags” are:
- Progressive motor or sensory loss
- Bilateral leg weakness or sciatica
- Unexplained weight loss
- No improvement with 6-8 weeks of conservative therapy
- History of trauma
- Saddle anesthesia
- Urinary or fecal retention
Now that we have all of our categories and “red flags” out of the way, let’s get into the 12 Myths of Back Pain Article
MYTH 1: REST IS THE KEY TO RECOVERING FROM BACK PAIN
Rest is actually worse for low back pain. True story! (How I Met Your Mother reference).
Don’t believe me?
Some very reliable evidence shows those with acute low back pain who choose to follow advice for bed rest actually have more pain and less functional recovery than those who stay active (Hagen, 2005).
In regards to sciatica (leg pain with back pain), resting still is not better, but it is not really worse either.
I know your logical mind is thinking, “If I rest, my back will get better.”
I don’t blame you for thinking that way, but back injuries are different than foot or knee injuries. A majority of the time, they occur because of how you are using your back (we will go over this — more to come).
Back pain is an endless cycle if you let it go. The muscles of the trunk (the core muscles, diaphragm, pelvic floor, glutes and lats) are all skeletal muscles and will weaken with rest. Muscles weaken at a rate of four times faster than you can build them.
When the muscles become weak, then your spine takes more load and begins to accumulate damage.
Now, the logical answer would be to keep the muscles of the trunk from weakening right?
How can you do this?
Train the trunk to compress and increase intra-abdominal pressure (we will go into this later as well)
Even if you don’t know how to do that, the above study shows that you will improve if you simply just get up and walk.
So why not stay active and enjoy life?
The evidence says you should.
Here’s some easy Actionable Tips I give my patients.. I call it the 10,20,30 Rule:
- Get up an go for a 10 minute walk two times a day
- Get in and out of a dining room table 20 times a day (use your hips)
- Practice getting in and out of bed/ off the couch, 30 times a day (see next video)
Other Important section (click links to read immediately):
MYTH 2: BACK TIGHTNESS SHOULD ALWAYS BE STRETCHED
If you feel like stretching is the way to go, you are not alone.
I would venture to say a large majority of the U.S. population feels this way and rightly so… because it makes you feel better… but does it help long-term?
It feels good because we are stimulating the stretch receptors within the soft tissues of the back.
Let’s consider why the muscles are spasming in the first place.
What if the body was naturally protecting itself against expansion of a disc injury?
What if you had a fracture of the spine?
Have you ever considered stretching is the wrong thing to do regardless of how it feels when you are done?
Everything that feels good is not good for you.
Anyone ever done heroin?
I haven’t, but word on the street is it feels awesome… but really not good for you!
So when is stretching OK?
It’s OK when we are dealing with an actual tight muscle, but when we are dealing with the “feels tight” type of tight, we need to consider neural tension.
Neural tension is different than muscle tension and is treated slightly different. Do not stretch neural tension, as it will result in more pain.
Some findings of tightness around the back are due to neurogenic tightening (T-Nation 2017).
Stretching will still feel good, don’t get me wrong, but this feeling of comfort comes from stimulating the muscle’s stretch receptors. The “feeling of tightness” is extremely common with many types of back pain, but can be secondary to the actual problem.
An example is a disc injury. Stretching of the muscles around the disc injury will make the area more susceptible to injury and bring more pain in the coming days.
If you are unsure of what you have, you need to see a sports medicine specialist.
Even though your first thought may be to start stretching your back out, you should think twice.
More and more evidence has come to light showing that more motion in the back is not the answer. Sure, oftentimes it can make you feel better, but does it really address the issue?
We’ve already discussed that most people with a past history of back pain are more than likely going to have more back pain in the future. Perhaps that is because many people don’t address the underlying issues in the first place?
I was under the impression that maybe half of all people with back pain seek care, but was startled to read in one study that only 28% do! The exact number was 301 out of 1071 people experiencing back pain sought medical attention of any type (Mannion 2013).
Come on people! No wonder past injury results in future problems. Realistically, the underlying issue was probably never corrected. Your spine never learned to keep its composure during normal, everyday challenges.
Now, let’s get back to the flexibility topic again.
Is it OK to stretch your hips or hamstrings?
Most people default to their hamstrings and feel better after, but are there real reasons to do this?
I would vouch for hip stretching more than stretching the back, but mainly to improve functionality of the hips. Improving the function of the hips has been found to assist in saving the back from sustaining repeated microtrauma.
Back in 1996, we found back pain patients actually had the same amount of forward flexibility of the hips and back as people without back pain (Esola 1996).
Why is this significant?
Flexibility was not the reason for back pain. It was how people used their hips to save their back the work.
People with back pain bent their backs forward sooner than those who didn’t have back pain.
Stretching the hips was suggested to assist mainly in getting people to move their hips sooner in motions, rather than their backs.
For this reason, I stand by stretching the hips as a way to improve hip usage in bending over, squatting and lifting objects. Using the hips well allows the back to be used as intended: as a rigid tube, resistant of bend.
Gaining motion in the hips can greatly assist in combating and preventing back pain.
Mobile hips allow the spine to remain in the correct position. Back injuries usually don’t occur from singe incidents. They occur over time or repeated deviations from midline.
The core/trunk functions as a spring. It wants to stand upright and will resist deviations from midline, but the issue is the eyes always win.
What do the eyes have to do with anything?
Just walk around and observe people. 99% of everyone you see (if they are not texting and walking) will look forward when walking. Both of their eyes are always even.
You will almost never see someone walking with their head tilted to one side.
You will almost never see anyone walking with his or her eyes/head looking up.
I say almost because I’m sure there will be one person who breaks the rule.
The eyes matter because no matter how the spine is tilted from the base, no matter how twisted and curved it is, somehow the eyes are always straight and even.
Proper hip mobility and pelvis function will allow the spring to have a proper base and then the eyes will do the rest.
I know there are so many ways to stretch the hips, so what kind of stretching do I recommend?
Dynamic or Active Stretching has been shown to have more beneficial effect allowing the nervous system to do its job.(Carvalho, 2012)
Passive stretching does deaden pain, but it also deadens the stretch receptor’s response leading to loss of functionality of that muscle, at least for a short period of time, such as using static stretching as a warm-up to sprinting.(Fletcher 2007)
Deadening the ability of the hips to do work leads to less strength, power and speed, which could lead to a back injury.
How does this matter if you don’t care about strength, power and speed from the hips?
You still need the hips to do work. You need them to stand from a chair, to pick up your son or daughter and to do cardio. Athletes just need their hips to work better…period.
Nobody should expect a healthy back without functional hips.
Still hanging onto the concept of static stretching?
When in life do we ever move by having someone else move our limbs under no strength of our own? I can’t think of one, unless you are training to be in a wheel chair, bed-ridden or a stand-up improv comedian. (Think Who’s Line is it, Anyway?)
Am I saying we don’t need hip flexibility?
No not at all. I’m just saying there is not a need to move any joint through range of motion if we don’t have the ability to control it through that range of motion. If you want to attain extreme range of motion (for some odd reason), I would suggest doing so with active or even assisted stretching, but not passive.
If you still insist on passive stretching, then at least spend some time actively going through that new range of motion immediately after.
If you don’t believe me about the importance of active hip range of motion in relationship to back pain just try this hip mobility exercise (ask your doctor first). Many of my patients feel over 50% better immediately after doing these with good form. Enjoy
Other Important section (click links to read immediately):
MYTH 3: CORE TRAINING IS JUST A FAD
When I first began training my core, I thought how cool it was going to be to have a killer six-pack, but as I began to learn more, I found the core is actually the inside.
Unlike a leg, the core is actually a hollow tube. The rippling muscles of the abdominal area are actually just the walls.
Think of a balloon…one of the ones they make balloon animals from.
The muscles are the walls of the balloon, but much of the strength of the core comes from the pressure inside.
The reason a balloon “dog” can even stand up at all is because there is pressure inside the balloon. Try to make a dog from a deflated balloon. I dare you.
For a person, the “pressure from the inside” is produced by the diaphragm, pelvic floor, and abdominal wall. The whole loop is complete as the muscle of the spine contract to keep the spine in place.
Yes, I meant to include the diaphragm or “breathing muscle.”
You may be wondering how you could control a “breathing muscle” since you have to breathe.
Just like your hamstring, the diaphragm is a skeletal muscle, which means it is voluntarily contracted (Kolar 2009). All skeletal muscle is capable of being contracted when you want it to contract.
The diaphragm has two functions: getting air into your lungs and stabilizing your trunk for correct posture of the spine.
We have actually found the diaphragm can multi-task. It can allow breathing and stabilize the spine at the same time (Kolar 2010).
You can learn to do this as well.
Learning to have the diaphragm in a “lower position” permits the muscle to allow breathing while simultaneously keeping pressure inside the abdominal cavity high. A muscle of the abdominal wall also assists the diaphragm in doing this, the transverse abdominis.
You need to learn to allow the diaphragm to do both of it’s jobs at the same time.
When the core is functioning extremely well athletes can experience “superstiffness,” which is The concept where the muscles of the trunk contract together to create more stiffness than any one muscle could on its own (McGill 2107).
Contraction of the muscles of the trunk in unison allows you to “keep posture” better and will enhance your athletic performance.
The more rubber bands we have on the spring, the better we will be able to withstand daily life.
This picture paints a very simple concept, but it really is more complex.
The trunk muscles do not function as simple as 1+1=2.
It’s more like 1+1=3.
How does this work?
When working together, the trunk’s stiffness increases by leaps and bounds when the muscles work together, and while each muscle individually may be capable of “X” amount of contraction, when working together, they are capable of more than “X”.
Still don’t get it?
Giving muscles stable bases for contraction will improve their function.
Think of squatting on a soft, rubber floor versus a hard, wood platform with lifting shoes. The stiffness of the shoes and hard wood allow for more weight squatted on your part, but it doesn’t make you stronger, right?
Still don’t believe increasing pressure is the key?
A great study in 2005 showed an increase in low back stiffness (providing stability) as intra-abdominal pressure increased. Because this results in less aberrant motion of the spine, there are less low back injuries and pain. (Hodges 2005)
Let’s practice some breathing techniques:
Here’s a great video to begin with.
Below, I placed some written instructions for you as well.
#1) Lay on your back, feet against the wall so your knees are pointed straight to the ceiling and your shinbones are parallel to the ground. Place your hands on your stomach and just feel your belly moving. If you don’t feel it, stay on the ground until you do. This is an important step.
#2) In the same position, depress your ribcage. If you don’t know how to do this, place your hand on the bottom of your ribcage, and practice making it disappear. Next, place your hands just under the ribcage and press in. Fight your hands with your trunk wall.
When breathing you should feel the pressure INSIDE your core pressing back on your hands. The ribs will move, but only laterally, or to the side. You should never see the ribs flare.
If you have heard the instruction “bring your navel to your spine” then you have heard of abdominal hollowing. The current thought is:
Hollowing is out and bracing is in (Koh 2014).
Why is hollowing out?
The current thought is that of a wire system holding the spine in place. Hollowing narrows the wire contact point creating less support than a broad contact.
I have taken some pictures of a model I show my clients about the wire frame system. Note the picture with a narrow contact point of the rubber band; the less leverage it has, the less support it gives the spring.
Growing up in Boy Scouts, we were required to make tripods for our water at camp, and we eventually found the more broad the base of the tripod the more stable it was.
Dr. Stewart McGill has suggested a baseline of these three exercises while using abdominal bracing and proper breathing to effectively stabilize the lumbar spine (RunWaterloo 2014).
The McGill “Big 3”
- Side Bridge
We have full videos on them in our ONLINE COURSE HERE.
I would use these exercises to train the trunk to function better as it is intended. I don’t care about looking shredded or having a six-pack. As long as your trunk has the ability to retain an upright position through all of your activities, I would be happy.
The curl-up is intended to train the front side of the trunk without having to go into flexion or extension the way you would with a sit up, a crunch, or even doing ab work on a ball.
If we take into account the true function of the trunk, this is a perfect exercise. The only downfall is some patients try to ditch it because of neck pain. Granted, there are corrections to make to diminish neck pain, so they just have to be utilized in order to keep this exercise in a program.
The McGill curl-up challenges the concept of “anti-extension”.
What does “anti-extension” mean?
Extension of the spine occurs when you are bending backwards like a “crab walk.” This exercise trains the trunk to resist extension.
Why do we want to resist extension?
In everyday motions, our spine likes to resist all extreme motions.
The goal with a curl up is NOT to flex at the spine.
During a proper curl up, we are attempting to keep the spine in a constant position during the entire exercise.
Here’s how we do it:
#1 Lay on your back with one knee bent and your foot flat on the ground
#2 Place your hands under the small of your back
#3 Subtly rise up off the ground, bringing your neck, head and shoulders off the ground (as if you are lightening a scale they are resting on)
#4 When raised, it is important to not lead with the chin or curl the neck (to combat this, form a double chin)
#5 Breathe through the belly
Hold for 10 seconds or until just before your form degrades and then lower
Just like any other exercise used for the first time, the first time around can be used as a test to see if your injury will tolerate it. For this reason (at the very least), you need to see a healthcare professional to troubleshoot your condition.
Some corrections I often give are:
- Press through my finger (on sternum)
- Hover your elbows off the ground (stops cheating)
- Curl up with oblique pulling (fight my hand with your abdominal wall)
- Hold the top position for 10 seconds and breathe deeply
For correction of neck pain, McGill says:
Make the double chin and drive your tongue to the roof of your mouth HARD. The area under your jaw that was once soft will become hard.
The Side Bridge
The side bridge is not a side plank. Let’s get that part clear. It is more like a hip hinge with an anti-lateral flexion challenge.
With a side bridge, just as with the other “Big 3” from McGill, we are working on building the endurance of low-level trunk stabilization.
Here are the steps:
#1) Lay on your side on the ground
#2) Your foot position should be with the top foot in front. Your elbow, forearm and hand should be in contact with the ground. With your palm down, “press the ground away”.
#3) Your feet and your forearm should be inline. Your hips will be just behind them in the resting position. Think of this exercise as a forward-backward motion, like squatting, not bending.
#4) Top hand on your hip
#5) Drive the hips forward to “raise” the body up, just as in squatting.
#6) In full contraction, everything should be inline: head, neck, spine, shoulder, hip and foot.
#7) Hold for 10 seconds and slowly “sit back” into the starting position…everything should be under control as if you were deathly afraid of reinjury…in some cases this could be true.
Again, this is a test before it can be recommended, so be examined first.
These would be considered regressions from the one I showed:
Depending on the person’s ability, we may not even start them on the floor. Standing and leaning against a wall in the plank position is a great starting point if that is all they can do.
When first going onto the ground, we can start from the knees. Sitting the hips down into a squat position.
Use the topside hand to press downward on top of the shoulder. Do not roll over to accomplish this.
#1) Wall lean
#2) Floor knees bent
#3) Floor knees straight
#4) Oblique Rocks (pelvis & ribcage stay connected…don’t lead with the butt)
#5) Rollovers to alternate sides
The Birddog is a great exercise for multidirectional stabilization.
Here are the steps:
#1) Go on your hands and knees; shoulders and hips should be directly over your hands and knees.
#2) Find your low back neutral (go up, then down, then up to half way).
#3) Exhale and compact the trunk
#4) Pack the neck by making a double chin
#5) Pack the shoulder by pressing the ground away.
#6) Start with the arms: reach one arm out like you are superman. Make an angry hulk fist and contract the entire shoulder and upper back. Then do the other. All parts of the low back, mid back, and neck should remain still. Imagine you have a cup of hot coffee on your back…don’t spill it.
#7) Next, drive one of your heels straight back, making yourself long. Don’t raise it to the sky. Look for changes in the spine or rotation of the hips. Your pelvis should be facing flush to the ground at all times.
#8) 10 second hold at the top, come down and sweep the floor.
Arm leg opposition at the same time.
Make symmetrical squares at the same time with the heels and fist. Up, out, down, and up.
Pop up using the hips and shoulder at the upward part of the square. Don’t use the back.
We can make this easier if there is pain or inability to perform it perfectly. Instead of raising the limbs all of the way up, we can just raise up part way or change the range of motion.
Other Important section (click links to read immediately):
MYTH 4: ONCE BACK PAIN IS GONE, IT IS GONE FOREVER
Having pain in your past is a predictor of future injury.
Does that mean if you have bad luck once with your back then you will have bad luck forever?
Not at all, but you should be aware if you rehab it the correct way now you will have less issues in the future.
Are there factors that will increase the probability of your back pain in the future?
Yep, there are.
Psychological distresses in your younger years (early 20’s) and continued smoking have both been found to more than double your risk of having back pain.
A short list of psychological factors contributing to early back pain is:
- Job dissatisfaction
- Lower education level
- Moderate to low life control
- High level of ergonomic stress i.e. repeated “postural loads”
- Single parenthood
Does this mean back pain is linked to your happiness?
Perhaps, but this does seem to indicate that people with a lowered quality of life report to the doctor with back pain in their early 30’s more often (Powers 2001).
Is there anything measurable to predict back pain?
Actually, we can use flexibility of the back and endurance for something more objective.
Increased back flexibility and low endurance of the spinal erector muscles has been shown to increase the possibility of first time back pain cases (Biering-Sorenson 1984).
Muscular endurance is a predictor of future low back pain as well (Alaranta 1995).
Go back to these points and read them again please. Note that the MORE spine flexibility you have the more at risk you are of having your first injury. Interesting, huh?!
But we can’t forget quality of motion is also a huge factor. In our clinic, we have mirrors so our patients can examine their own motion after we teach them what to look for.
Complete attention is needed to correct these motor control errors, and we have found that even just being distracted can negatively affect the quality of motion (Brereton & McGill 1999).
Other Important section (click links to read immediately):
MYTH 5: DEADLIFTING IS BAD FOR YOUR BACK
Deadlifting is one of those exercises that scare people with “bad backs.”
Rightly so, but if you have read to this point in the article, you should be seeing by now that motion and how you use your back is the most important factor in preventing a flare up (Marras 1995).
Think of deadlifting as training for real life. Deadlifting is the most efficient way to pick up a child or other heavy object you encounter in your lift.
Actually, let’s retract that “heavy” comment since it is always the “straw” that breaks backs. Even picking up light objects can hurt your back if you don’t know how to use your body.
I have a friend who just recently got into lifting weight. He has turned to an absolute maniac about it. He videos himself squatting and deadlifting, so he can analyze his form; one day he showed his new personal record deadlifting to a co-worker.
This co-worker wasn’t into lifting and watched the video in horror.
He asked my friend, “Why are you lifting so much? I feel like you’re going to hurt your back.”
My friend is a pretty logical guy so he said, “I’ll never stop deadlifting. Deadlifting is life.”
What he meant was we will encounter a “deadlift” of varying loads every single day of his life. He wants to be able to do it safely every single time.
Now, back to my commentary.
Is there a need to deadlift a ton of weight?
I don’t think everyone needs to be able pull double their own body weight, but they should certainly be able to do above 75 pounds. Children weighing as much as 50 pounds can still want to be picked up.
My dog needed help into the car and she weighed 72 pounds.
Personally, I only max deadlift 300 pounds, but weekly, I lift more than half of that at least 40-50 times/for reps.
I want to be able to dominate any deadlifting challenge I encounter in everyday life.
Still scared of deadlifting?
Actually, there is a way to mitigate your risk.
The Biering-Sørensen test is a great way to screen a possible injury from deadlifting rehab. If you can’t hold this test for 1 minutes then you need to start building your anti-flexion tolerance before you deadlift (Berglund 2015).
The second best way to predict an injury is simply pain intensity. If you hurt then you are going to get hurt. Duh.
I bet you’re wondering how to deadlift safely with back pain now?
It all comes down to proper cueing. Here’s a video on some of the cues I like to use. You should really just subscribe while you’re on Youtube.
Here’s some written deadlifting form tips:
The Deadlift Technique
The deadlift is an extremely important motion so even if you are hesitant to deadlift, I would really dig deep and understand the hip hinge so you can do it well. There are many reasons why people refrain from deadlifting (even light weights), but they are all bogus minus a few extreme conditions.
If you do have a condition, ache or other injury that you feel prohibits you from deadlifting, then you need to have it assessed by a qualified, medical professional to ensure that doing this exercise is safe for your condition. Run this by a few sports docs to get a good, honest answer.
Why do I teach deadlifting?
Here’s a short list:
- To rehab back, hip, knee and ankle injuries
- To improve sports performance
- To prevent sports injuries
- To build a strong core, strong hips and reinforce good, quality motion of the hips to save the spine from injury
This is going to be a very long section. I cut it up into sections of the lift, but you need to watch the entire video… probably multiple times to get all of the nuggets from it.
Here are some verbal cues I often give people. I’ll go over them again so remember which ones your body responds best to.
- Bar on the shins
- Pull yourself down to the bar
- Break the bar or show me the big logo on your shirt
- Drive the ground away
- Hips high
- Pull the bar into your hips; drive your hips into the bar
- Look 3 feet out in front of you
- Tension the bar, take the click out of the bar
Deadlifting: The Breathing and Bracing
I may be getting way ahead of myself, but core stabilization or what we call “rigidity” is one of the most important parts of proper/safe hip hinge motion.
I have all of the steps to this in the “Core” Section of our courses. The ones I would watch and master before you even attempt gripping the bar in a deadlift are:
- Deadbug Progression
- Side Bridge
- Pallof Press Anti-Rotational
To obtain proper breathing and bracing during a deadlift, we need to keep a rigid trunk by maintaining high intra-abdominal pressure throughout the entire lift; and that includes putting the bar back down.
Deadlifting: The Stance and Grip
Stance is typically the feet shoulder width apart with the knees stacked over the feet.
Hand position is best just outside of the shins.
For grip, I like to use a full palm contact when learning. Gripping with the fingers is a no-no.
The hook grip is the best option. People tend to use it when they are starting to lift heavier weight.
The hook grip is accomplished by wrapping the thumb around the bar and then wrap your fingers around your thumb.
Does it hurt? Yes, but you will get use to it just as the rest of your body does with training.
Deadlifting: The Set-Up
Let’s go over some set-ups. The first two are ones I teach in person at our clinic, but there are many other ways. Different systems work for different people. It’s all about what your body responds to best.
Set-Up Option 1: Pulling your Chest to the Bar
I find this to be one of the best setups for beginners in the hinge pattern. I strongly encourage this one because we can use the bar’s weight as feedback to pull the back into a “flat” or “extended” position. I find if we focus too much attention on the hip height, then people tend to round their spine, which is the last thing we want.
- Bar on the shins
- Squat down to grab the bar
- Break the bar/Pull yourself down to the bar (to pull the chest through)
- Breathe and brace
- Raise the hips (tension in the hamstrings)
Set-Up Option 2: Rock the Hips
I find beginners have trouble with getting off their toes. In lunges, squats and deadlifts, many will creep onto their toes like a “smooth criminal”.
To get them to feel the weight shift in this setup, we have them start more “over the bar”, which will put their weight onto their forefoot. With the “Rock,” we use the bar as a counterbalance. This builds trust that they can start bringing their weight back to the center of their foot.
- Bar on the shins
- Goodmorning to get to the bar and bend the knees (your weight will be on your forefoot and your shoulders will be in front of the bar)
- Breathe and brace
- Break the bar and rock into the hips (your weight will shift to the midfoot)
Set-Up Option 3: Rolling the Bar
- Bar 3-4 inches in front of your shins
- Bend down to grab the bar
- Breathe and brace
- Roll the bar towards you, pull your chest through and drop the hips as the bar rolls
- Pull when the bar reaches the shins
Set-Up Option 4: Dip, Grip and Rip
Very simple and practical once you have extensive experience and have achieved proper technique. By extensive, I don’t mean being able to lift a lot of weight with poor form.
This is a popular technique, but it is used to get outside of your own head. There are no external cues which makes practice perfect. We are in the market to teach proper motion, not to crush weight with poor form.
Deadlifting: Before The Pull
I recommend “tensioning” the bar before we actually pull it off the ground. You will typically hear a “click” as there is a slight amount of room between the barbell and the weights attached to the end. It’s actually the extra room to get the weight on and off the bar that we are looking to eliminate with “tensioning”.
Tension the bar, hear the click and then bring the bar from the ground.
Why does this matter? Jerking the weight off the ground will create an “impulse” when the unweighted bar contacts the weights.
This sudden impulse can create injuries to the components of the spine… it’s like pushing someone when they aren’t ready for it versus telling them it’s coming.
Engage The Lats or “Break the Bar”
I touched on this earlier, but the reason to do this is to engage the lats. We want to break the bar by “driving your elbows back” towards the back of your body, but you need your elbows to be locked. That means no bending your arms.
Engaging the lats is important from a safety standpoint. The lats wrap around the low back and when engaged, they actually prevent it from rounding. This is what we call the “lat sling”.
We have some exercises we use in the preparation stages of the loaded deadlift to emphasize the use of the lats. Yes, it is actually that important.
Deadlifting: The Pull
Now that we have obtained pinpoint accuracy on the:
- Breathing/Bracing Component
- The Set-Up
- Tensioning the Bar
- Engaging the Lats
We can start to lift the bar from the ground. By the way, if you have not mastered all of those components, just go back and practice them for the next few weeks. Getting to the setup and tension can be tiring when done over and over again. Let’s get all of the necessary steps down pat before we attempt to pull the bar.
Don’t think “lift the bar.” In fact, ignore the bar and focus on these cues:
- Chest up
- Drive the floor away
- Drive the hips towards the bar
If you’re wondering how fast you should be bringing the bar from the ground, it is different based upon your lifting goals.
For beginners, I suggest a lower speed when going from the ground to just above the knees.
When the bar is above the knees we drive the hips forward aggressively so it becomes a quicker motion.
Deadlifting: The Finish
Now that you are standing up tall, you need to be aware this is not a passive position by any means. I always tell people you should be ready for “photo day”. You should be as upright and tall as a statue.
- Crush the quarter between your cheeks
- Hold paper under your armpits
- Stand tall
Deadlifting: The Descent
Going back to the ground with the bar is exactly the same path as we came up.
Some common faults are:
- Squatting the bar down (This will look like you are forming a shelf for the bar at the knees).
- Reaching for the ground (This will look like you are rounding your back). I tell people to let the ground come to you.
Other Important section (click links to read immediately):
MYTH 6: HOW YOU USE YOUR BACK HAS NOTHING TO DO WITH AN INJURY
Quality of motion is more important than flexibility. I went over this in another section on flexibility.
Now, let’s focus on the motion aspect.
The purpose of the spine is to keep its shape, remain as “stack as possible,” and rigid and resistant of bend.
Here’s a video so you can understand this better.
Throughout everyday life, we encounter events where we need to lift, bend, and twist our body, not our back. If you’re moving properly, your chance of having a back injury drops significantly (Escola 1996).
People with back pain use their back earlier in motion than those who don’t. Making the back do more than required doesn’t make your back “weak”…it could mean you are not making your hips work.
People who don’t use their hips will use their back more (Escola 1996).
So, how do you improve how you move?
How would you improve how you dance?
How you hit a baseball?
How you play the piano?
Repetition is not the only answer. One of the phases I remember one of my coaches growing up saying was:
Perfect practice makes perfect.
Meaning you need to being doing it right to make your practice reap results. This is why we teach “perfect practice” in sports rehab and don’t just send you home with a sheet of exercises.
MYTH 7: “MY BACK IS WEAK” OR “I HAVE A BAD BACK”
Let’s do some tough love in this section.
Stop treating your spine like it is broken. The majority of back pain cases are not surgical and can get better with some instruction and training.
Yes, I know…you have arthritis…that has nothing to do with it.
I know this concept is hard to swallow. Let me explain before we go on.
There are many different types of arthritis. In the past, we used to believe osteoarthritis (“old age arthritis”) of the spine created back pain. Osteoarthritis can be in many places of the spine. One type you could have is facet arthosis.
OK, now to blow your mind.
There has been no association found between facet osteoarthritis and back pain (Kalihman 2008).
So, when your x-rays, CTs and MRIs come back with the findings of osteoarthritis, arthosis, or degeneration, stop getting distracted. There are bigger fish to fry.
Besides, after age 60 there is a 100% probability of having arthritis, but I’m sure you know people over 60 without back pain, right (Kalihman 2008)?
Arthritis is only an issue when it’s severe. If I had to estimate how many back pain cases that I’ve seen with severe enough arthritis to merit their back pain, I would say it’s less than 1%.
Most people have movement issues.
What about your disc herniation?
It doesn’t matter.
You heard me right. How did you get the disc injury in the first place?
Repeated poor motion creates more disc injuries than single incident trauma.
Even small compressive loads when repeated will damage discs, leading to herniation and prolapse (Callaghan and McGill 2001).
MYTH 8: “MY MOM/DAD HAS A BAD BACK SO I WILL TOO”
This is one of the most common misconceptions I hear about back pain, and it is one of the most debilitating ways to think. Back pain has many different causes and only a few of the major ones are hereditary. For the sake of staying on track, I will not even go into the exceptions.
Mechanical low back pain is by far the most common type of low back pain.
How your father destroyed his back in his younger years has nothing to do with how your back develops. This logic is similar to thinking that lung cancer from smoking runs in the family when your great grandfather smoked like a chimney and you have never touched a cigarette to your lips.
As far as the majority of back pain is concerned, do not blame it on your family. Your activities and how you’ve used your back throughout your life is the reason your back feels the way it does today.
MYTH 9: AN X-RAY & MRI ARE NEEDED FOR DIAGNOSING THE CAUSE OF BACK PAIN
Images of the spine are great to have if you do not lean on everything they say. X-rays and MRIs find normal, non-pain generating findings all the time.
Some examples of some findings you think are big deals, but really aren’t are:
- Mild stenosis
- Small to medium disc herniation
- Spondylolisthesis (grade dependent)
There are many other big words that are used in imaging studies that don’t mean much when it comes to identifying the source of your pain. It’s like two mechanics talking about your car. Just because they used a word like “carburetor” doesn’t mean there is anything wrong with it.
The images also relay normal findings.
Oftentimes, the findings of x-rays and MRIs are not that big of a deal. They are not big enough to merit the type and severity of pain you are experiencing.
Does that mean you are making it up?
Not at all, but it should make you think about what the image doesn’t show.
If you can recall, in both of these images, you were asked to stay still.
These types of images do not show motion or how you move.
Here’s a list of things we look at as possible causes of pain NOT shown on imaging:
- Movement patterns
- Joint play or mobility
- Spinal muscle endurance
If you are anything like most patients, you want a definitive answer to what is causing your pain.
Rightly so, but be open to the possibility that your imaging is normal and your habits, the way you move, the way you sit, your lack of core stabilization, and/or hip mobility could be the reason. It’s not a diagnosis, but if you don’t believe it, go back to the smoking example.
Smoking constantly will yield a chronic cough…regardless of what a chest image shows you will decrease the chance of your cough if you stop smoking.
Constant poor motion and posture will yield back pain. The answer is to move better. This is why a majority of low back cases get better in therapy. Images are reserved for when you have a “red flag” in your case.
MYTH 10: “MY X-RAY, CT & MRI IMAGE FINDING CAN’T BE CURED SO THERE’S NO HOPE FOR ME”
As I noted in the section above, images do not hold the answer. Findings on images are often normal, non-painful and can be left alone.
If we find a 2mm disc herniation, we do not need to have surgery right away. Since most back pain starts slowly and non-traumatically, chances are the herniation was there well before you felt the pain.
If the herniation was there before pain, isn’t it rational to think you can be out of pain again regardless if it is still there or not?
Let’s correct the motions, endurance and correct possible activities that started the pain in the first place. If there is still no change after months of hard work on your part, then we can investigate the image findings some more.
MYTH 11: POOR POSTURE WHILE SITTING HAS NO EFFECT ON BACK PAIN
Poor posture is one of the things I will agree with Grandma on, but her instructions on how to do it properly could be better.
Sitting for prolonged periods and in poor posture will be the reason for many of your friends’ and family’s back pain.
Poor posture leads to compression on the discs of the spine and eventually, the demise of the back. This happens over years and years.
Everyone knows sitting can cause irritation on the back, but sitting properly can greatly decrease the possibility of a nagging back injury when you’re just trying to making a living for your family.
Here’s a video that can help guide you on how to sit properly.
Here’s the tough love again: I get it; you have to sit, but that doesn’t mean you can’t be the best sitter you can be.
Just like deadlifting, sitting can hurt you if you suck at it…so just get better at it.
Remember: perfect practice makes perfect!
MYTH 12: THE WAY YOU BREATH HAS NO EFFECT ON BACK PAIN
That’s right, breathing the correct way does affect your back. Improper breathing patterns can increase the amount of pressure on different aspects of the spine, from the discs to the small joints.
You may be wondering what the correct way to breath is.
You have heard of chest and belly breathing before.
Chest breathing is when you see lots of ribcage and chest motion.
Belly breathing is when you see the belly move in and out, more so than the ribcage.
The current thought is we want to be belly breathing. We want the diaphragm to remain “low” in the abdominal cavity to keep pressure, and when contracting, we want it to move outward to the sides (Clare 2013).
Not up and down and not forward and backwards.
We can assess this by placing your hands on the bottom/sides of your ribcage. Close your eyes. You should feel the ribcage move towards your hands and you inhale deeply.
I would learn this lying down first, then seated and then standing.
Learning to breath in this manner will allow your intra-abdominal pressure to shoot through the roof, protecting your back.
DNS (Dynamic Neuromuscular Stabilization) practicing doctors suggest there is an easy, visual way to see if the core is properly engaged. In someone thin or in-shape, if you see a dominant six-pack then it is probably incorrect.
The abdominal area should be fairly convex, absent of the six-pack. If the six-pack appears contracted, then we have the possibility of an overactive rectus abdominis (Reinolds 2012).
The diaphragm is the muscle used while breathing. Breathing occurs when the diaphragm contracts and depresses downward into the belly cavity. This downward motion creates negative pressure in the chest cavity and air gets “sucked in”.
This is similar to a how a vacuum works.
Vacuums create less pressure inside than at the end of the hose leading to “sucking”. If we reversed it and increased the pressure inside the vacuum, then it would turn into a leaf blower because the pressure on the outside is now less than inside.
I hope this was helpful to everyone. If you would like to hear more of me breaking down sports medicine lingo and thought processes, I have a podcast on iTunes. You can access it right here, and remember to share your favorite part about this article with a friend who has back pain and is sitting at home “Resting it off!”
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