We live in a world where low back pain is a very common issue.  We all know people who have back pain or who’ve had hernias or hurt there back playing sports, training or sometimes just picking up grocery bags off the floor.  I read a statistic somewhere that stated that 80% of the population will, at some point in their life, suffer from back pain.  That is A LOT!  And the truth is that low back problems are still very misunderstood.  Even in the research world, we seem to have a better understanding of the injury mechanisms of the lower back, thanks to great researchers like Stuart McGill, but there are still some gray areas.  There seem to be much more that we need to learn.

But as I just mentioned, there is definitely a better understanding of the injury mechanisms of the lower back.  According to McGill’s research there are different movement patterns that cause low back problems.  Hernias and other back problem are usually a result of one of the following:

• repetitive and/or excessive flexion at the lumbar spine
• repetitive and /or excessive extension of the lumbar spine
• repetitive and/or excessive rotation at the lumbar spine
• a combination of flexion and rotation
• a combination of extension and rotation

Most back problems originate from one of these mechanisms.  There are different reasons why these injury mechanisms develop.  Lack of hip mobility, lack of thoracic spine mobility, muscle imbalances and compensation patterns in the hips and core, poor posture, and sitting too much are all reasons why back pain these injury mechanisms can end up causing back pain.

One thing that is really important to understand with back problems is that they do go away.  Having back pain at some point in your life doesn’t mean you have to be stuck with this pain all your life.  Even serious back problems such as hernias don’t last forever.  If it needs surgery, you obviously need to get it.  If you don’t need it (which is often the case with low back hernias), according to McGill, the disk will go back in place by itself if you allow it some recovery time.

If the pain persists or come back, it probably means that the source of the pain hasn’t been addressed (note that I said the source, not the symptoms).  As mentioned above, the injury mechanisms that I outlined that are at the source of most back problems need to be addressed.  That might mean to learn to bend over the right way and learning a good hip hinge (e.g. let the hips move and do the work while keeping the spine in a neutral position).  It could also mean learning to get more hip extension when you run instead of having the lumbar spine compensate and extend too much.  There are also many daily behaviors that will need modifications in order to avoid the faulty movement occurring at the spine.

The bottom line is that you need to re-train your body to move the right way.  If you don’t, the pain will keep coming back because the injury mechanism is still there.  There is also usually a big mental component to any back problem, and understandably.  Folks who suffer from back pain often apprehend the pain coming back, whether it’s when they train or just in their daily activities.  Part of the re-training process in teaching good movement patterns and teaching back pain clients to move better is going to be mental and making sure they understand that they are not stuck with that pain their whole life.

It’s THAT important that you explain all of that as well as possible before you drop the word ‘Deadlift’ in front of them.  The deadlift is not only a safe tool, but an essential part of their rehab.  Most of them will associate deadlift with back injury, or think of it as a dangerous exercise for their back.  This couldn’t be any further form the truth.  And obviously deadlift doesn’t mean ‘heavy’ or ‘full range of motion’ right from day 1.  But there is a very under-appreciated rehab component to the deadlift for clients who’ve had back pain.  The deadlift is probably THE best way to teach someone how to hinge at the hips, while keeping their spine in a neutral alignment.  By reinforcing this movement pattern you will help your clients reduce their risk of re-injuring their back.  A very careful approach must be taken though, and no flaws should be allowed in their form before any type of loading is even considered.  The deadlift is really just a hip hinge and everyone should own that movement, whether you lift weights or not.  It’s just a back saver to know how to deadlift the right way.

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Core Training. One of the most important component of a training program.  We all include in our program exercises like planks, rollouts, knee tucks, rotation/anti-rotation exercises to work the core in all possible ways. 

But what happens when you perform these exercises with high loads or you go to failure on them?

You overload the rectus abdominis, external obliques and in some cases the lumbar erectors. 

But isn’t that the whole purpose of core training?

The answer is, in part.  The rectus abdominis, external and internal obliques as well as the lumbar erectors are part of what we call the outer core.  The thing is there is also an inner core.  The inner core is a term I learned from Dr. Perry Nickelston and it is used to describe the core muscle group formed by the diaphragm, the pelvic floor, the multifidus and the transverse abdominis (TVA).

The inner core is responsible for the muscle activation that support respiration and segmental stability at the lumbar spine.  When these muscles are not properly activated, more stress is applied to the outer core muscles to stabilize the spine and this can further lead to back pain.

So how do we train the inner core?

First of all, the inner core needs some low load exercises to activate properly without having the stronger, more dominant outer core muscles compensating if the load is too heavy.  The inner core is also easily activated by squeezing something between your knees or by reaching overhead with your arms.  With that in mind, I am currently using a variation of the dead bug series that combine both activation patterns of the inner core muscles. 

When performing this exercise, you should focus on keeping your belly thight the whole time, crushing the ball with both knees and you should avoid arching with you lower back as you reach overhead (you want to keep a slight natural arch in your back though).

I’ve had great results from implementing this movement in my own training program.  I still need to play around a little more with these inner core activation exercises, as I’m just starting to understand their true function.  I do believe that inner core training is a good complement to any core training program.

Dr. Nickelston also wrote a very interesting blog post on Carson Boddicker’s website about the inner core where he demonstrates 2 simple progressions of exercises that  work on activating the inner core.  You should definitely check it out HERE.