Wednesday, March 11, 2009

Exercising with a history of back pain or back surgery


Here is a post I received from one of my friends who is living up in the Northeast. Thought I would share it and then comment more on the subject.

Hey Snowman!
I love the blogs you've been writing. I've been working out myself for the past 6 months or so, taking sporadic breaks. Last year I had back surgery for a ruptured disc that I had been dealing with for quite sometime. Since the surgery I'm scared to death of doing squats and I saw that you no longer recommend leg extensions. So I'm wondering what type of leg exercises you would recommend for me. Right now I'm doing leg press, leg extensions and hamstring curls. Would lunges be an option? I'm curious about your thoughts and your recommendations.

Here is what I replied to him:
The important thing after back surgery is to work on exercises that stress the core but keep your spine in a neutral position (the way it was designed to be). Any crunches or weighted back squats can be problematic for your back.

I will get some videos up on hip hinges, deadlifts and front squats. This will help. Lunges are terrific if you can keep your spine in neutral. Leg presses can be hard on the spine and extensions and curls just aren't very functional.

Another good suggestion would be to get your hands on the book by Stuart McGill
titled: Ultimate Back Fitness and Performance Book.
Dr. McGill has extensive knowledge of working with athletes who suffer from back pain. He even states that the leg press may not be a good option due to the fact that it increases pressure on the lumbar discs. I also feel that the leg press may be dangerous is due to the reason that the exercise does not require any trunk stability which is vital to the back.


To begin, in the opinion of someone who has a background in sports medicine, performance enhancement and injury prevention, I would get you performing exercises that keeps your spine in a neutral position (no more weighted crunches) and works on the muscles of the hips, trunk and scapula to help support your back.

I think it would be in everyone's best interests to first and foremost see a Functional Movement Screen Certified Specialist and get screened to see if any imbalances may exist within your body that may have been the reason that the back pain/surgery resulted. They can clean up your movements so you can work on functional strength without the fear of re-injury.

The importance is when you lift to have the ability to brace your abdominals like you were about to get punched in the stomach.

Here are some examples of leg exercises that I would give in order of difficulty. I want to emphasize the importance of keeping a neutral spine with all activities. This is just good practice for everyone, especially those recovering/suffering from a bad back.

First and foremost-MOBILITY

You need to have mobility before stability. So if your hip flexors are tighter then tight. You need to spend time on them and get them to open up. Think about this. If you squat and you feel pain in your back, then more than likely your hip flexors are tight.


Frog Stretch

This exercise is a doozy, but really has helped with my
kettlebell swings and squats. My problem was that I
lacked hip mobility. Didn't matter how many times
I performed the exercise, I had to have good hip
mobility to take stress off of my other joints.

Stability Exercises

These exercises will require you to have the proper mobility
and also make you kick in your stabilizers.


Hip Hinges
This exercise is a great start to learning how to hinge with
your hips instead of using the motion in your ankles and
knees to perform a squat. Great to work on the eccentric
loading of the glutes and hamstrings for proper hip
extension.

Quadruped Training/Supermans
Leg lock bridge

Hamstring Bridge

Reactive Neuromuscular Training/Complex Lifts
These exercises help to program the body to use the mobility
and stability you just achieved to work together to train the
body to be more functional.

Reverse Lunge

Deadlift


For all of you who believe that the deadlift is one of the
worst things you can do for your back I am here to tell
you differently. If you perform the deadlift incorrectly
yes you very much can put too much pressure on your
back (But on the other hand, you can also do that with
the squatif performed incorrectly).
Hip hinges are a great place to start, then move onto
using tubing, then onto a weight like a plate or a
kettlebell. Use enough weight to make sure you fire
your trunk, too less of a weight will only make you
use your back extensors and that may be the reason
you are here in the first place.

Gray Cook has a terrific YouTube video on the
deadlift that is much worth watching. Gray Cook and
Brett Jones have teamed together to makea "Secrets
Series" DVD set. On one video they speak about
training the backside using the deadlift.
Brett loves to deadlift and he had a previous back
surgery as well and he can now perform a Turkish
Get Up with a 108 lb. Kettlebell.


So there you have it. I hope that this provides some idea
of how to train your legs after suffering from back
pain/surgery. Get screened 1st and foremost, clean up
any imbalances that exist, then work on mobility and
stability, then tie everything together by using your
stabilizers in unison.

The only thing that I did not cover in this post is
squatting. But I believe that you should be able to
deadlift first before you even think of squatting.
Improving your squat I am going to save for another post.

Questions? Comment on the blog or email me at
sghumanperformance@gmail.com.

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