10 Myths About Lower Back Pain (LBP)

Mr J

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ever done J curls?
any opinion on them?
Freeride, that looks like a loaded back and hamstring stretch to me. Do you practise any other forms of stretching? I get the impression you must surf a lot and like to keep fit with additional training. Could you describe a typical week with how you schedule surfing and training?
 

VonMeister

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Ah, now I know where your blinkered view is coming from. Unlike yourself I have been lucky enough to stumble on a team of practitioners who have successfully fixed me up - with one exception a physio who couldn't resolve a knee problem which another one later succeeded in. He may have been good at fixing other things - I don't know after the problem didn't get better, I stopped going and never went back.
No, my blinkered view comes from decades of medical research and publications and years of working with physicians (actual real doctors) who specialize in pain management and injury rehabilitation.

Medicine evolves. There was a time where persistent lower back pain was a life sentence but we are beyond that now and the treatment has changed and the results have been radical across all age populations and groups. Manual joint and tissue manipulation is a treatment designed to help relieve pain in the moment....treating the symptoms, not the disease. It's not a remedy, cure, or immunization against future pain or injury. Beyond that, because the measured results of manual joint and tissue manipulation treated injuries so poorly over decades we developed an opioid crisis.

When a person is in pain it's very easy to reject critical thinking and grab at the headline that promises a cure. It's a stressful emotional time. The human health and performance is about biology, physics, and chemistry. If you can separate your self from the stress and emotion and just consider what you are being told..... and match that against public data and a good old fashioned biology book. Self directed education has never in history been easier to pursue. If you want to learn how the body works there are tons of good resources and publications out there. The data exists.

Conceptual Physical Science, Hewitt, Suchoki, and Hewitt
Essentials of Human Anatomy and Physiology, Elaine Marieb
The Atlas of Human Anatomy, Frank Netter

Three books that should be in the library of every physician ever and available on Amazon.

Be curious. It's your health.
 
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GWS_2

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Martial arts, gymnasts etc all need varying levels of range of motion which comes from a degree of static stretching and a degree of performing the movements. This is much different than prescribing stretching or flexibility as a cure for an ailment...because it isn't. This is widely accepted by the medical community that is focuses on these things. There is simply no medical evidence to suggest that pulling on a joint to a subjective point of discomfort to joint angle does anything useful, and plenty of evidence that suggests that it is doing more harm than good. Another good point is, if you go a couple days or so without stretching and lost some range of motion, you probably are OK without it and this would be a good sign that you are hyper extending a joint.

To use an outlier as proof isn't really a good argument. Look at doctors that still prescribe R.I.C.E for injuries...when we know that ice is the last thing you want to apply to an injury to increase tissue healing and NSAIDS to be effective in reducing swelling need to be taken in the range of 8000mg per day, which will cause all sorts of other health issues.

I'm not trying to discount your kids injury but the other side of the coin is, would he have been injured if he had more range of motion? The easy and honest answer is we don't know. But to take it a step further...there's a lot of people on earth who can not touch their toes without bending their knees, me being one of them. I've never had a hamstring injury and I don't have any lower back pain anymore and a large percent of the population haven't either. When I was suffering through persistent lower back pain I was stretching, and being stretched by "professionals" and relief was never significant, lasting, or in anyway able to be directly related to a therapy event.

This leads to my earlier point. How much range of motion is enough. If this is a legitimate medical necessity, there should be a metric to use. There isn't because all studies point to range of motion as being a non issue with respect to injury prevention. Hyper extending joints with static stretching...or to put it simpler, taking a joint beyond its natural range of motion in search of a subjective increase in ROM has been proven to increase injuries.

Short of a severe neurological or structural issue, more often that not range of motion issues are a problem of the mind, not the body. We believe more is better, or accept some subjective points as healthy.

We are talking on two different tracks here. I know this started as a back pain thread. I'm not talking about back pain. I'm talking about the benefits of stretching for athletic performance/longevity and injury prevention.

1. If you are pulling on a joint to the point of discomfort, you are doing it wrong. It should feel good. If it is hurting you are going too far.

2. You are talking about ROM like it is static/set. It isn't. As you age you lose it unless you do something about it. That will probably be what eventually stops you from surfing. You will no longer be able to execute a pop up. You will probably also have to wear velcro closure shoes because you can't reach your feet. You will need need assistance with a whole lot of things and lose much of your athletic ability as your age, much of it due to a loss of flexibility. Most of us will if we live that long. I'd like to put that off as long as possible.

3. It is worth restating here that I am not advocating stretching as a cure for an ailment. I am advocating stretching as a way of extending your athletic capabilities as you age and preventing injury in (aging and otherwise) athletes.

4. Ice still has benefit re some injuries, (usually impact injuries and for the first 24 hours) but for a very narrow window of time. Chinese medicine states that "ice is for dead men." Not a fan of Chinese medicine most of the time, but that is one thing they got mostly right. Ice on a hurt back always made my hurt back worse as the muscles tensed/splinted even harder. But I digress.

5. My kid is an outlier story. Just like your story re being treated for back pain with stretching that failed is your personal outlier story. Once again, I'm not concerned with the back pain issue at the moment, but if we want outlier stories we can find tons of people who will tell you yoga cured them of back pain. But again I digress.

6. Stretching as injury prevention. I think you will still find every single solitary NFL team out there still puts everyone through flexibility training. Because they know that their players flexibility will be tested via contact and they know that flexibility helps players bend instead of break. The same with submission wrestling. (BJJ etc) They know that enhanced flexibility will allow them to work out of submissions that would take them out with less flexibility.

7. Here is that link from the Mayo clinic re stretching again. You will find them stating many of the same things I have stated above. They also state that there is evidence on BOTH sides of the coin re stretching, but the side they look to be coming down on seems fairly clear. https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/stretching/art-20047931

So, all of us need to evaluate the evidence, see what it does for us personally, (bodies vary widely) pay your money and take your chances. Outlier story again, via martial arts I have been put in contact with a number of men in their 70's who were still relatively impressive athletes. This is at an age when most Americans are dead. Every single one of them stretched. And every single one of them resistance trained. (mostly light, which I know you don't like) At some point, the outlier thing becomes evidence. As I head over the hill, I'm going to have to go with what I have seen over and over again and what my own body is telling me. I simply run better when I am properly stretched. And this is mostly about hanging onto more youthful ROM as opposed to trying to make new gains.

EDIT: I was interrupted during the course of writing the above like ten times. It's probably not going to be as organized or clear as I would like it. My phone won't stop. Later. EDIT: Courtesy of my titanium parts, I have an asymmetrical ROM from one side to the other. If I stretch I can mitigate that. And I run far better when I am closer to the way my body was when I was younger. Most aging athletes have asymmetrical ROM. Stretching helps them stay closer to the way things ran when the original equipment was new.
 
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GWS_2

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Worth noting. Old school they used to have us stretch out BEFORE training. I hated it. Because I hated it I would skip it when i self trained. What I found was my flexibility during that workout was better if I just started the motions with a restricted ROM and as i warmed up increased ROM. Stuff that was out there on the edge for my body was easier without the pre workout stretches. Just warm up, go slow, increase ROM as you go and stretch post workout. Decades later that is kind of what many have come to. And there are certain traditional stretches I just don't believe in. I will give them a miss. And that is based upon what my own body is telling me. I'm relatively certain my hip problem was started with a weighted butterfly stretch gone too far. So, just like with weight training, you can fvck yourself up with stretching. But just like weight training, that doesn't mean that no benefit can be derived from intelligent stretching. IMO.
 

VonMeister

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Just to be clear. I stretch. Not any specific regime, schedule or for any other purpose than it just feels good when tired or sore. My only point through these 9 pages is that stretching does nothing for injury prevention, injury recovery, fatigue prevention or fatigue recovery. This is a science based and peer reviewed opinion that I just didn't come up with on my own.

Head kicks aside, I think we're in agreement that generally range of motion is trained by practicing and performing the activity you like. As you gain proficiency you gain access to the range of motion required.....which is the safest way. Any range of motion beyond what is required is useless and does absolutely nothing positive.
 
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Mr J

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No, my blinkered view comes from decades of medical research and publications and years of working with physicians (actual real doctors) who specialize in pain management and injury rehabilitation.

Medicine evolves. There was a time where persistent lower back pain was a life sentence but we are beyond that now and the treatment has changed and the results have been radical across all age populations and groups. Manual joint and tissue manipulation is a treatment designed to help relieve pain in the moment....treating the symptoms, not the disease. It's not a remedy, cure, or immunization against future pain or injury. Beyond that, because the measured results of manual joint and tissue manipulation treated injuries so poorly over decades we developed an opioid crisis.

When a person is in pain it's very easy to reject critical thinking and grab at the headline that promises a cure. It's a stressful emotional time. The human health and performance is about biology, physics, and chemistry. If you can separate your self from the stress and emotion and just consider what you are being told..... and match that against public data and a good old fashioned biology book. Self directed education has never in history been easier to pursue. If you want to learn how the body works there are tons of good resources and publications out there. The data exists.

Conceptual Physical Science, Hewitt, Suchoki, and Hewitt
Essentials of Human Anatomy and Physiology, Elaine Marieb
The Atlas of Human Anatomy, Frank Netter

Three books that should be in the library of every physician ever and available on Amazon.

Be curious. It's your health.
Thanks for that thoughtful reply. If you are a medical researcher then that does add credibility to the things you say. You would be familiar with say the different statistical techniques used for studies and their merits. I don't have those skills so try not to get sucked into too much "internet research". However, just like the physicians you have worked with you are not infallible. Some of us have got fixed by practitioners who you do not consider to be valid.

If you are alluding to chiro when you say manipulation brings momentary relief from pain, well that's not how it works for me. It has never done that for me, although it might for some people. Instead I don't feel any different immediately after an adjustment (manipulation). When I first started going I actually used to feel a bit of soreness in my lower back the next day - which I was told was normal. Then as I got used to it I used to I feel nothing the next day - although I always take a rest day. It took me a long time to get there, but I don't get pain anymore. I tried the superman bird thing Lillibel posted, felt zero discomfort. I tried that thoracic thing on the paddling fatigue thread, felt zero discomfort. My next appt chiro/massage appt is on wed - I do it as "maintenance" now.

If it was the massage manipulation you were alluding to then that's not momentary relief either. Some of the muscle knots they find in me sometimes require prolonged and verging on painful pressure before the muscle relaxes. The next day I have to rest - no surfing, skating, weights etc.

On top of that I'm doing posture correction exercises and made adjustments to daily life - getting the computer screen and keyboard exactly the right height etc. My wife tells me I have noticeably straightened out over the last 10 years.

On top of that I'm doing core strength exercises. Then add to that targeted stretches prescribed specifically for me and my condition. I'm also doing some dumbbells and pull ups, but those weren't prescribed at the chiro clinic.

We could say its a bit like using a shotgun to hit a bulls eye. I don't honestly know for sure if some of what I am doing is a waste of time or not. All I know is that overall the shotgun approach has worked and it didn't involve sucking up the pain and getting on with the squats and deadlifts. Although having said that I think its great that it fixed you and awesome that you were able to help Havoc.
 

Mr J

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...
EDIT: I was interrupted during the course of writing the above like ten times. It's probably not going to be as organized or clear as I would like it. My phone won't stop. Later. EDIT: Courtesy of my titanium parts, I have an asymmetrical ROM from one side to the other. If I stretch I can mitigate that. And I run far better when I am closer to the way my body was when I was younger. Most aging athletes have asymmetrical ROM. Stretching helps them stay closer to the way things ran when the original equipment was new.
GWS2, despite the interruptions to your post, it looks well composed to me. I agree with pretty much everything you have said on this thread. Actually there is nothing I disagree with, just the subject of icing after trauma/exertion I don't have an opinion of. I have done it with a bag of frozen peas in the past because I was told to, left to my own devices I haven't bothered after every trauma. I don't know whether it helps or not.

I can relate to what you are saying about flexibility, because it was my brother who first got me on to the idea of stretching after exercise and not before. I was in my early thirties then and many years before I had back trouble and got this idea confirmed by the massage therapists at the back centre. He was into Taekwondo which as you know requires a lot of groin/hip flexibility for the high kicks. His enthusiasm for that sport got me into it and I did taekwondo for 2 and a bit years. I even entered some full contact tournaments (the type with the chest guard and soft helmet) - scary, but I never got hurt - I suppose small people don't do so much damage to each other :LOL: Anyway I am naturally flexible and by stretching after exercise got myself to the point where I could do the splits one way (one leg in front other behind) and close to the splits the legs apart way.

Movie stars Jean-Claude Van Damme and Bruce Lee did have the advantage of choreography for the taekwondo they incorporated in their martial arts, but they were clearly both flexible and strong.

Despite being naturally flexible I do get tight in certain places which I correct with stretches - tightness gets noticed by the masseurs. Age and repetitive motion (sport) can tighten muscles.

When I was reading VMs advice about putting a block under the heels when squatting, I thought to myself I can easily squat right down on my haunches (unweighted) and have both feet flat on the floor with no calf strain. If nothing else it can be convenient, like this morning after my surf I could squat right down to operate the combination lock key safe under the rear bumper of my car and I see other surfers bending over awkwardly to do the same.
 
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VonMeister

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Hey VM, any bad info in this set?

I'm not a fan of dumbbells for strength training, but anything is better than nothing.

I would say a good way to begin would be to grab a couple dumbbells and hold them up, elbows at your side so they are up around your shoulder. This will mimic a front squat a bit. While it doesn't put much stress on the lower back it's a good place to start. You could also try single leg RDL's with a dumbbell for added resistance. They are relatively safe and you have your free leg acting as a counter weight.
 

silentbutdeadly

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Martial arts you need flexibility for obvious reasons. Contact sports IMO, you need flexibility so when you get forced into a nasty position you bend instead of break. Surfing, as you age, flexibility training will become more and more important for you.

yup
 

One-Off

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can u carry 100+ lb dumbells?
Dude. I'm the proverbial 90 lb weakling (think Rob Machado without the locks and mad surf skills). Whenever I had to do concrete work I would buy the 60lb bags instead of the 90lb bags because the 90 lb bags were a PITA to move around.

I'm starting where I'm at.
 

One-Off

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I'm not a fan of dumbbells for strength training, but anything is better than nothing.

I would say a good way to begin would be to grab a couple dumbbells and hold them up, elbows at your side so they are up around your shoulder. This will mimic a front squat a bit. While it doesn't put much stress on the lower back it's a good place to start. You could also try single leg RDL's with a dumbbell for added resistance. They are relatively safe and you have your free leg acting as a counter weight.
In the link I posted the last two- straight leg dumbbell deadlift and dumbbell sumo squat seem good. I liked watching the videos. The straight leg deadlift looks like it would definitely stress the lower back. Not sure I'm ready for that one yet.
 

Autoprax

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Why can’t a single proponent of stretching, you know dingdong‘s like gbg, articulate how much stretching is necessary or enough? If it’s so necessary or important, especially for health you would think there’s a metric to follow. How could something so supremely important and medically necessary be measured so subjectively with zero dosage or delivery guidance. It’s completely irrational.
The thing that makes life tricky is over reaction and under reaction are both viable threats.

Maybe it would be better to think of stretching as muscle activation of the antagonist muscles?

Or simply moment.

A lot of inflexibility is neural. The ANS doesn't feel safe to do that motion. But it's over reacting.

Stretching might be beneficial not because the muscles are getting "stretched" as much as the nervous system is getting primed.
 

One-Off

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I have a question regarding the back and exercise, specifically the weight training.

In all the tutorials I watched, there were a couple constants I noticed. Keep your back straight. Feet straight ahead or very slightly pointed out. When you squat or deadlift your knees go slightly outwards.

Instead, when I surf my back is curved and my stance is kind of knocked kneed with my feet splayed out (think Mark Richards). I think it's called the valgus position. I tore (or badly sprained) my lcl once getting squashed in a crash tube in that position.

I've been doing squats and now my back is almost 100% pain free with that movement (no weights yet), but after thinking about it, yesterday I decided to squat in my surf stance and- ding ding ding pain alarm!
So what do you do about strength in that valgus position with a rounded back?
 
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VonMeister

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I have a question regarding the back and exercise, specifically the weight training.

In all the tutorials I watched, there were a couple constants I noticed. Keep your back straight. Feet straight ahead or very slightly pointed out. When you squat or deadlift your knees go slightly outwards.

Instead, when I surf my back is curved and my stance is kind of knocked kneed with my feet splayed out (think Mark Richards). I think it's called the valgus position. I tore (or badly sprained) my lcl once getting squashed in a crash tube in that position.

I've been doing squats and now my back is almost 100% pain free with that movement (no weights yet), but after thinking about it, yesterday I decided to squat in my surf stance and- ding ding ding pain alarm!
So what do you do about strength in that valgus position with a rounded back?
If you get stronger doing squats in a safe way, your muscles will get stronger and help protect your back when it is in a compromised position. Muscle fibers don't care what position your body or legs are in and there is no reason to try and train them is a compromised position. Functional training has been completely and throughly debunked.
 

Bob Dobbalina

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It seems that there are 2 camps. Pardon my butchering of terminology, but here goes:
1)Pain Management/Reduction: This is when people are in acute pain and want that pain to subside. The pain makes it difficult or seemingly impossible to move freely (IE, me. today).

2)Rehabilitation: This is when people are able to move freely enough to focus on strength and movement, not the perceived limitation that the pain is telling them.

It's hard to imagine squatting when you can't get out of bed. It's hard to imagine dead lifts when you can't walk freely for an hour after you wake up. Hence, people gravitation toward pain management (read: sheet that makes you feel better). Despite the clinical impacts of soft tissue manipulation, chiropractic adjustments, massage, trigger point therapy, or otherwise, people want to feel as if they are free to move before they feel that they can strength train. Most of these things make you "feel good" but don't necessarily fix your condition, and for many, that's where they stop. Inevitably, they experience the symptoms again later. But sometimes it gets them to a space where they can start the long term work of fixing the problem through strength training.

Just my ignorant current view as I struggle to move today. It's subject to change.
 
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