There are two kinds of people in life: those with lower back pain, and those who are going to get it
Lower back injuries are some of the most persistent, frustrating and debilitating injuries a rugby player can suffer from. Though mostly preventable, the contact nature of rugby coupled with the emphasis on heavy weight training means that occasional back injuries are here to stay, particularly amongst the forwards.
If a back injury is managed poorly it can mean poor performance, months sat on the sidelines, chronic pain or even the end of a playing career. Personally I struggled for nearly five years with a lower back injury during my twenties acquired from excessive load with poor technique when deadlifting. At one point during my internship year with London Wasps the pain was so bad that I couldn’t put my socks on.
Whilst trying to rehab this injury I made a lot of mistakes that could have made the process a lot faster and a lot less painful. However thankfully I gradually found a way to train around my back pain and allow myself to heal whilst still making gradual progress, and I’ve compiled below the top five lessons I’ve learned during this process.
As usual with anything I post up on injuries: I am not giving medical advice here. I am not a physio. I do not even play one on the internet. This is just what worked for me, and if it is able to help or guide your training, great. If it conflicts with what your doctor or physio has said, I of course defer to them.
#1 Breathing mechanics and rib cage positioning
Though I came to this lesson quite late in the day, what I learned from Dr Quinn Henoch of Juggernaut Strength on breathing mechanics and rib cage positioning has stuck with me. It boils down to this: as the centre of the body, the torso and pelvis acts as the anchor for movement at the shoulder and hip. If these segments are not properly aligned, the muscles that brace the torso and create this anchoring effect are not held at optimal length, and exert less force.
The less able the muscles surrounding the spine are able to brace and absorb the forces acting upon it, the more slack has to be taken up by passive tissues like ligaments, tendons and discs which can cause pain and injury. This can either be due to poor positioning of the pelvis itself, or inefficient breathing mechanics (ribs flared, chest rising), which has a secondary effect on the pelvis.
Learning how to properly position the pelvis and maintain “neutral” positioning, whilst breathing from the belly is the foundation of maintaining a healthy back. The trick with this is to start basic (supine, no limb movement, predictable forces) and progress to higher levels of instability (standing, upper and lower limb movement at the same time, unpredictable forces). For a detailed breakdown of how to do this, check out Dr Henoch’s articles and videos:
#2 Thoracic mobility, hip mobility
This tip is stolen straight from strength coach Michael Boyle and Gray Cook, originator of the Functional Movement Screen (check it out if you’re a strength coach). Together these guys came up with the joint by joint approach: a simple but highly informative way to describe the training needs of the various joints of the body.
Consider the body as a series of joints stacked upon one another. Research and experience has shown us that as we trace up and down the body, the major joints generally alternate between those that need more stability (the prevention of unwanted movement) and those that need more mobility (the creation of movement). This is obviously specific to range and plane of movement, but the principle is a sound one:
- Ankle- mobility
- Knee- stability
- Hip- mobility
- Lumbar spine- stability
- Thoracic spine- mobility
- Scapulothoracic girdle- stability
- Shoulder- mobility
- Neck- stability
Because of the remarkable compensatory capacity of the body, when a joint lacks its requisite mobility or stability, it will tend to “borrow” it from the joints above and below it in the kinetic chain. Tight ankle? The knee will start to move into greater valgus. Immobile shoulders? The scapulas may start to wing away from the rib cage to create movement. Specific to the back, when the hip and thoracic spine lack mobility, the lumbar spine will likely take up some of the slack.
Is asking a joint to do a job it isn’t designed to do a bad thing? Well, to paraphrase Mike Boyle, “we call a hypermobile knee an ACL tear”. Dr Stuart McGill would call a hypermobile lower back a good recipe for back pain and injury, and his research shows that excessive loaded movement through the lumbar spine is an efficient way to injure a disc.
A major way to reduce loaded flexion extension through the lumbar spine is to minimise the mobilty demands placed on the lumbar region by its neighbours in the kinetic chain: the hip and thoracic spine. Surpise, suprise: we do this by increasing the mobility of these joints (in all three planes for the hip, and primarily in the saggital and transverse planes for the t-spine).
A full breakdown of how to achieve this goes beyond the scope of this article but stick to these principles:
- Position the joint properly
- Inhibit overactive tissues
- Activate inhibited tissues
- Stabilise and move through range
#3 Switch to unilateral exercises only
“The squat is King” is a cliche. Cliches have a lot of truth. The squat is a fantastic exercise and all my healthy athletes perform some kind of variation in their training plans. But the squat is by no means a pre-requisite to being strong or athletic (and research is starting to show this). The same goes for the deadlift too.
The majority of weight room back injuries occur during squatting or deadlifting. Whilst good technique and sensible loading can near eliminate the likelihood of a back injury (how I wish 2006 me could meet 2016 me), once the damage is done and the back is injured these exercises can still cause a lot of back pain even with good technique. Going super light is possible, but when you lose the load you lose the adaptation.
One work around in this situation is unilateral (single limb) exercises. Let’s look at the math using an 80kg man back squatting 100kg as an example. The mass of body segments are based off this normative data.
- Mass of the lower limbs: 28.8kg
- Body mass minus lower limbs (which the spine must bear the load of): 51.2kg
- Additional load of the barbell: 100kg
- Total load borne by the spine: 151.2kg
- Load borne by each leg: 75.6kg
Now let’s look at an example of an unsupported single leg box squat with an additional 10kg in dumbbell load (from my younger, more handsome days):
- Mass of the supporting lower limb (supporting the body): 14.4kg
- Body mass minus the supporting lower limb: 65.6kg
- Additional load of the dumbbells: 10kg
- Total load borne by the spine: 75.6kg
- Load borne by each leg: 75.6kg
Are unilateral exercises and bilateral exercises created equally? Of course not. My preference will always be to perform a mixture of both in my programmes. However in the event that heavy bilateral exercises cannot be performed due to back pain, the math and my experience shows that switching to just unilateral exercises can be a good substitute, whilst placing far less stress on the lower back. Certainly, when I could barely back squat an empty bar at my worst, I was still able to perform heavy single leg squats and gradually work up to 50% of my bodyweight in additional load for several reps.
#4 Non-axial loading
I have typically found axial loading (bar on the shoulders) to be the most problematic when training around lower back pain. Perhaps due to the high compressive or shear forces placed on the vertebral discs, for whatever reason axial loading really disagrees with lower back pain.
This means that if you are suffering from back pain, but really want to keep bilateral lower body strength training in your programme, traditional barbell squats are probably out. You will have to get creative and experiment with other forms of loading including but not limited to: belt squats (machine or simulated), zerchers and goblets.
When choosing forms of loading for unilateral lower body lifts the options can also be expanded to dumbbells, sleds, weight vests, and landmine variations (popularised by LA trainer Ben Bruno, who I have personally found to be a great resource on training around an injured back. He also trains a bunch of super models, the poor guy):
If you have back pain, experiment with different positions and see which causes you the least irritation. Once you find what works, progressively load it as heavy as you can whilst time and more direct rehab sorts the injury out.
#5 Multi directional torso stability
Once again returning to the joint by joint approach, the partner to increasing hip and thoracic mobility is to increase stability directly at the lumbar spine. Generally speaking: increased stability = less movement, less movement = less irritation and damage to the discs = less back pain.
As previously discussed, Dr Stuart McGill has identified the loading primary mechanism to damage intervertebral discs is flexion-extension. But we have to consider lateral flexion and rotation too, as these movements can still be problematic and painful if suffering from lower back pain. Likewise sport happens in all three planes of motion, so it is just good athletic programming to be able to produce, transmit and absorb forces in all directions.
Like any other motor pattern, lumbar stability is a skill. As such it should be trained and progressed as the level of mastery increases. Drills can start out as elementary as supine bracing (no limb movement, no load, no postural demands, no unpredictable forces involved) and progress to something as demanding as a crazy bar Zercher carry (upper and lower limb demands, high load, high postural demands, dealing with unpredictable forces):