The Ten Back Commandments
I been in this game for years….
Please tell me you’re singing along in your head right now.
Back pain is one of the most common complaints I hear about from friends, family, and clients. In addition to acute back injuries, I often hear from people who are experiencing chronic back pain. With our sedentary work situations, stay-at-home orders during COVID-19 limiting activity outside the home, and contributors to poor posture such as cell phones and computers, its no wonder that back pain is such a common complaint. In fact, 80-90% of Americans suffer from back pain at some point in their lives, and back pain is the second most common reason people visit their primary care physician. Chronic back pain also affects our mental health, in fact is has been shown to have a correlation to depression and anxiety. Often, people are unsure of how to take action when it comes to the discomfort they are feeling sooooo……
…..I wrote me a manual, a step-by-step booklet for you to get your game on track, not a painful back. (just go with me on this one guys).
Rule number uno: Always let someone know - how much you let go, cause you know…
I can’t tell you how many people just accept their back pain as normal! (Or maybe you already know, because you’re one of them?) From my friends, to my own dad, to my clients - often people come to me with another injury, and when discussing their history they casually mention that they’ve been living with back pain for months and even years, and have just kind of let it go as something they will always have to deal with. This seems to often be the case after an injury like a herniated disc, and often becomes part of someone’s actual identity: “I have a bad back.” It’s important to let someone know about the pain or discomfort that you’re feeling, and equally as important to not allow it to place long-term limitations on you. Once we know, we can do something to change it.
#2. Help us better plan your next move - don’t you know fit pros don’t want silence from clients? Take it from your highness (uh huh)…
Especially when you’re involved in a training program as you recover from an injury or are working to battle chronic pain points, good communication is essential. At a minimum, you want to let the professional you’re working with know the following:
An honest assessment of how you’re feeling going into your session - are you tired, stressed, sore, in pain, frustrated, or excited, motivated, and ready to go today?
If an exercise causes pain during your session (so they can make an adjustment or select another exercise to achieve the same goal via a pain-free movement)
How you’re feeling after your session
Instances of pain that come up in between sessions (and triggers if you are aware of them)
Instances of productivity that occur between sessions (for example, the ability to utilize a new functional movement pattern you learned, feeling how activation of certain muscle groups decrease your daily pain, or your ability to make the connection between an exercise and a regular daily activity).
Of course, the responsibility isn’t all on you here - a good fitness professional will be sure to check in with you consistently on these points, as they provide us with valuable information that influences the way that we plan your workouts..
#3. It’s never just “NO, body” - go ‘head and set that class up you would have passed up.
Multiple studies have shown that people who avoid movement when they have back pain actually experience more pain, experience higher incidence of depression, and have a more difficult time returning to their daily activities. Most back specialists advise no more than 2-3 days of bedrest/limited movement upon onset of back pain, and prefer their patients to get moving sooner rather than later. That being said, you might not be able to jump back into your normal activity at full tilt. Some modifications you can try include:
Choosing a walk instead of a run
Choosing restorative yoga class instead of a power flow
Extending your warm-up and cool-down periods and shortening the more intense segment of a workout
Choosing a low-impact workout
Staying in the saddle during spin class
Splurging on a Pilates solo or duet where the teacher can give you one-on-one attention, cueing and modifications that you’ll be able to utilize in mat classes down the road
Taking the modification options your group fitness instructor gives in class
If you want more specific adjustments to your programming to help get you through this time, it’s best to work one-on-one with a fitness or rehab professional who has experience in this area.
#4. I know you heard this before - never comply till you own your “why”.
If you work with me you definitely know this is my motto! I love explaining programming to my clients, I believe it helps them take ownership of their body, especially after an injury when it can feel like your body has betrayed you. It’s important to me that you understand the purpose behind an exercise, my intention in programming it, and how it fits into your goals. As anyone who’s experienced an injury knows, the experience can feel incredibly disempowering. Understanding the “why” of an exercise helps you take control back of your body, and improves motivation and consistency.
#5. Never cut no slack where you rest at - it’s what you do repeatedly in small amounts that really counts.
One thing I tell my clients all the time is, “You train with me 2-3 hours a week. But what are you doing in all the other hours?” It’s not that I want them exercising 24/7. But when it comes to back pain, I can’t stress the importance of consistently good posture enough. If you are slouching through your whole workday, our work together will only go so far. It’s what you do at home that’s most important! The habits you’re in can be hard to break, and you might not even be aware of them at first! An easy way to check in with yourself throughout the day is to set an hourly reminder on your computer or phone for a “posture break.” Have you moved into what I call “screen drift”? Are you slouching forward or to one side in your chair? Can you pause for a moment, close your eyes, feel both SITS bones, and take some diaphragmatic breaths? Can you get out of your chair and walk around for a minute, even if it’s just to refill your glass of water? Can you show your spine some love with gentle stretches or isometrics? Your body will thank you for making these simple corrections, and soon they will become your new normal.
Some of my favorite postural exercises for at home include:
Cervical Retraction/Elongation
Scapular Retractions
Wall Angels
Isometric Wide Rows
Tranverse Abdominis Isometrics
Figure 4 stretches
Seated & Supine Twists
#6. That goddamn dreaded deadlift - you think this move’s bad for your back, sh*t forget it.
I’ve heard so many people - clients and colleagues alike - say that deadlifts are “bad for your back.” In actuality, deadlifts can be an incredible addition to your programming, whether you are focusing on injury prevention, or recovering from a back injury. Deadlifts are amazing for a few different reasons. First, they are an exercise that improves posterior chain strength (glutes, hamstrings, spinal erectors) as well as core stability (all 360* degrees of your core at that). Second, they train you in the ability to transfer force and generate power throughout your whole body. Third, they are incredibly functional, and improve your ability to do everything from moving a heavy piece of furniture to picking up bags of groceries. Fourth, this is an extremely versatile exercise, with variations to accommodate beginners to advanced lifters. My clients often work traditional deadlifts, RDLs, and single leg deadlifts, to name a few variations. The caveat to all of this, of course, is that this movement, like any other, has to be done with correct form - with a neutral spine and correct hip hinge pattern, and, you must have the proper range of motion and flexibility to do that. Again, when done correctly, deadlifts strengthen your hips, legs, and core, and therefore help spare the spine undue stress during activity.
#7. This rule is so underrated - keep your ego and your training completely separated.
Often injuries occur when we do too much, too soon. Whether you’re coming off of an injury or a training hiatus, or you are beginning a new fitness routine, it’s important to not compare your work to anyone else’s, or even to a former version of yourself. In the yoga world, we like to say, “Stay on your mat.” It’s not just a physical ask to respect students’ personal space, it also reminds everyone in class to keep the attention on themself, and to drop into how their body is feeling in that moment, on that day. By keeping your ego out of your workout, you’ll be able to challenge yourself while staying safe.
#8. Never keep no weight on you - work done with bodyweight can be fun too.
This comes after rule #7 for a reason! We never want to add weight to an exercise until we can perform it with good form for a pre-determined number of reps. Adding weight before you can accomplish this at best means you aren’t getting the intended benefit of the exercise, and at worst leaves you more susceptible to injury. When you begin to add weight, a good rule of thumb for making sure you’ve picked the correct amount is to be sure that it is a weight with which you can maintain proper form, while feeling that the last 2-3 reps in each set are challenging.
Some of my favorite bodyweight exercises for my clients with chronic back pain are those that work 360* of your core, meaning that muscles that control all directions of your trunk are involved. These include:
Planks (and all their variations!)
Hollow Holds
Bridges (and all their variations!)
Dead Bugs, Donkey Kicks & Bird Dogs (basically all the animal exercises)
Modified Pistol Squats
Modified Single Leg Deadlifts
Multi-Directional Lunges
Remember, good form is a priority here before you increase the time of your holds, add weight, or make the exercise more complex by choosing a challenging variation.
#9. Shoulda been #1 to me - If the pain lasts too long, better call your MD.
Sharp, sudden pain or pain that lasts for more than a few days should always be checked out by a medical professional. If you’re concerned that you may have an injury, it’s best to avoid any exercise that causes pain until you see a healthcare professional such as an orthopedist, a physiatrist, or a physical therapist. If you’re not sure whether you’re experiencing discomfort or pain, check out my blog post “No Pain, No Gain: Myth or Motto?.”
#10. A strong word called alignment
Health and fitness practitioners, as well as our patients and clients, need to be careful with the way the work “alignment” is used. The phrase “my x (pelvis, spine, rib) is out of alignment” is often used as an easy and straightforward way to explain pain. However, placement of blame on something structural leaves us feeling helpless and hopeless, with either the sense of “this is just how my body is” or the idea that we will always need to rely on a practitioner to manually “fix” this for us. I believe that our bodies are strong, capable, and adaptable. Rather than focusing on any abnormalities in structure as a place to lay blame, I focus on muscle imbalances in length and strength that exist. Our bodies were made to move, and while not every movement is textbook perfect as we were taught in school, there is always a way to create pain-free movement patterns that are optimized for each individual.
Follow these rules
Oh, and stretch when you wake up, If not, do it at night, just to make up.
I’ll be adding all the exercises I mentioned in this article to my YouTube channel , so be sure to subscribe. Some of them are already there now!
If you enjoyed this, please leave a comment me - or for my Dad, who taught me to do this as a “game” back when I was a kid. We would take the lyrics to one of his oldies, or a theme song from a TV show, and change them to make them relevant to whatever I was into at that time. We even owned a “Rhyming Dictionary” that allowed you to look up a word and find all the words that rhymed with it! I give playing games like this with my parents full credit for my love of creative writing - a random skill that didn’t always come in handy as an athletic trainer, but was the reason for me adding this blog to my website as a passion project.
