How to go back to the gym…even with back pain and what machines to avoid
Many people getting back to the gym this January are dealing with back pain or sciatica. It is easy to be confused about what to do at the gym about it? When dealing with back pain, many say that you should strengthen your back and core. But, what are the best ways and are there some things you should avoid? There are often many machines or equipment at the gym or sold that say they “strengthen” the low back. If you are dealing with back pain or sciatica right now, strengthening probably should not be your first option. Why? In most cases, feeling weak in your core or back is as a result of the pain and usually not the cause. In fact, for most, they already have enough strength to protect their back but they often develop pain or stiffness because of sitting too long or bending forward too often. So, if strengthening isn’t the first thing to do to get rid of back pain…what is? More often than not, a gentle stretch into the stiffness is what is needed. So if sitting for too long makes it worse, then a gentle stretch in the opposite direction often eases stiffness and calms aches. While how to do that is the topic of other posts, as a Physio, I’ve noticed that when you take care of the pain first, a good amount of the strength returns without ever having done a “strengthening exercise”. But, let’s say that you are now out of pain and are wanting to work on getting a stronger core, what should you do? What should you avoid? Having worked with people working on getting back into shape for 19 years, I generally have them avoid any machine for core because they don’t create good functional strength, because many are wanting to use a machine and are confused about what to do, here are your 4 gym machines to avoid when dealing with back pain along with some options to do instead to strengthen your core and low back.
First, what are the muscles we are actually targeting? What is your core?
Like it sounds, your core is at the center or you and functions like a back brace. If you think of it like a box, it has your diaphragm or breathing muscle at its top, your spinal erectors as its back, your oblique muscles(muscles on the side of your stomach) as its sides, your “6 pack” at the front along with your and your pelvic floor connecting your tailbone to your pubic bone and supporting you from below along with the core muscle everybody forgets-the glutes forming the base. Deep to all these is another muscle that acts like your internal back brace, the transversus abdominis. All of these muscles work together to brace and control the spine and give it what it just one of the things that it needs, stability. The logic goes that if you can just stabilize your spine you will be pain free but that often is not the case(because stability is just one of the things that the low back and spine needs). Often when people stabilize their spine-they overfocus on stiffening it and less on giving it “just enough strength” to do the job. This causes them to move differently and
How to think about core exercises
So, what do those core muscles do anyway? Well-their first job is to resist movement. Before gyms, everybody got strong cores not by laying on the ground and doing a sit-up, holding a position for minutes on end, or by using a machine. They did it through lifting things, moving things, and by daily chores. Their core got stronger by resisting twisting, bending, or by pulling on things. So we can think of our cores as “anti-” muscles. So how can you mimic some of those tried and true ways of getting a stronger core and using those muscles how they were meant to be used?
Avoid: 45 degree Low Back Bench/Roman Chair and any Low Back Machine Risk level Moderate Benefit Level Low
Why? Often these benches and machines rarely if ever actually isolate the low back muscles. Of all the low back machines I’ve ever worked with patients and clients on in the past 19 years, only the Lumbar MedX was actually designed to isolate the low back. Everything else mostly has you pushing with your legs. Second, these machines and the 45 degree low back bench actually take your back into a position that is most likely to cause a low back injury. In other words, when you have the most load on your spine on either the machine or the bench, your spine is in a forward bent position. Now, if you’ve been dealing with back pain, not only are you in a position that most likely triggers your pain(forward bent), but the muscles that are supposed to be protecting your back are not working like they used to so now all that force goes to the disc and joints of the spine.
What to do instead: Before we get to 3 options for strengthening your back, first we need to look at what the job of the muscles of the spine actually is. To start with, the main job of the spine muscles, aka your core, is to stabilize and resist motion. This makes for a stable platform for you to do basic things like roll out of bed or get out of a chair pain free all the way up to giving you a stable platform to run, jump, and lift. This means that your obliques job is to resist rotation, your abs to resist extension, and your low back muscles like your spinal erectors or quadratus lumborum’s job is to resist forward bending. Once they’re able to stabilize your spine in neutral, then they can be counted on to bend and twist while making a stable platform.
What to do instead: Cook Hip Lift: Risk Low, Benefit, High -Isolate the glutes to create a stable base
Avoid: 45 Degree Leg Press or Sled Leg Press
Risk Level High Benefit Low/Moderate: Scores moderate for benefit mainly for bigger leg muscles but minimal benefit for the low back, functional strength(very few activities have you pushing your legs up off your back or on a sled), and no benefit for stabilization or balance.
Similar to the back machine, the leg press has the highest stress to your back when your back is in the most vulnerable position. In this case, when the knees are fully bent, often the hips roll up off the pad shearing the bottom part of the spine.
Do this instead:
Rear Leg Elevated Split Squat/Bulgarian Split Squat
Risk Low for low back, with knee pain, it may be bothered. Benefit High for balance, low back, and hips
Avoid: Smith Machine Squat or Lunge: Risk Moderate/High Benefit Low
Like the above machines, the smith machine leaves your back in a bad position just when the load is highest on it. In addition, the machine provides the stabilization instead of your core and doesn't help with improving functional strength. In addition, it does not let your body move in a natural motion and if your set-up isn’t spot on, it massively increases the load on the lower part of your spine most responsible for sciatica and disc herniations.
Do this instead: Goblet Squats or Goblet Lunge
Risk: Low Benefit: High
The goblet squat or lunge engages your core before you ever enter the movement making sure your low back muscles, glutes, and abs are engaged.
Because the weight is at your chest, it makes sure you are not able to go beyond what you can control and if you run into any problems in your lift, you are not stuck with a bar on your back.
Please make sure it is safe for you to try any of the exercises in this post. Often we find that when we make some of the changes, like improving our posture or getting stronger core muscles at the gym don't take away the pain or we find that we reaggravate our issue. Why? Often because some of the underlying causes remain untreated. Often our nervous system becomes so sensitive that these fixes only partly calm down our nerves, ease our stiff backs or loosen tight muscles. Sometimes we try stretches or exercises that only aggravate our spine, muscles, or pinch nerves that then send sciatica pain down the leg or make our muscles spasm. Often there are other natural solutions to fix low back pain.
Concerned that getting back to the gym will only aggravate injuries? Schedule your Gym Readiness Assessment. Whether you are dealing with pain, we’ll help to get to the root cause of your sciatica, low back pain, or just to make sure your back isn’t the cause of hip, knee, or even foot pain. Or, you are just concerned that an old injury will flare when you get back to the gym, our Gym Readiness Assessment will give you the confidence you need to hit your fitness goals.
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