Saturday, June 6, 2009

Eliminate Back Pain

Back pain is the #1 reason for missed days of work. But it need not be. Most people have weak cores, and that is the reason they hurt their backs so easily. Ab strength is crucial for core strength and sit ups aren't going to get you there.

Eric Cressey is a genius of rehabbing and preventing injuries - here he tells you how to strengthen your back, or more indirectly, your whole core. Be sure to check out the previous two installments in this series.

Be sure to also go check out the videos - the Band Resisted Ab Wheel is my new favorite ab exercise.

Bulletproof That Back

It's time for Round 3 of my Lower Back Savers. If you missed Parts 1 and 2, check them out here and here, respectively.

This time around, we've got fewer bullet points and plenty of videos.

15. Reevaluate Your Use of Unstable Surfaces.

I've spent a good chunk of the last five years studying unstable surface training (UST). In fact, the results of my master's thesis were published in the Journal of Strength and Conditioning Research in 2007, and I've written an entire e-book about the topic.

My main impression that's come about from all this research and experimentation is that UST is like the food guide pyramid of the exercise world. There are certain people in certain scenarios (e.g., ankle sprain rehabilitation, upper extremity proprioception drills) who need to use it, whereas it's remarkably inappropriate for others. Standing on an unstable surface is different than sitting on an unstable surface, which is also different than doing a push-up on an unstable surface.

I could go in a hundred different directions with this, but for the sake of brevity — and to avoid the guaranteed Internet pissing match that would ensue — I'll simply highlight one obvious perspective and back it up with a bit of research. Classic "core" work on unstable surfaces doesn't really carry over to anything.

Stability balls might increase fiber recruitment on these exercises (and double the spine load, according to Dr. McGill, but that's another story). The bigger issue is that the core stability improvements may not carry over to functional tasks.

A 2004 study from Stanton et al. is a great example of the divide between testing proficiency and performance. Researchers found that six weeks of stability ball training improved core stability in young athletes — as it was measured (in a manner consistent with the training itself).(1)

In other words, this is like saying that bench press training will make you better at bench pressing. Well, duh! The more important question, though, is whether or not that bench press performance will carry over to athletic performance.

While their measure of "core stability" improved, it did not effect favorable changes in running economy or running posture, or modify EMG activity of the abdominal or erector spinae muscles. In other words, it didn't carry over.

A comparable result was seen in a 2005 study from Tse et al. After eight weeks of stability ball training in collegiate rowers, while "core stability" (as they tested it) improved, the experimental (core training) group showed no performance improvements over those who did ZERO core training during this time.

And, the researchers tested several measures: "vertical jump, broad jump, shuttle run, 40-m sprint, overhead medicine ball throw, 2,000-m maximal rowing ergometer test."(2)

So, I guess the question is why bother doing this stuff if there really isn't any evidence to suggest that it directly improves performance? I could take the "it may lead to injury" perspective, but I think that the "why waste your time?" mindset is far superior.

Of course, if you're training with unstable surfaces just for comedic value, carry on.

16. Appreciate the Role of the Thoracic Erectors in Protecting the Lumbar Spine.

Take a look at any high-level Olympic lifter or powerlifter, and you'll see some monster thoracic erectors. Why? They subconsciously know to avoid motion in those segments most predisposed to injury, and the extra meat a bit higher up works to buttress the shearing stress that may come from any flexion that might occur higher up on the spine.

Novice lifters, on the other hand, tend to get flexion at those segments — L5-S1, L4-L5, L3-L4, L2-L3 — where you want to avoid flexion at all costs. Show me a lifter with crazy hypertrophy in the lumbar erectors, and I'll show you a guy who probably has a history of back pain. Our body is great at adapting to protect itself — especially as we become better athletes and can impose that much more loading on our bodies.

Here's the issue, though: you've got to take care of your thoracic erectors or else they won't perform up to par. Tissue quality is incredibly important, and since regular massages aren't always feasible, we utilize two "home versions" with our athletes.

First, you've got the more diffuse approach with the foam roller.

Second, you can get more focal with a doubled tennis ball (held together by masking tape) by working with a ball on each side of the thoracic spine.

17. Consider the Different Classes of "Core Training."

There's been a pretty solid back-and-forth jabbing here at TMUSCLE over the past few years about whether or not specific "core" work is overrated. Some say that squats and deadlifts are enough, while others insist that you've got to train the core directly. Who's right? As usual, my answer is "it depends."

Would a powerlifter and other breed of athlete — whether it's hockey, soccer, baseball, football, or whatever — have different demands? Yep!

Now, how about an athlete who played baseball when he was younger and then took up powerlifting after a collegiate baseball career? Wouldn't he have a unique set of a) weaknesses and b) functional demands? Of course!

Next, how about a 38-year-old guy who a) chases his two kids around, b) sits at a desk eight hours a day for work and then in the car for another hour to commute, c) lifts heavy stuff three days a week, d) does interval training twice a week, d) does yard work, and e) plays on a beer-league softball team once a week? Think his core might have different functional demands?

Different people, different needs, limited training time and energy. What do you do?

If you're me, you categorize your core exercises in one of the following four disciplines (although there may be some overlap):

I look at both squats and deadlifts as anti-flexion. Your goal is to maintain your neutral spine in scenarios where the load is positioned in front of your center of gravity. Honestly, if you are regularly doing squats and deadlifts (and their derivatives), I don't think you need to add in extra anti-flexion exercises.

Working with predominantly athletes, though, anti-extension and anti-rotation exercises are of paramount importance. As the majority of athletic lower back injuries involve uncontrolled extension or rotation in either an acute or chronic sense.

With anti-extension exercises, we're generally setting up in a position where gravity makes our job tougher. Examples include regular ol' prone bridge variations (video at right).

These can be progressed to include all sorts of push-up variations and ab wheel/bar rollout masochism (video at right).

Finally, I love to integrate this work with overhead medicine ball throwing variations, where you resist extension each time you go overhead with the ball, whether you're getting ready to throw, or just catching.

Taking this a step further, you can appreciate that overhead pressing can serve as a great anti-extension exercise.

As you can see, several of these exercises also include a rotary stability component (the overlap to which I alluded earlier). However, it's also important to directly train rotary stability, particularly in rotational sport athletes. A basic side bridge is an excellent start for beginners (see photo at right).

These can be progressed into variations with perturbations, or single-leg side bridge variations. See the video on the right for a side bridge wall slide.

Next, you can toss in some Pallof press isometric holds and split-stance cable lifts (videos at right).

And these are all great lead-ins to rotational medicine ball training (video at right).

Taken all together, I hope that this classification scheme makes you appreciate that "core training" isn't just about training abs and obliques. More importantly, it's about training motor control: maximizing hip motion and lumbar stability, and then integrating the two in more complex movement schemes.

And, since very few of the readers out there live and die exclusively by squat, bench, deadlift, it becomes increasingly valuable to dabble in all three realms of my classification scheme each week.

18. Learn to Love Single-Leg Movements.

One other realm of stability I think is important to cover is single-leg stability or, simply stated, how well you stand on one foot. It's crucial to overall health and performance for a number of reasons.

First, we spend a good chunk of our lives standing on one foot. Lunges, split squats, 1-leg RDLs, step-ups, and other single-leg drills are specific to the real world.

Second, and more specific to back pain, in many (but not all) cases of lower back pain, you can use appreciable loading on single-leg exercises because it's much easier to maintain the spine in a neutral position in split-stance than in the position of bilateral hip flexion that occurs with squatting and deadlifting variations.

Additionally, you can generally drop a vertical line down through the center of gravity from the load on single-leg movements (whether they're loaded with dumbbells or a barbell). As a result, there's less shear stress and a reduced likelihood of going into lumbar flexion under load.

Third, using single-leg exercises with correct technique elicits equal contribution of the hip abductors and adductors; the abductors have to "cancel out" the commonly dominant adductors, or else your knee falls in. Seems easy enough. However, there's more.

Imagine how improved abductor function carries over to the standing position, including gait. If a person's hip falls out (adducts) in weight bearing, the photo to the right shows what happens to your spine.

This just goes to show you that the role of the hip abductors (glute medius, if that's your cup of tea) is as much dynamic stabilization in weight-bearing — or resisting hip adduction — as it is pure hip abduction. You can also tell that it has direct implications of increasing the likelihood of anterior and lateral knee pain (more valgus).

And, if you don't know what the hell I'm talking about, just recognize that single-leg work is insanely important, whether you're healthy or have back pain. Here are a few articles with some good single-leg flavor:

Five Programming Strategies for Quick Results
Single-Leg Supplements

19. Tinker with Your Foot Position on the Bench, or Change the Exercise Altogether.

It may be hard to imagine if you haven't ever had back pain before, but those who have tried to do upper body days with back pain can tell you that setting up on a bench can be a pain in the butt.

A lot of lifters with extension-based back pain will have problems with lying back on a flat bench. These individuals can get some quick symptomatic relief by simply elevating the feet on some 25-pound plates or aerobic steps. This little bit of foot-lift leads to a slight increase in hip flexion, which allows the lumbar spine to flatten out a bit, eliminating some of the extension stress.

Another option for these individuals is to simply switch to incline pressing variations. The angle between the seat and back pad on the bench ensures that same position of hip flexion. Or, they can switch to floor pressing with the knees flexed, which keeps the spine a bit flatter on the ground.

It's also worth mentioning that if you're trying to train upper body while dealing with back pain, it's generally a better bet to opt for barbells as opposed to dumbbells with your pressing exercises. When a lower back is hurting, the last thing you need to be doing is bending over to pick up heavy dumbbells from a low rack and maneuvering around the gym with them.


Next up, in the last installment of this series, I'll bring everything to a close with the introduction of some drills you may not have seen before, plus a few technique cues to optimize lower back health and performance.


1. Stanton R, Reaburn PR, Humphries B. The effect of short-term Swiss ball training on core stability and running economy. J Strength Cond Res. 2004 Aug;18(3):522-8.

2. Tse MA, McManus AM, Masters RS. Development and validation of a core endurance intervention program: implications for performance in college-age rowers. J Strength Cond Res. 2005 Aug;19(3):547-52.

About Eric Cressey

Eric Cressey is a highly sought-after strength and conditioning coach and owner of Cressey Performance, just west of Boston. Eric has worked with athletes of all levels, from youth sports to the professional and Olympic levels. He publishes a free weekly newsletter and daily blog at

Eric's products are available in the TMUSCLE store, and you can pick up a copy of his new e-book, The Truth About Unstable Surface Training, here.

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