Is it really the case that you can’t do strength training with back pain? Dr Suess was quite right when he wrote “I’m sorry to say so, but sadly it’s true, that bang ups and hang ups can happen to you” (1990). If exercise and physical training are a regular part of your life, you are bound to sustain an injury. Mostly these will be mild, niggling injuries that stop you from training for a day or so. But rarely will you be that lucky with back pain.
“How does your back feel?” I asked one of my patients. “Shit” she replied “and if you make me do exercise I’m going to punch you.” It’s a frustrating, but all too common situation. Your back hurts and stops you from doing what you need to do, and some spritely AEP is telling you that you need to exercise. Back pain sucks, you can be sitting there minding your own business one minute and the next you’re gasping in pain. What’s worse is when you want to exercise and your back starts playing up. More often than not, lifting weights cops the blame for back pain. Ask almost any group of people and you’re likely to hear the same rhetoric repeated, “lifting weight is bad for your back.” What they should be saying is “not lifting weights is bad for your back.”
What does research say?
I’ll save you the trouble of running over to Google to find out the prevalence of back injuries in weight training, they rate second behind shoulders (Keogh & Winwood, 2017). For athletes (just so we’re clear, athletes don’t train for funsies, they do it to win. If you’re training for fun or to be healthy, (you’re probably not an athlete) they usually sustain 1-2 injuries per year (Keogh & Winwood, 2017), with training schedules that include 2-3 hours of training per day.
What the research doesn’t tell you is the specifics of the injury; was the person being an idiot and trying to lift more than they are capable of. What sort of warm-up had they completed? Were they rested from the previous session, did they use a training program that was logical, I could go on. If you dig a little deeper, you’ll also find that regular strength training reduces the likelihood of a back pain episode by about 45 % (Steffens et al., 2016). If you’re sitting there wondering if it’s worth the risk, consider this, you can suffer an injury any time of the day or night, but you can’t magically improve your back strength in the moment that you need it. So yes, weight training is worth the risk.
What really is Back Pain?
Let’s have a look at why we get back pain. The World Health Organisation reports that upwards of 60% of people get back pain at some point in their life. And of that, the most common diagnosis is non-specific low back pain (NSLBP). In other words, your back hurts and we don’t know why. Yes, I know, that doesn’t sound very reassuring; your back hurts and you want an answer. Without being able to see inside you or have you stand in front of me to perform some testing, I can’t tell you what’s wrong. However, here are the usual suspects that I see in the clinic:
- Non Specific Low Back Pain (NSLBP). You woke up one day and realised your back has been sore for a while, but you can’t remember injuring it.
- Bulged disc. You went to pick up your child/dog/a box of paper and felt a bit of a pop and now it hurts when you bend over.
- Spondylosis. A type of arthritis. Arthritis makes your joints feel sore and the spine is made up of lots of joints.
This is no means an exhaustive list, and if you have back pain you should seek the advice of an Exercise Physiologist or Physiotherapist.
My role as an Exercise Physiologist
When I have a patient who complains of back pain, one of the first things I try to get them doing is deadlifts or some variant. Now this doesn’t always go too well, and it’s almost always because of the fear of lifting weight with a sore back. I can usually tell which of my patients will do well with the introduction of the deadlift, and those that prefer the traditional and more conservative approach. For those that I can get pulling weight of the floor, a large portion of the treatment is actually directed at education; how to lift properly with your back and why it is safe to do so. For those that don’t, I still provide the same education and encouragement to use their back, but we modify the exercise selection to suit their needs.
It is important to use your back when you lift weight. Because if you don’t, your back won’t get stronger! There is only one thing I can think of that we get better at by avoiding, and that’s dying. Your body will adapt specifically to the stress that is placed on it. If you never use your back, the muscles, ligaments, tendons and bones that comprise the back adapt to that lack of use, meaning their strength is compromised. If on the other hand, you systematically subject your back to a logic progression of strength training, those same structures get stronger, increasing your ability to interact with the world and reduce the likelihood of it injuring you.
Starting Strength Training
So how do you start strength training with back pain? First things first, get it checked out. Because it’s hard to treat an injury when you don’t know what the underlying cause is. The treatments between injuries can often overlap, we want to make sure we are going after the right injury and not wasting both yours and my time.
Second, don’t stop training, keep physically active. It is rare these days to be prescribed rest as an initial treatment option and even rarer to be prescribed bed rest. Just know that rest and sitting on your arse all day are two different things. Rest means avoiding or reducing activities that may provoke an increase in symptoms or damage.
Third, if you regularly train the squat and deadlift, reduce the volume and intensity for a few sessions. If you’ve been pushing hard in your training, there’s the chance that your technique has started to slide. Giving your body a chance to recover from the residual fatigue of several days/weeks/months of training, plus a slight de-load in volume and intensity, may be enough to reduce your back pain.
Back pain is a normal part of human life. Injuries in weight training happen and there is very little you can do about it, even if you are careful. If your back hurts, don’t just train through it, get it checked out. If the physio/AEP/doctor/chiro tells you to stop lifting weight “because they’re bad for your back” find a new physio/AEP/doctor/chiro. There is no evidence to suggest you can’t engage in strength training with back pain present.
Steffens, D., Maher, C. G., Pereira, L. S., Stevens, M. L., Oliveira, V. C., Chapple, M., … & Hancock, M. J. (2016). Prevention of low back pain: a systematic review and meta-analysis. JAMA Internal Medicine, 176(2), 199-208.
Seuss, Dr. (1990). Oh, the places you’ll go! New York :Random House.