Blog

12
Nov

Exercises that can lead to Low Back Pain

If you have information that will be taken as controversial, but has pretty much been proven correct, do you tell everyone the dirty little secret? Or do you stay silent because you don’t want to piss people off?

I have debated writing this article for a while. Should I do it? Should I not do it? I’m doing it. I feel like it will allow people to have informed consent about what they do in a gym. Sure, maybe less people will “like” my page, but that doesn’t matter to me as much as presenting the best information that is out there and helping people live life to the fullest (aka not hurting).

People will take this information in one of two ways: As a personal attack and get pissed and argue about it OR as a learning opportunity. I ate a big piece of humble pie when I learned it.

I have lived personally what I am about to tell you guys. I have been doing CrossFit® since 2007 almost exclusively. I like CrossFit®. I think CrossFit® is about taking the best components of many different areas of exercise/movement/lifting and putting them into one program. If a movement isn’t beneficial/has unnecessary risk of injury, it doesn’t mean I dislike CROSSFIT® because of it, it means I don’t like that particular exercise/movement and CrossFit® as a methodology would be better without it. I hope that makes sense.

This article is about your low back and repetitive low back rounding exercises, basically low back pain and situps, GHD sit-ups, toes to bar, knees to elbow, and how it all relates.
Now, I am not some joe schmoe whining about this. I do CrossFit®, I treat people with low back pain, and MOST importantly for this article, I have lived this. I know what it’s like to wake up with low back pain every day for a year (and I was a decent crossfitter before having exercise-limiting-back-pain for 18 months…My grace was 2:29, Isabel 2:50, fran 3:17, max DL: 450, max BS: 350, mile: 5:59). Nothing is the same as living through something yourself. Reading a book about low back pain doesn’t even come close to living it and seeing it through.

General Lumbar Spine Anatomy

Lumbar spine

In order to lift the veil, so to speak, on low back pain, there is a fundamental amount of anatomical knowledge you have to have. Opinions don’t matter here. You don’t get to have an opinion on anatomy. Anatomy just exists and we have to accept that.

If you read my article on kipping HSPU, you know some basic spinal anatomy. The lumbar spine is more or less the same in structure. There are 5 vertebrae called L1, L2, L3, L4, L5. There is a disc between each pair of vertebrae. There are nerves that come out between each pair of vertebrae. And there is a stocking of connective tissue around the whole thing and then layer upon layer of muscle on top of that. We could name all those structures but, for our purposes, it doesn’t matter. The concepts matter.

 

General Disc Anatomy

There is a disc between every vertebra in the spine (minus the top couple). The disc is basically made up of two things, an outer circular portion called the annulus and an inner squishier part called the nucleus. A disc herniation occurs when the outer circular part has tears in it and then the squishy inside squirts out. You can also get tears in the outer circular part without the squishy nucleus stuff coming out.

A very interesting thing to note in the anatomy of the disc is that ONLY the outer 1/3 of the disc can feel pain! So you could potentially damage just shy of 2/3 of it without feeling pain. “My back doesn’t hurt when I do that”…yet. When someone “throws out their back” from bending forward and picking up a pencil, that crap was brewing for awhile. Misusing the lumbar spine over an extended period of time is the most common reason people injure it. It isn’t from one wrong move.

Motor Control

When you bend forward, or when you move any joint for that matter, ligaments really aren’t on tension until you get to the end range, so they aren’t loaded. What this means is that when you bend forward or round your low back, you don’t really put strain on the ligaments SO LONG AS YOUR MUSCLES ARE KEEPING YOU FROM END RANGE. This seems fine, right? Well there is this thing called the flexion-relaxation phenomenon that happens when people round their low back: the muscles relax and people end up hanging on their ligaments and discs. Not good. I would guess most people don’t have good enough control to prevent that from happening. Maybe 1% do, but definitely not the majority. That takes specific training to be able to do that.

Logic

What do you care more about? How fast you can kick your feet to a pull up bar or how much you can squat, deadlift, clean, and snatch? I think most people would agree: lifting stuff. So we have to ask ourselves the following question: what is the biggest issue we see in the deadlift, squat, clean, and snatch? The low back rounds.

What are the things we do to train our core? GHD sit ups? Toes to bar? Sit ups? Knees to elbows?

The muscles of the lumbar spine are best suited to stop motion, not create it.

If low back rounding is one of the most common flaws we see in lifting, why are we doing “core training” that teaches us to repetitively round our spines? In all the lifts, the job of the muscles of the spine is to HOLD THE LOW BACK IN ONE POSITION. Why aren’t we training it like that? We should train the spinal muscles in a way that teaches them to do what we want them to do (which is to resist rounding so force can be transferred from the hips and up to the shoulders). Don’t train the spine to generate power. Power gets generated at the hips.

Training the low back to move would be the same as trying to improve your squat by training your hips to NOT move!

I think we can agree that doesn’t make sense. If we see someone sitting with a rounded low back we tell them, “Hey that is a crappy position”…”now go round your low back 150 times in the wod”. That doesn’t make sense to me.

Why do we do repetitive spine rounding exercises? What are we trying to train? Honestly ask yourself this question. If toes to bar weren’t in competitions, would you train them? They aren’t making your deadlift and squat better. They are training your brain how to be really good at rounding your low back. You are spending time training your low back to do exactly what you don’t want it to do.

Research

If you don’t know who Stuart McGill is, you should google him right now. First thing, his mustache destroys yours. Instant respect. And second, he is a PhD in spine biomechanics, writes authoritative textbooks on low back pain, and is the go-to guy for professional athletes that have low back pain. And then those professional athletes win. Oh and he probably trained the person who trained the person who trained the person who trained the person who trains you.

What Stuart McGill’s research tells us is that exercises that require high repetitions of lumbar spine flexion and extension (low back rounding to fully extended) have the greatest potential tear that outer circular annulus layer of your disc, cause disc herniations, and can damage spinal ligaments. I can tell you from first-hand experience, both because I had these issues and I treat people who have these issues, that those things SUCK. It definitely didn’t make me fitter…

In the lab, when using spinal specimens, McGill’s research showed that

the most reliable way to herniate a disc in the low back was to basically put it through lots of reps of situps.

Here are a few links to studies McGill was part of.

Here
There is probably “minimal effective dose” to lumbar spine rounding, meaning there is SOME amount of flexion that will make the spine more resilient in that movement. I don’t think we know what that is at this point in time and we may never know since it probably varies substantially from person to person.

My Thoughts

I have probably done more toes to bars and sit-ups and GHD situps than most people reading this, so it was a really hard pill for me to swallow when I learned what the research said about these types of exercises. But then I got to thinking, why DO people do those exercises? I teach this stuff at my coach’s course and at first people look like they want to kill me. But then when we start having an honest discussion about it and think about WHY we are doing the things we are doing, it starts to make sense.

If you want to make your “core” stronger, train it to do what you functionally want it to do, which is transfer power, not create it.

Anytime we challenge pre-conceived notions or ways that we have been doing things, it’s challenging. If we change, it means we are admitting we are wrong. I think of it like this: if I don’t change, I am not learning and I am probably missing the bigger picture. People used to think if someone had a disease you could bleed the disease out of them. Wouldn’t it be silly if we still did that knowing what we know now? As we learn, we should change.

Invariably I get asked this question: Well what if I can do toes to bars and NOT go to full end range (not fully round)? I say: great! I don’t have a problem with touching your toes to a bar. I have a problem with exercises that go through a full spinal range of motion. If people can do it without going to full end range, then that’s fine. I just don’t think most people can.

Invariably I also get asked this question: Well what the heck do we do instead of toes to bar? My answer: You are asking the wrong question. The real question is do you even need to replace it? To me that’s like saying, “If I take donuts out of my paleo diet, what should I replace them with to lose weight?” Maybe you don’t need to add anything at all, you just need to take the junk out.

I expect some backlash and criticism because of this article and that is fine. You should definitely challenge what you read. Just because it’s online doesn’t mean its true! So let me just end with a few things.

  • Why do most people do crossfit? Why do people exercise? To feel better, to get stronger, etc. Injuring low backs does not help to achieve that goal.
  • The military has been taught to not have their people do sit-ups anymore because so many people’s backs are getting jacked up. It is unfortunate this hasn’t been fully implemented yet.
  • I am not criticizing crossfit methodology with this article. I want to encourage the implementation of it, which has ALWAYS been to get rid of the not-so-good stuff and keep the good stuff. It is time to follow the methodology of constant refinement.
  • I see crossfit patients all day long that are suffering from low back pain and all I do is take out the repetitive low back rounding exercises and they get better. Proof is in the pudding. “GHDs make my back hurt”. Ever heard that?
  • If you want to help the longevity of crossfit, the awesomeness of crossfit, the improvement of crossfit, please join me in not programming these movements and not putting them in competitions.
  • If you are a competitor, it’s inevitable that there will be competitions with these movements in them. This goes back to the idea of training versus competing. If you want to be decent at the movements, you will have to train them to a degree. The goal would be to do as few as possible to make sure you can perform them competently in a competition.
Now with all that in mind, since a lot of people are still going to do toes to bar, here is a video on how we think you can make it potentially less bad.