H+ Performance Client Case Study – Generalised Lower Back Pain Caused by a Mild Disk Degeneration and a Small Vertebrae Bulge
Tim came to H+ Performance asking us to help him with his lower back pain. During the consultation he spoke about how he had been seeing a doctor for his lower back. He was yet to undergo an MRI, which revealed that he had a mild degeneration of the L5 – S1 vertebrae. The L5 vertebrae is at the base of the spine (Lumbar) where it meets the Sacrum, hence L5 – S1.
The doctor’s advice was a possible surgical procedure, and to avoid any squatting or deadlifting in the gym.
Contrary to popular belief, a bulging disc is not a problem for strength training. Generally they are caused by an excessive strain directly to the vertebra – which is due to the surrounding musculature not being strong enough – therefore causing the spine to overwork. It goes against traditional thought, but when you have a slipped or bulging disk, probably the worst thing you can do is to stop training altogether.
When someone has a bad back, it is a symptom of weakness in the posterior chain muscles (hamstrings, adductors, glutes, and lower back muscles), as well as a weak core and hips. All these muscles below and around the spine should be supporting the spine, and taking the strain during load bearing exercises. When they don’t, you end up with a spine that is doing too much work, which can lead to compression issues like a bulging disk.
To counter issues such as spinal compression in general, we always warm our clients up in a similar fashion – we activate the glutes with banded walks, traction the spine with reverse hyperextensions and activate the abs whilst in a standing position with a banded abdominal crunch. This was the first part of Tim’s exercise programme – rather than using it as a warm up, we used it to begin to build him up and we still use it before every session for him. We then looked at changing the exercise order to make sure that he had fully activated his core using a Swiss ball plank and a Pallof press (which is an anti-rotation exercise – you have to work against being pulled sideways by the cable machine).
Isometrics like these (where a muscle is working against weight but not moving) are a great choice when bringing someone back from injury.
Once we had gone through this activation routine to make sure all the posterior and abdominal muscles were warmed up, we introduced Tim to what we believe to be the best thing for rehabbing a bad back, as well as building total body strength – the box squat.
A box squat is very different to a normal squat. The box squat is often performed incorrectly, as it requires a wide foot stance – this then allows the squatter to sit onto the box (or bench as seen here), whilst keeping the shins as vertical as possible. This places all the weight of the barbell onto the larger, posterior chain muscles (hamstrings, adductors and glutes), and places particular emphasis on the glutes for one main reason – you have to stand back up. The box squat falls into a category of lifts called ‘Static – Dynamic’, which essentially means that because the box stops the movement, the muscles will have to work harder to stand back up – whilst a normal squat would retain the kinetic energy from the downward movement.
We followed up this main exercise with some accessory work to further strengthen the glutes individually with a single leg step up and a prone hamstring curl to develop hamstring strength which was lacking.
We then followed on from these exercises with a weighted isometric back extension (I had Tim hold a weight below him so his lower back was holding him in place for as long as possible), and then also a Copenhagen plank – which is to further strengthen the adductors.
The result of all this? Tim is now pain free in his lower back. He will not need surgery. He is not constantly in pain, or fear of hurting himself further. He is a lot stronger than when he started and is quite surprised that all it took to sort his back out was to get stronger, and then learn how to maintain it.
These results were achieved between the start of June 2019 to the end of August 2019.
Need help with your back or have a different injury? Come and see us for a free consultation.
Director, H+ Performance