Posts Tagged ‘Low back pain’

**FYI – This post has been marinating for several months and I’ve struggled with what I want to say with it.**

Training and my first marathon(er)

Now that spring is here (near record rainfall here in Lexington this month), people are taking to the streets and sidewalks in effort to lose weight, get in shape, improve their running speed, etc. As I watch many of these runners trot around, I’m not convinced that they should be logging the kind of miles they are. One of the first forms of exercise we learn is running. Running is a basic human movement which we learn to do at a young age and it’s (relatively) easy to do. Lace up your shoes and take off for a run. No treadmill? No problem. Just walk out your front door.
Due to its low cost of entry (shoes), unlimited availability (you can run just about anywhere), and intrinsic nature (we learn to run as kids), just about anyone can go for a run. I’ve worked with countless recreational runners over my career and I was even a recreational runner for a while too. I usually tell the recreational runner that distance running is not a great idea for them – as THEY’RE NOT BUILT FOR IT AND THEY’RE NOT PHYSICALLY PREPARED FOR DISTANCE RUNNING! (Several months ago I began training an elite distance runner and it has given me a new appreciation and understanding for running. More on that later.) For example, people who work seated at a desk for long periods of time acquire certain positional or postural alignments that can have deleterious effects on how they move especially when they run. This seated position is often accompanied by computer-based work which results in anterior head carriage (AHC) and slouched shoulders. But I’m going to focus on how the hips, pelvis, and lumbar spine are affected by long-term sitting and why running without treating this fauly posture may not be the best idea.


While sitting, the hip flexors shorten and stiffen exerting a downward pull on the front of the pelvis and upward pull on the knees which can contribute to low back and knee pain. Additionally, if the pelvis is pulled down in the front, the hamstrings exert a protective pull on the posterior of the pelvis to prevent it from falling too far in to anterior tilt. (This is why people with this type of low back pain tend to have “tight” hamstrings.) Stretching the hamstrings feels good and can relieve symptoms temporarily, but that stiffness will return in about 24 hours. I could go on for days about the muscles, force couples, neuromuscular control and myriad other factors that come in to play, but I won’t today.
So let’s get to the specifics of running and why it may not be a good idea for you. Typically the mechanics of recreational runners over-emphasize the hip flexors and de-emphasize the glutes and anterior core. This is essentially what happens when we sit for long periods of time. Therefore it makes sense that if we already have short, stiff, hypertonic hip flexors we shouldn’t perform exercise that’s going to make it worse, right? I see lots of people with this scenario who come in with a weak anterior core and inhibited glutes and suffering with low back and knee pain. So while running, we (recreational runners) tend to stride out with our hip flexors (without achieving much actual hip flexion) and pull through with the hamstrings. The hamstrings are constantly “on” to help control anterior pelvic tilt and now they’re being asked to perform the majority of hip extension, which is not a good approach. The more simple way to look at this is that the anterior core and obliques work together with the hamstrings and glutes to keep the pelvis from falling forward from the pull of the hip flexors, adductors, and spinal erectors (low back muscles). When these muscles exert the appropriate force, the resulting movement is a thing of beauty. If one group exerts too much force without balance from the opposing muscles, things get ugly.


As I mentioned, I recently began training an elite female distance runner named Tina. I had no frame of reference to what “elite” meant when pertaining to distance running. Additionally, I wasn’t really sure how I was going to help her. Sort of. I knew what I would do with a recreational runner, but this is a woman who has sponsors, an awesome running coach (you’re welcome Steve), and a half-marathon time more than an hour faster than my half marathon time. Yes, that’s correct – an hour. While getting her history, I found out that she previously suffered a strained left hamstring and actually ran the Chicago Marathon with said strained hamstring. I watched and recorded her running on a treadmill at our gym, and to be honest she moves so fast, I had to put it in slow motion before I could really see anything “wrong”. Granted I’m not skilled in running gait analysis. YET…

Before we got in to her training Tina traveled to the University of Virginia’s Speed Clinic to have an analysis done in hopes of pinning down what was causing her dysfunction leading to her injury. When she returned, she was excited and revitalized with the results. The 3-D video – with kinematic analysis of her pelvis, hips, and legs, and more graphs than high school algebra – all pointed out that her glutes weren’t doing enough work and she was striding out too far. (Somewhat similar to a recreational runner)

The Training

Her training started similarly to other runners who simply need to move better. We focused our training on getting some length to her adductors (she has anteverted hips) and hip flexors while strengthening her glutes, improving her anterior core and neuromuscular control. Additionally Tina reduced her stride length significantly which reduced the amount of “braking” in her stride and increased the amount of propulsion she can generate. Her stride looks much more smooth and she suffers significantly less jarring on her frame which is critical over the course of a 10, 13.1, or 26.2 mile run.

Often times we assume that because someone’s desired or daily activity requires a certain quality (in this case running in a straight line for long distances) that we should train them similarly – so high rep, low weights circuit training. However, Tina’s cardiovascular fitness and Type I muscle fibers were getting plenty of training from her running. Instead, I used low rep, heavy resistance training to “fill in the gaps”. Additionally, I included exercises that demanded frontal plane control while working in the sagittal plane. In other words, performing a reverse lunge while I used a band to pull her front knee in, thus making her glute work more to keep the femur in proper position. Finally, due to her excessive thoracic rotation to the left and a subsequent across-the-body reach as she strides, I added rotary stability exercises to reduce the amount of energy Tina wasted with each stride.

In the 17 weeks since we started training, I’m amazed at Tina’s progress and her determination. Tomorrow is the London Marathon, and Tina is there with her family and friends ready to put all her hard work to the test. I’d be crazy to think that in 17 weeks, we could correct everything she has acquired running thousands of miles over her lifetime. However, I do believe that Tina is in better overall condition for this race than any previous race and I’m excited for this step in her journey toward continued greatness.


If you learned nothing else…

So what does all this mean? It means that running can be an effective and enjoyable form of exercise. It also means that if your body isn’t ready for distance running, there may be better options for you initially. Even the pros have coaches and it is much better to start with good movement and build a foundation for running (or whatever) than to start with poor movement and add more bad movement on top of a bad foundation. If you would like to run, do like to run, or want to run faster, hire a trainer or coach and ask for help. It’s amazing how a new perspective from a professional can help. I’ll continue to post updates on Tina’s progress and you can follow her blog here which has lots of nutrition, running, and lifestyle content. Once she returns from London and recovers, Tina and I hope to start a training program specifically for runners who want to improve, but may not have an idea of the next steps to take. IMG958711

I started training others in 1999 and over the course of 15 years, I’ve seen lots of trends in abdominal training come and go. Back then, if someone told me they wanted a six-pack (which was just about every client), I told them to clean up their eating and we would hammer their abs for 15-20 minutes at the end of each session with sit-ups, 374 different crunch variations, side crunches, hanging leg raises, and anything else I could dream up. I even created a group class called “Hard Core” which would challenge your balance, endurance, and abdominal strength in any way I could dream up (I used Swiss balls in every class). During the past 5-7 years however, through lots of reading articles, books, and research publications from people much smarter than me, and coaching hundreds more people I’ve changed my approach. I understand more about the true role of our core musculature and some of the mechanisms of pain and injury.

Low back pain (LBP) is the most common complaint I hear from people who come to me interested in training. I’d imagine than anyone reading this knows several people who have suffered through LBP or required some type of medical treatment to resolve it. Much of this can be attributed to the fact that as a population, we sit more than ever and we adopt faulty sitting, standing, and breathing patterns. Unfortunately though we all want six-pack abs and think that the best way to achieve them is to do lots of sit-ups, crunches, side crunches, hanging leg raises, etc. There are many other “ab” exercises that I have neither the time nor interest to type which you might be performing and might be detrimental to your spine health resulting in low back pain in the future. I’ll discuss some of them and if possible, I’ll post videos of them at some point.

    Some of the common culprits

  • The sit-up – If you’re doing sit-ups, you should probably stop. The sit-up imposes approximately 3300 N (730 lbs) of compression on the spine (Axler and McGill 1997). The National Institute for Occupational Safety and Health set the action limit for low back compression at 3300 N, yet every time you do a sit-up you are subjecting your spine to this high compression with each repetition. In his book, Low Back Disorders, 2nd Edition, world-renowned spine specialist Stuart McGill says, “Those who are training for health never need to perform a sit-up; those who are training for performance may get better results by judiciously incorporating them in to their routine.” Essentially, the risk isn’t worth the reward.
  • Straight Leg Raises or straight leg holds – Most people have performed a straight leg raise at least once in their lives. Our high school soccer coach would make us hold them for maximum time at the end of practice to see if our abs were in shape. I vaguely remember my longest hold being somewhere in the neighborhood of five minutes. Did we use good form? I think not. The straight leg raise with feet a few inches off the floor (or hold) engages the hip flexors which forces the pelvis in to anterior tilt thus pulling the lumbar spine in to extension and compressing the spinous processes and nerve roots. Most of the clients I work with or see in our gym “live” in extension and training them in a way which exacerbates this pattern isn’t a good idea. As you raise your legs (mainly a hip flexor action) your lumbar spine will tend to flatten or even flex, right before returning to an extended position. And during the Straight Leg Raise the flexion / extension cycle is repeated often until exhaustion. The problem is that the overwhelming majority of people lack the core control to pull off the Straight Leg Raise.
  • The crunch – Crunches came about as a way to alleviate the problems created by the sit up, yet still “feel the burn” of abdominal training but crunches have created an entirely new set of problems because of our excessive thoracic kyphosis (hunched over) and neck posture namely; anterior head carriage and cervical spine extension. I see some pretty bad crunch technique, most of which includes pulling forward on the head and using the arms to help perform the exercise. So yes your abs will burn from doing 100 crunches, but at what cost? You could further damage your already hunched-over upper back and shoulders and create problems in the neck and head. (The number of people who come to me complaining about neck pain and headaches is almost as many as those who come to me with low back pain.)
  • Planks – I know what you’re thinking, “Wait, planks are supposed to be safe for your back and good for the core, and I can hold a plank for 17 minutes!” First of all, planks CAN BE good for your core and safe for your spine, but they are more often than not performed with less than optimal technique. Secondly, if you can hold a plank for more than a couple minutes, I’d venture to say that you’re doing something wrong. As we fatigue, our bodies compensate. And when we compenate, we make alterations to proper movement / position. For example: try to stay up a couple nights straight and don’t take naps during the day then see what happens. Chances are, you will start making silly mistakes, dozing off, or hallucinating. THAT is your body’s way of compensating for your lack of sleep. It’s shutting down the systems that should be running properly in favor of simply keeping you alive. (Why do you think the FAA has time-out regulations for flight crews?)

So what CAN you do for your core that will not hurt your low back, upper back, neck, etc?

It starts with the ability to control your core with very subtle but important breathing and bracing technique. Fundamental exercises that allow you to control spine position while moving are first.
Hip extensions (glute bridge) – This a great warm-up exercise that can serve as a primer for the rest of your workout or if you have poor core control, it may constitute part of your workout. Most people get this wrong by driving their low back up in to greater extension (remember most people live in extension) rather than driving from the glutes while keeping the lumbar spine neutral. Lie on your back with your feet 12 inches from your butt. Brace your core and pull your low back to the floor. Press your heels to the floor and drive through your glutes lifting your hips. Hold for one full breath, lower and repeat. Perform 10-15 reps.

Plank – I test the plank for all my new clients to determine if they tend to fall in to one or more of these faulty positions (low back sags, head falls forward, hips up too high). As you can see, this client sets up with a couple positions which need correction. A plank should look like a plank of wood. Straight.

Bad Plank

If you cannot hold a good posture in the plank, you have no business moving on to more advanced exercises. Sorry. I know you saw this crazy cool exercise on Youtube, but you’re not ready for it. Don’t put the cart before the horse. It’s easy to tell you how to fix it, but it’s better to teach you. Essentially, I would like the hips lower (by actively turning on the glutes) and posteriorly tilting the pelvis which will bring the lumbar spine to neutral. Then we want the chin tucked in and back to created a more neutral cervical spine as well. All this is easier said than done however, because some people whose hip flexors dominate their pelvis cannot effectively activate their glutes (distance runners and desk jockeys).

Side Plank – A side plank should look like a plank…on your side. Hips extended with glutes squeezed, lumbar spine neutral, and head in line with the spine. I usually start with a kneeling side plank or a side plank up on the wall to master the position before going to a full side plank.

This is only a very basic introduction to this idea and I will have many more posts, pictures, and videos to follow which will take us deeper down the rabbit hole. But until then, remember this. The function of the core is to control movement of the spine and to transfer power from lower to upper extremity and vice versa. Train it accordingly, and you will feel better, move better, and be stronger.