Derran Langston is a Personal Trainer and founder of Real World Fitness. He was a speaker at BackMentorMe’s Back Health event in Nottingham UK, May 2016. There he explained how strengthening up, and approaching back exercises correctly, frees his clients from back pain.
Back pain sufferer does 2 week Inca Trail hike in Peru!
A client who came to see me had close to no core strength. It was amazing that she was able to function, maintaining a relatively high position in the National Health Service (NHS). Her back pain was so bad that she was considering a spinal fusion. She was on painkillers with very long names, and these drugs were causing stomach issues.
6 months after I met her, she booked a trip to Peru to do the Inca trail with a 20 kg back pack. This was something she had always wanted to do. She completed the 2 week trip pain and almost painkiller free. She did taking Ibuprofen, but none of the very high strength prescription painkillers she had used previously.
She managed to improve her life. Don’t get me wrong, she is not doing cartwheels, but she is broadly pain free and leading a decent life. We had to build up her strength from scratch.
Why does back pain happen?
It’s a symptom of wider societal attitudes to exercise and movement. We don’t move anymore. We sit at home, in cars, at desks. It’s not just the sitting that’s causing the problem. It’s the lack of movement in general. In fact there is a lack of NEED, in modern society, to do any strenuous exercise at all. When you don’t move and actively target muscles you get into trouble. Gluteus, hamstrings, etc., don’t strengthen by accident – ever! They just get weaker and weaker.
The load these muscles are supposed to support is then transferred into smaller, far less capable muscles. And in worst case the load gets transferred into the spine. The spine is not designed to carry your entire body weight. Purpose of the spine is to give structure to your body and support your muscular system. So, time and time again we see a body that is forces to rely on small ineffective muscles, and joins that are used in a way they were not designed for.
Eventually these small muscles strain or spasm. When that happens, even more workload gets transferred to the remaining muscles. This can create problems in parts of the body that weren’t initially affected. We work closely with the client and their medical team and pay attention to everything they tell us.
Mental blocks to better back health
Our biggest challenge is to inspire confidence in the client that training in a big scary gym is not going to make things worse. People enter the gym and see weights, bars, stretching bands, squat racks and instantly think, “this guy is going to make me worse”. However, we have yet to fail helping anyone who has come through our doors with back pain. That’s a bold statement, but everyone we have worked with has got better, though not necessarily completely cured.
One of our aims is to create parity of strength. That means ensuring the posterior chain is at least as strong as the anterior chain. A relatively weak posterior chain leads to problems. What gets results is ensuring that clients’ gluteus and hamstrings can load bear the way they are supposed to. To strengthen up, clients have to “work their socks off”. And they have to train more than 15 min per week. And they have to train more than once a week. And they have to go outside their comfort zones in many different ways, for example by doing targeted back exercises.
Overall, strengthening up takes more than a couple of months. So, that is probably why a physical solution, despite being so effective, is often ignored or dismissed. It gets put on the back burner as the last resort. As personal trainers, we cannot offer the instant results and relief people are after. But we can deliver results and relief long term.
Don’t just do something. Do the right thing!
Comment from the audience (Ian Garside):
I had a client come to me with back pain who said, ‘I can’t understand why I still have a bad back, because I am very active and do loads of press-ups and sit ups’. The problem was that he wasn’t actually doing any back exercises to create that parity of strength
Back pain sufferers tend to avoid back exercises exactly BECAUSE they have bad backs. The first thing people do when they want to get fit, unfortunately, is running. That does not do anything to strengthen your gluteus, unless you sprint or run uphill. Most peoples’ approach is, “I’m going to start jogging, do press-ups and sit-ups”.
So, the most effective thing for back pain sufferers would actually be to do back exercises that directly support/target their backs. But it’s a question of confidence. Until you feel confident that you are not going to make things worse, you are not going to go near back exercises.
Comment from the audience (Richard Moore):
I refer people to Derran quite often, and sometimes clients respond, ‘a referral is not necessary, I know what to do’. My response is, ‘You don’t know! If you knew you would be doing it’. Especially people who exercised when they were younger still think they can do it. But having that extra pair of eyes and being told what to do make a massive difference.
Also, sometimes people in their 40s think of activities they were doing in their 20s, when considering what type of exercise to do. “I am going to play Rugby again”, may be their first impulse. Or they may want to play squash again or run marathons. That’s not the right way to go. You have to start as if you were “new”. Start from scratch. Unfortunately, that requires a base level of strength that, more often than not, has faded away.
So, take-away messages are, “use it or lose it”. And, if you are going to do something, do the “right thing”. Pursuing inappropriate activities may make you feel you are doing something, when in fact you are just making the situation worse.