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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.

 
  • Fiona Davis

    Good info! What do you recommend doing to strengthen and aesthetically change the mid section when you remove all the well known exercises that supposedly do that?

  • http://www.scienceforfitness.com ScienceForFitness

    I’m not sure I follow your argument completely. If people are doing squats and cleans and so forth properly they are training their lower back to not be rounded. Doing T2B and Situps is then not training the lower back to do a different movement, it’s training other muscles that are doing the work (e.g., abs and lats in T2B). Further, in CrossFit now almost everyone uses AbMats for situps and GHD situps, if done properly, don’t have a lower back rounding as the hip flexors should be kicking in to finish the movement before there would be rounding. Finally, if repetitive body weight movements that round the lower back are so dangerous, shouldn’t we be stopping gymnasts from doing all those pikes and V-Ups they do?

  • Jill Johnson

    Great info, based on solid science, but it still looks like loaded lumbar flexion in the video.

  • Ryan DeBell

    Hey Jill,

    Yes the video shows an exercise I do not recommend. It is a reality that many people will still do toes to bar and other spinal flexion exercises with a load despite the current research. The video is intended to do it as least bad as it may be able to be done IMO.

  • Susan Moore

    The only thing I disagree with (and wish I didn’t) is that our military has that the military has been taught to not have their people do sit-ups anymore. It is still alive and well and unfortunately not going anywhere anytime soon. This is something I deal with daily and as long as it’s in the pt tests, it will be done in pt. Great article and thanks for sharing. I love your take on making Crossfit better.

  • ryandebell

    Hey Susan,

    I believe they have been advised to take them out, but you are correct, sit ups are still alive and well in the military. Hopefully at some point we will see them go away.

    Thanks for reading!

  • ryandebell

    Hey Jill,

    I agree. The video does indeed show loaded lumbar flexion. Whether I like them or not, people will still do toes to bar until a great shift occurs. I advise they don’t do that, but if they insist, I will try to show them a “better” way, so to speak. Thanks for reading!

    Ryan

  • ryandebell

    Hello,

    You are correct, if they are doing those movements, they are training to resist lumbar flexion. I am not sure that AbMats reduce lumbar flexion at the top of the situp, so I don’t think it is a superior movement to “not abmat situps”. I am not against GHD situps if people can do them without hinging through their low back under a load. Unfortunately I don’t think most people can. So if someone is going to play with fire, they should be very diligent.

    Gymnasts have a lot of back problems.

    Thanks for reading!

    Ryan

  • ryandebell

    Hey Fiona,

    In my opinion, eating well is the best way to aesthetically change the mid section!

    Thanks for reading,

    Ryan

  • Antonio DeAscanis

    I have two herniated discs and a bulged disc……all three degenerated from my years in the Marine Corps. What core strengthening exercises do you recommend? Obviously variations of planks, but I am hoping there are more challenging yet safe techniques to utilize.

  • http://www.realscottsdaleliving.com/ Jon Griffith

    The abs are made in the kitchen, not the gym. Lift heavy, lift safe. Pick it up, Put it Down.

  • Ruby Red

    So if you do the floor version of toes-to-bar, but basically just let the legs go perpendicular to the floor, (and no further) aren’t you effectively training the abs on the leg lowering portion, without adding in lumbar curve? That seems like a reasonable solution. A hanging leg lift where the legs lift parallel to the floor would create the same effect, no?

    On the other hand, there are situations all the time in which the lumbar spine rounds forward. Why wouldn’t we want to train our body to handle that movement rather than avoid it at all costs? Whether someone bends down to tie a shoe, bends forward to stretch, or ends up on an airline seat for hours, lumbar curve is going to happen in life.

    I’m willing to eliminate sit-up movements from my workout, but I still question the “spine must always be in neutral” assertions that I read here and elsewhere.

  • ryandebell

    Hey Ruby thanks for the question.

    I apologize my message may have not been 100% conveyed as well as it could have been. I am by no means against flexion of the lumbar spine. It is critical for maintaining a health disc. There is no way the discs could get the nutrients they need to be healthy if the spine was never flexed.

    The point I was hoping to get across was that if you repetitively do lumbar spine flexion as an exercise, especially with an added compressive load, you may be putting the posterior-lateral disc elements at risk.

    People need to learn how to control their lumbar spine in all positions because in real life, all those positions will occur.

    However, when people are training for metabolic conditioning, I don’t think it is necessarily the best choice to choose an exercise that puts so much motion through the spine for so many reps while fatigued.

    I hope that helps!

    The spine should not be only kept in neutral! But under load during exercise, that probably is the best choice.

  • ryandebell

    deadlifts! squats! kettlebell swings!

  • Hassan ‘Sean’ Mahfouz

    interesting point, what do you think of the Reverse Hyper machine, created by Westside Barbell (Louie Simmons) , it’s said to have saved a lot of backs. honest question btw, I would really like to know what u think.

  • ryandebell

    Hey Hassan,

    I am sure it is a matter of dosage. Hard to argue that a lot of people have been helped by it according to what I have heard Simmons talk about.

    I personally don’t use it or have people use it, but that doesn’t mean it couldn’t be effective for the right person at the right time with the right dosage.

    I think people should proceed with caution before using it to treat their own back pain without being evaluated!

  • Vickie White

    Leon Chaitow, Gray Cook, and Craig Leibenson all address and specialize in what your article is talking about. I don’t think taking out a movement is the answer. I think training and bracing properly are key. If you are rounding you back, you need to know how to properly stabilize the lumbar spine and work on mobility. Most cases people round from lack of flexibility and lose abdominal tension. Glute inactivity is also a huge culprit. Our bodies were made for mobility. Just not doing something isn’t the answer.

  • ryandebell

    Hey Vickie,

    Thanks for your comment!

    I think taking out a repetitive spinal flexion movement from strength and conditioning is exactly the thing to do.

    Even if you properly “stabilize the spine”, you still get mechanical disc pressure and movement, which over time, when done in amounts that exceed the body’s ability to adapt, can delaminate the disc and cause disc bulging, herniation, and low back pain.

    There are lots of things my body is physically capable of that don’t make sense to do as an exercise to build strength and metabolic capacity. These 4 are definitely on that list.

    Thanks for reading!

  • ryandebell

    p.s. McGill wrote the lumbar spine chapter in Liebenson’s book :)