The Back Pain Paradox

Philip Pape 0:01

If you are experiencing back issues of any kind a little bit of back pain and fatigue all the way up to more significant back problems or a quote-unquote bad back that leaves you either sitting or even in your bed or on the couch for stretches at a time , and then you hear phrases like heavy lifting . You might think that that is not for me . I'll stick to my walking , my lighter weights , my machine work , but what if avoiding the heavier weights is what's keeping you from building the strong , resilient body and back that you need ? Today we are talking about the counterintuitive thinking behind building strength with back issues . That will change the way you approach strength training when it comes to your back . Welcome to Wits and Weights , the show that helps you build a strong , healthy physique using evidence , engineering and efficiency .

Philip Pape 1:01

I'm your host , philip Pape , and today we're answering a fantastic question from a listener named Kristen that I think perfectly captures the concern shared by millions of people women , men of many ages , especially over 40 , over 50 , and beyond . And Kristen wrote , quote I'm a 51-year-old woman who is overweight and I need a great program and tips for strength training for a strong , healthy future in my body . I have a back problem , so when I hear heavy lifting , I'm not sure this is a great fit for me personally . What are your thoughts Now ? I did get back to Kristen with a lot of details specific to her , but today I want to answer the crucial thing that I think this question hits on that there's a massive disconnect between what many people believe they should do for their bodies , especially as they get older , and what the evidence actually supports . The truth is that not only can most people with back issues safely perform strength training with barbells and heavier loads , but it might be exactly what they need for long-term back health . The one caveat is I am not a medical expert . I'm not a doctor . I'm not dispensing medical advice , so , when in doubt , always seek the help of a professional or a physical therapist . I know some great ones in the industry , in fact , and I've worked with them myself , but today we're going to break down the principles and specific approaches in general that can help Kristen and everyone in a similar situation build the strength that they need for this vibrant , active future for decades to come , no matter what age you are .

Philip Pape 2:40

Now , before we get into specifics , if you have a question that you'd like me to address on a future episode , just like I'm doing today , featuring Kristen's question . And you want a personal reply from me ? Just go to witsandweightscom slash question or click the link in the show notes . And I love these questions because they allow me to address the real concerns that are holding you back , that preventing you from reaching your potential , that you're curious about , that are holding you back , that preventing you from reaching your potential , that you're curious about , that are very specific and contextual to you and I'd be happy to tackle your question or situation in an episode . Usually it's going to be featured all on its own and I'm going to give you a shout out , just like I did today for Kristen . So go to witsandweightscom slash question to do that .

Philip Pape 3:22

All right , let us start by understanding what the problem is . After I got Kristen's question , I followed up . I asked her some more details because it always depends right and she shared with me that she had injured her back in her 20s . She has very weak core muscles , she occasionally has flare-ups where she could be bedridden for up to a week , and she mentioned specifically that poor form had caused a severe episode where she couldn't even get out of bed for five days . Now I can definitely relate to this .

Philip Pape 3:51

I've had back surgery and it was exacerbated when I had a herniated disc while I was lifting with poor form . I remember specifically I forgot to put on my belt not that you need to have a belt , but I forgot to put on my lifting belt for the final set . Not that you need to have a belt , but I forgot to put on my lifting belt for the final set of really heavy deadlifts . I was in a gym talking with people getting totally distracted and I just went after it just in a very sloppy way . This is , this is before . I knew better and I could just feel that I pulled something , but it was just an exacerbated , um uh injury from years and years . That probably happened when I was in CrossFit and or snowboarding , you'll never know , but in this case it sounds like she , you know , lifted improperly and she said she walks one to two times a week , uses machines at the gym one to three times a week doing chest press rows , pec , fly seated leg presses , and she gave me some specific numbers and reps and you know I again I gave her specific advice .

Philip Pape 4:47

But what I want to talk about today are are three key principles that will change how you think about strength training with back issues , and this is especially true for men and women in midlife , over 40 , over 50 , when these things really start to catch up with

The Stronger Back Paradox Explained

Philip Pape 5:04

you . So principle number one is the stronger back paradox . All right , this is where most people believe that having back issues means you should avoid challenging your back through heavy lifting . But the evidence points in the opposite direction , because a weak back is more vulnerable to injury than a strong back . When I say it that way , you're like yeah , okay , that makes intuitive sense . But when you avoid training your back due to fear of injury , then you're creating a self-fulfilling prophecy , aren't you ? Your back , then , remains weak . It's unstable . It is prone to exactly the injuries you're trying to avoid . Most people are going to get their back injured doing something stupid , like trying to lift something up into the back of a truck and twisting their body , and they lift it up with a massive amount of back curving . You know those kinds of things Very rarely , but occasionally somebody might injure themselves in the gym , but again , it's usually because of very poor form or trying to do too much too quickly .

Philip Pape 6:07

The research shows us that progressive overload , progressive resistance , training right . This is where you continue to get stronger over time actually reduces back pain and improves function in most individuals who have chronic back issues . A 2016 systematic review in the Journal of Rehabilitation Medicine found that strength training led to significant reductions in pain and improvements in physical function for individuals with chronic low back pain , and I've seen it directly with so many clients clients who were hesitant to lift weights . We got them doing deadlifts and , all of a sudden , the pain starts to go away and they're shocked , they're surprised , but they're super happy and pleased . Um and I've seen this time and time again start deadlifting .

Philip Pape 6:50

Now , this paradox applies to Kristen situation perfectly , because , by limiting yourself to light machine work , I think she's missing out on the training stimulus that can make her back more resilient , and I told her this . You know she I'm not calling her out here , she knows . You know I said the thing that I first learned through starting strength right it's better to have a strong , bad back than a weak bad back , and , of course , bad back is a subjective thing that we like to label , but the strong back is going to serve you far better in daily life . The key , though , is leading me to principle number two that progressive overload is non-negotiable

Progressive Overload is Non-Negotiable

Philip Pape 7:25

. So when you think , okay , what does it mean to have a strong back ? Well , you actually have to challenge it . You have to adapt your body to increasing demands over time . If you keep lifting the same weights , the same you know loads , the same exercises forever , your body has no reason to build more strength or muscle and it's going to stay at its current level . And I would say that this is even more critical for older folks , people over 40 , 50 , 60 .

Philip Pape 7:51

I did an episode specifically geared toward the over 50 crowd where I talked about the importance of the big compound lifts specifically for the back and for bone density and for like those functional things that we really care about . Take women , for example . After menopause , women can lose 3% to 8% of their muscle mass per decade . Of course , men lose muscle mass as well , but for women it increases at an accelerating rate because of the hormones . So in your 20s and 30s you had a let's call it good enough , quote unquote strong back and you had some muscle . Just that came along for the ride . Well , now you're losing that muscle . So unless you do something about it , it's just going to get worse .

Philip Pape 8:45

So when Kristen mentioned that she increases weight when it feels too easy , which was one of the replies when we were discussing this . We talked about how our perception of difficulty some people call it RPE , or just you know how it feels is pretty subjective . It's influenced by a lot of things on that day that you go into the gym , your sleep quality , your stress , your nutrition , you know whether you're gaining or losing weight at the time , or in a calorie deficit or not . And this is why I like a structured plan that takes the guesswork out and does not depend on how you feel for the day until you get much more advanced and and can really rely on that . And so for all of us whose bodies are going to be forever aging and you're worried about that muscle loss , the principle of progressive overload has to be applied , and applied intelligently . You know , small , consistent increases over time , not dramatic jumps , not taking lots of time off from the gym and also not just staying at the same weight . Right , it's okay , if you're doing 30 pounds now , go in the next session or the next week and try 35 . And your body will continue to adapt and stay strong when you do that .

Philip Pape 9:55

And then , principle number three I just slightly alluded to this already , but I'm a big fan of focusing on movement patterns over isolated muscle groups when the concern is a strong back

Movement Patterns Over Machines

Philip Pape 10:08

. Kristen said she was using machines . I think that's great . It's definitely better than nothing , and certain machines can definitely give you similar results for hypertrophy , for building muscle , but it's not going to develop the coordinated function of multiple muscle groups working together for that overall stability and posterior chain , which is what your back needs . It needs those very strong rope-like attachments that go up your spine to become strengthened , and that is best accomplished through , you know , a systematic multi-joint , multi-muscle compound lifts . Because back pain here's the thing it usually stems not from a single weak muscle but from not moving the right way .

Philip Pape 10:54

Right , doing again , I said doing something stupid right and the fact that you don't have very good coordination between your muscle groups . You are just not neuromuscularly adapted to it and training on machines might feel safer , but it bypasses the development of these neuromuscular connections . Think about it Functional movements like squats , deadlifts . They train the body as an integrated system . They teach your bodies or your muscles to work together and they develop what we're going to call useful strength . Right , useful strength , not just big muscles , not just size , not just higher load for the sake of it , but the actual strength that translates to daily activities lifting and carrying your groceries , moving furniture , playing with your grandchildren all the things that actually end up pulling people's backs right . Even just the fact that you have to sit in front of a computer for your job potentially could cause back issues . But having a stronger back through coordinated , functional I hate the word functional , but the compound movements is going to mitigate that significantly . And again , this doesn't mean machines have no place .

Philip Pape 11:59

So , kristen , I'm talking to you as well . I don't want you to feel bad with some of the stuff I'm saying in this episode . They can be extremely valuable for building specific muscles , for working around limitations . In fact I'm going to do an episode soon about building muscle despite injuries and limitations , so you might actually like that one as well . But the machine should complement right . They should complement and not replace the compound movements . I think those should be the foundation right , especially deadlifts when it comes to back health .

Philip Pape 12:30

And if you're not doing them yet , kristen , you can start with a light , empty bar and work your way up from that . If you can pick something off the ground for a set of five with very little effort , then you could , of course , pick something slightly heavier for a set of five and heavier for a set of , and eventually you're gonna hit a point where it starts to feel heavy and your body will then adapt by building more connections , neuromuscular connections , as well as building muscle over time , and that's what's going to make your back really , really strong . Now let's talk about putting this all together for a , you know , application

Breaking the Fear-Avoidance Cycle

Philip Pape 13:04

of the principles . I don't want to get too deep in the weeds about , like specific programming , um programming , prescriptions , I should say , and it also doesn't mean you have to jump straight into , like super , what you would consider heavy barbell deadlifts If you have back issues . Of course , again , as I said before , caveat , this is not medical advice . If it's something that is surgically indicated or requires physical therapy , that's really up between you and your doctor .

Philip Pape 13:38

What I would suggest , however , from a training perspective , is starting with the movement patterns using body weight or very light resistance . Yeah , that could be bands , that could be an empty bar , an empty light bar . Right , there are light barbells , there are women's barbells that are 35 pounds , and then there's even 15 pound bars or even just like a broom handle . So if you can learn how to brace , how to breathe right , stabilize your spine and have a neutral spine during the movement , learning the squat and the deadlift pattern properly . I can't tell you pretty much every client that I start working with when they send me their first video of them doing a deadlift , it's always got some major issues the bar's way too far from the legs , they're rounding their back . There's something that's off that I know you're going to get injured by , and this is also why working with a trainer or coach can be really helpful .

Philip Pape 14:24

I know I mentioned , you know , physique University . In there you could post a video and get a form check from me . I will break it down either in text or on a screen share video and I'll say look , here are the , here are your , here's your low hanging fruit and here are the cues that you can use to improve your movement pattern . Um , so it's . It's . It's the hip hinge right , the foundation of the deadlifts . It's the uh core stability that you get through doing squats and deadlifts and progressing them over time . It's modified versions of those movements . If you need them . Like , let's say , you carry a lot of excess weight and you can't get into a squat , maybe you could do a leg press , all right . But let me tell you , I work with clients who are in excess of 300 pounds on the scale and they can generally do all of these movement patterns . They just have to be taught the right way to do it and start light and work your way up right the .

Philip Pape 15:13

The key here is we're not avoiding the movements that challenge the back . We are introducing them in a controlled way that builds strength and confidence . And if you could do it light with good form , then eventually you could do it heavy with good form and your body will adapt to it . So again , if you need modifications , like if you have to do goblet squats , initially really light , with a kettlebell or dumbbell , then that's fine . Start with goblet squats . If you had to do kettlebell deadlifts instead of just full up deadlifts , or if you have to use a trap bar I'm not going to , you know , get dogmatic here , criticize you for that I think it's great If you have to do seated overhead presses instead of standing overhead presses , right , like . As long as you're doing the movement patterns and then you have the appropriate load on your spine , establish you know proper technique and then start to progress . You're going to be able to adapt to it as you go , and that is the best way not to get injured .

Philip Pape 16:09

So I think perhaps the most important thing when it comes to the back is actually not the physical , it's the psychological , it's the fear of the re-injury , and I get this . At the same time , I was so excited to want to get back to lifting , because I had done it for several years before my back surgery that that building of the habit and the strength actually got me through without nearly the amount of fear I suspect I would have had if I wasn't a lifter and I wasn't already in shape . And so I've talked here and there before about the importance of being strong leading into a surgery . And again we're talking about injury . But , like , a lot of people get injured and then they have to do something about it , they have to recover , and then they're afraid that they're going to get injured again . And then what pain specialists call this is fear avoidance behavior , right , and that's where you limit your movement to avoid the pain . So , kristen , if you're listening to this , and that's the thing that is going on um , you know , recognizing that is a good step one , for .

Philip Pape 17:11

And then we're going to talk quickly about breaking the cycle . But what does the cycle look like ? Well , you have fear , then you avoid the movement , then , when you avoid the movement , you get deconditioned , you get weak , weakness increases vulnerability to injury and then the injury reinforces the fear . Right , so that's the vicious cycle . Fear , right , so that's the vicious cycle . And so it requires this mental shift in your psychology from seeing your back as fragile and so so fragile right , you think it's fragile , it's breakable instead to thinking of it as adaptable , flexible and adaptable , but in a in a positive way . So this is a reframe that I'm asking you to consider right now instead of thinking your back as this fragile thing , think of as an adaptable thing , right , and that doesn't mean you ignore pain or you push through injuries . It means that you work with your body , doing the things we talked about putting it in controlled movement patterns and expanding the capability and the competence over time , by getting stronger as your body gets stronger mentally and physically .

Philip Pape 18:14

Right , instead of accepting that this is some sort of limitation , because , let me tell you , every single person over 30 has a back quote , unquote issue , and if they got an MRI , it would show something in their spine that an orthopedic surgeon would say , yeah , we need to go in there and cut you open , okay , um , and I had back surgery and it took me a while before I got to the point of saying , no , I actually need the surgery because I had an impinged , uh disc impinging on my nerve , so it was literally sending a shooting pain down into my nerve continuously . Um , and as soon as the doctor just removed the material , I was fine and I was able to walk . And I've been great ever since lifting PRs for my deadlift . I mean , I just did a new PR recently . Um , and I know for a fact I've seen people who are engineers cause I know a lot of engineers who are like , oh , my back hurts so much . I'm like , yeah , you're sitting down all day . Oh , my back hurts so much . I'm like , yeah , you're sitting down all day . Of course it's going to work . What do you do for activity ? It's like not much . Or I try to do this stretching , or these cobras . I'm like , let's get you deadlifting . Your body will respond to that Right and successfully implementing this strength training program .

Philip Pape 19:15

It's . It's not just about the physical piece . You're going to build confidence through small , consistent wins as you accomplish this hard thing , but do it in a controlled way . Every successful training session you have . Every little increase in weight or reps , it becomes evidence to you that challenges the narrative that you're vulnerable because you're not . Your back has so much potential and capability to be strong . It is not fragile at all . It is highly adaptable , whatever age .

Philip Pape 19:45

You are right , and this is why having proper guidance , proper coaching , is so valuable . Just get the form right . You've got to get the form right , even if it's spending one hour with like a starting strength coach or knowledgeable coach or talking to me and we can do a console , we can do a free call or you can jump into our program and get some um , you know , for the first month or two , as you're figuring this out , send videos and really rapidly skill up or level up your knowledge and ability . And , uh , you know , a good expert will help you distinguish between what we'll call harmful pain and the normal discomfort of training , although if you've had pain , you kind of will know the difference . Right Between that and some soreness and the way that I'm asking you to train , where it's fairly heavy , compound lifts , not a lot of reps .

Philip Pape 20:31

There is a lot of rest period . You're only doing it three days a week actually doesn't involve much soreness . It shouldn't hurt . You're actually just going to feel stronger and stronger over time and then you're actually going to notice the pain going away . That's the really cool thing that I want you to get to , all right . So this is all a long-term thing , but the change can happen quickly . You know , building strength is is a process . It takes time , right . It's measured over months and years . However , I've seen pain relief come in as little as a few days , like just a few sessions . Right , and again , you don't have to start super heavy .

Philip Pape 21:10

The goal is not to address the back pain . The goal is not to lose weight with your nutrition right , like all those things . The goal is not to hit PRs . The goal is to have a foundation of strength that supports your active , independent lifestyle that is pain-free . Now are you

Training and Rehab Are One

Philip Pape 21:29

going to have a little bit of pain in certain areas for the rest of your life ? Maybe , I don't know . I'm not here to help you with that right ? I know that there's aspects with me , for example , my shoulder , where I'm dealing with what to do to work around it , to keep it strong despite a little bit of pain , but I think that's different than what we're talking about today with the back right , I think we're talking about the chronic pain that a lot of people have , and they have a fear and they stay stuck in that fear because they're not taking the time to strengthen the back and then prove to themselves that they can do it , thus breaking through the fear cycle . So if we can get a consistent , structured progression , compound lifts , gradually get heavier , build that strength , you're gonna be good .

Philip Pape 22:18

Now , before I forget , there was one last thing in my notes , and that was rehab and training . Right , people think of these as two different buckets strength training and then rehab . Um , my , my good . Uh , I'll call him a friend , but he was my physical therapist for a bit and we still stay in touch . John Petrizzo , he was on the show . He combines the two as if they are basically one in the same , in in just the right way . What I mean by that is , the exercises that strengthen a bad back are the same ones that build an impressive physique . They're just at different points on the intensity spectrum .

Philip Pape 22:50

Like , you may have to make certain modifications , but you don't have to choose between healing your back and building a strong body . I don't want you to go and just do quote , unquote mobility and band and stretching work . That is not enough . You have to train , and a barbell is one of the most effective ways to do that . Obviously , you could use dumbbells and such , but when it comes to deadlifts , a barbell is a really effective tool for the job .

Philip Pape 23:13

And I've worked with so many clients in their forties , their fifties , their sixties who came to me with back problems and an assumption that they needed some sort of watered down program or senior friendly program or old person program . Right . And we're like no , let's get in the gym , let's get that power rack and bar set up and go after it . We'll just start light and we'll work up to it and it won't take long before you get super strong and then you get this pain-free strength that you never thought possible . I've started clients in their 60s , women in their 60s , never lifted before . Maybe they have trouble bending over to tie their shoes without pain , maybe they have trouble getting off the couch and we start with , say , chair squats and then we go to box squats and then we go to full squats and we're talking . Within weeks they're starting to get super strong .

Philip Pape 24:02

So if you're listening to this and you're thinking that can't be me . I want you to question that right now . The human body at any age , has a remarkable capacity to adapt and grow stronger at any age . Again , I just said any age twice . But it's important right . Your back is not fragile . It's not destined to be a liability . It can become one of your greatest assets for your posture , your strength , your function and a pain-free life , if you just give it the opportunity .

Philip Pape 24:27

So let's wrap it up . What's the key point ? Strength training isn't just safe for most people with back issues . It's essential for back issues to improve your back health . Start where you are , focus on proper technique , follow a progressive plan that evolves through the capabilities , be patient and the rewards will absolutely follow , because your body's capable of far more than you might currently believe and the limitations you perceive are just that . They are perceptions , they're not physical realities . All right , if you have a question you'd like me to address on a future episode , go to witsandweightscom slash question or click the link in the show notes . Maybe it's about strength training , nutrition , mindset , consistency , anything . I'd love to help you overcome whatever's standing in your way and absolutely feature it on the show and give you a shout out as well , if you'd like that Until next time , keep using your wits lifting those weights and remember , when it comes to back pain , the solution isn't to avoid strength , it's to build it . I'll talk to you next time here on the Wits and Weights Podcast .