Back pain can make bending over, getting out of bed, even breathing seem unbearable. Many of these individuals have back pain because they don't exercise. Yet many avid exercisers also experience crippling back pain. In their later years, bodybuilders often wince like their spine is lined with metal spikes when they lean over to tie their shoelaces. So it seems like you're damned if you don't train, and, eventually, damned if you do.
Particularly among those who lift weights, back injuries tend to occur in the lumbar region, the lower spine. The discomfort can range from mild, occasional twinges to chronic, long lasting, persistently intense pain. A pulled muscle, a damaged disk, a degenerative disorder, or the wear and tear imposed by Father Time can be to blame. Poor posture, incorrect lifting technique, and carrying around a gut for years in turn often cause those sources of pain.
To learn how to avoid eventual spinal damage and associated chronic back pain, I interviewed Jason Highsmith M.D., author of The Complete Idiot's Guide to Back Pain. He is a board-certified, fellowship-trained and highly sought-after neurosurgeon, a world-renowned expert on the treatment and prevention of degenerative and traumatically-sustained back injuries.
What do you treat and how would you describe your approach?
Neurosurgeons like me perform more back surgery than any other specialty as a whole. We treat everything from pinched nerves and sciatica to degenerative disc disease and stenosis. My specialty is minimally invasive surgery. Obviously most patients do not need surgery, but every day we treat dozens of patients with spine issues and help them find relief with the best options.
My approach to patient care is multi-specialty. Exercise, weight loss, lifestyle change, physical therapy, chiropractic care, injections and pain management are all steps along the way.
What are the major warning signs that a person's back pain might be symptomatic of serious injury?
Weakness, numbness or both is a serious cause for concern. Loss of bowel or bladder function is a medical emergency.
Persistent back pain in children is also a cause for concern. Most back pain in children comes from backpacks and poor posture, but it can be a warning sign of scoliosis, or even tumors.
How might one tell the difference between ligament and muscle pain?
Ligament pain is usually more apparent with active and passive motion; muscle pain is typically worse with active motion. But the difference is subtle.
Can you elaborate on why you feel bodybuilding is important for both strengthening one's back and maintaining its integrity?
Most back pain comes from a muscle strain or ligament strain. Having a strong core of musculature can stabilize and brace the spine to reduce injury. Those with a preexisting injury can benefit from core strengthening as well.
What tips do you have for a bodybuilder who wishes to train safely with the health of their back in mind?
Everyone knows that working antagonistic muscle groups is always important in exercise. This is especially true for those with back problems since you want to balance forces on the spine as you build your core. Doing tons of sit-ups for great abs on their own is not a good idea. It is important to equalize the forces on the spine by working opposite muscles.
Some exercises are contraindicated in patients with degenerative disc disease. Weightlifting that increases axial load (weight in line with the spine) can make pain worse. These exercises include leg presses (when done seated with hand grips), deadlifts, military presses and lunges with the load on the shoulders.
The good news is that most bodybuilders are aware of their physique and form and by definition are in great shape to avoid back injuries. However, poor lifting techniques, especially with higher weights, can really tweak things. If you start having back pain, lower the weights and increase the reps.
Why is weight loss the number-one thing a person can do to reduce back pain? And will losing weight also help to address the cause of this pain?
An overloaded car causes the tires to bulge and wears out the shocks. Likewise, extra weight on the spine has been shown to cause the discs to bulge more. Some weight bearing (walking) is vital to disc health because discs have no blood supply; they receive nutrients from the adjacent bone and cartilage "pumping" nutrients into and waste out of the disc.
Losing weight can reduce wear and tear on the disc as well as bulging. Sometimes damage is already done, but weight loss is almost always beneficial to the spine when done in moderation and when combined with low-impact exercise.
Why is a fat stomach particularly problematic in terms of back health?
A large abdomen distributes weight too far in front of the spine and affects alignment. It causes you to learn forward too much, and to compensate, most people "hyperlordose" their spine, which forms swayback. Extra weight overloads the discs and the facets.
What key muscles should be targeted to ensure a strong core region?
The obliques, transversus, rectus and psoas muscles in the abdomen, as well as and quadratus lumborum and paraspinals for the back.
When one experiences back pain who should they consult? How would an expert such as you put them on the path to recovery?
Most back pain goes away with conservative care that includes rest, ice and heat and over-the-counter medications. If pain persists for more than a few days or involves weakness or numbness, see your primary care physician.
Many non-spine causes of back pain can go undetected. The primary physician can help coordinate care among all of the specialties mentioned above. When I see patients, typically everything else has failed.
10 Rules For A Healthy Back
1 Get Moving
Keep your body well conditioned, maintain a healthy weight, exercise regularly and avoid sedentary living to help prevent back injuries and associated pain. The more you move and stay active, the healthier you will be.
2 Put Down The Cancer Sticks
The nicotine contained in cigarettes alters the chemical structure of our intervertebral disks, rendering them prone to rapid dehydration. This makes them brittle and leaves them more vulnerable to tearing. This is yet another reason to quit this foolish habit.
3 Maintain Good Posture At All Times
Through much of our daily life, we are required to sit, often for extensively long periods. Dr. Highsmith recommends that our computer screens be set at eye level and that our seat is positioned to where our legs are at a 90-degree angle with our feet tilted slightly upward.
4 Take Regular Breaks If Sitting For Long Periods
Regular small breaks are better than one large break, says Dr. Highsmith. A couple of minutes' walking every half an hour or so will help to relieve the pressure that has accrued through our spinal column while sitting.
5 Minimize Laptop And Cell Phone Use
"The laptop is the worst thing for proper ergonomics" says Dr. Highsmith. Cell phone use—when the neck is turned sideways—similarly encourages the kind of bad posture that can cause back stress. However, certain communicative technologies, such as Bluetooth headsets, can alleviate much of this strain and may be suitable replacements.
6 Work Your Entire Core Region
Your abs must be exercised in conjunction with all other core areas to ensure total core health. This means building strength in the lower back as well. Balance flexion (forward bending) with extension (backward movement).
7 Observe Your Sleeping Position
Dr. Highsmith recommends sleeping on our side on a firm yet comfortable mattress. This fetal position will help to take the most stress off our backs. A pillow tucked between our legs will help take pressure off the hips. The worst sleeping position is thought to be on the stomach. It exaggerates your spinal arch and may cause strain.
8 Don't Ignore Certain Symptoms—Or Else
When back pain first occurs, you'll probably keep doing what you're doing; you'll try to fight through the discomfort. Dr. Highsmith says to stop what you are doing, rest your back, and take an anti-inflammatory medication. Got leg pain or weakness? See your doctor. Lost control of your bowels or bladder? Get to the ER, stat.
9 Speed The Healing Process
If your back pain allows a degree of mobility, keep the area stimulated with light exercise, such as swimming and walking. This helps healing without risking further injury to the disks.
10 Avoid Certain Exercises
Although Dr. Highsmith stresses that physical activity is an excellent way to strengthen the back and help the healing process, some moves should be avoided if your back hurts. Military presses (where a barbell is lifted overhead) and weight-assisted lunges are not recommended; they can axially load the spinal column (compress the spine from the head area—as when a person dives into shallow water and lands headfirst). Running can also be risky, he says. Just make sure you get your cardio some other way. Your back needs love, but so does your heart and lungs.