Weight training for lower back pain

We know that different types of exercise e.g. Pilates and Yoga have been shown to be effective in the treatment of lower back pain. But what if you hate these types of exercise? Well, the good news is that new research has just been published to show that resistance training with free weights can also be effective in helping people who suffer with lower back pain – especially chronic lower back pain.

In this post:

• Weight training for lower back pain - New Research

• How ‘protecting’ your back can cause lower back pain

• So what about this bend with your knees business?

• How to use free weights to strengthen your lower back

Weight training for lower back pain - New Research

The researchers enrolled 30 participants, who had lower back pain for more than 3 months, in a 16 week training programme. All the participants underwent MRI investigations to look at the size and shape of the muscles in their lower backs. The MRI scans also identified a total of 33 herniated discs without nerve compression, 11 herniated discs with nerve compression, 1 disc injury without herniation and 20 cases of facet joint degeneration.

The aim of the study was to see if they could decrease pain, improve muscle bulk and strength in the lower back as well as improve the participants' movement patterns in the squat exercise. The researchers reported an impressive 72% and 76% reduction in pain and disability by the end of the 16 week period. They also found a significant decrease in fat infiltration as well as an increase in muscles bulk in the lower back muscles.

It is important to note that in addition to exercise, the researchers also worked with the participants to address any beliefs that they may have held regarding their injury that may have hampered their recovery. We know for instance that one of the reasons that a person can continue to suffer back pain may be due to them overprotecting their backs.

How ‘protecting’ your back can cause lower back pain

We know that people start to move differently when they have suffered back pain. This may be because they are frightened of injuring their backs again or in an attempt to ‘protect’ their backs.

They often end up splinting their spines during movements or avoiding certain movements, e.g. forward bending, altogether or overusing their superficial back muscles to keep their backs in extension.

While this may sound like a clever or logical thing to do, it can actually lead to more back pain for 2 reasons:

1. You end up with a stiff back. Our bodies and joints have to move to stay healthy and strong and pain free.

2. The deep muscles, the multifidi, that lie right next to your spine and are meant to stabilise it during movements, become weak.

We know this because studies have shown that if you looked at an MRI scan of someone with longstanding lower back pain, you often find that these deep stability muscles along the spine have a lot of fat in them and have shrunk in size. No, this does not mean that you are overweight. This is as a result of not using your back muscles enough.

Because you are splinting with the big superficial muscles of the back, these smaller ones that are meant to be active throughout the day are not really working much. The end result is that they become deconditioned. People who suffer with lower back pain are usually also less active on the whole, which can contribute to these muscles becoming weaker.

So what about this bend with your knees business?

Yes, of course you should look at your posture when you pick things up – especially heavy things. I am by no means advocating that you just ignore your back pain and bend and move as you like after an injury.

You will always have a period of a few days or even weeks, depending on the severity of your injury, during which time there will be certain movements and activities you should avoid. My point is just that they should not necessarily be avoided for the rest of your life!

Any treatment plan for lower back pain should involve a slow and gradual training programme during which movement and strength training are slowly reintroduced.

How to use free weights to strengthen your lower back

The participants in this study all had back pain for longer than 3 months. They did not include anyone who had active nerve root compression or inflammatory disease.

It is important to note that emphasis was placed on teaching the participants the correct technique to perform these exercises. I would advise that you ask a physiotherapist or experienced trainer to teach you how to do these exercises before you attempt this programme.

I also think that the participants must have had a relatively OK basic level of fitness, since the single leg glute lift is not easy to perform with good form.

The 16 week programme was divided into a 4 week familiarisation phase, followed by a 12 week strength phase.

Familiarisation phase:

Lasted for 4 weeks and included:

1. An assessment of the beliefs participants held regarding back pain.

I am often surprised at how many people think that once you have suffered back pain, you are stuck with it for life. This is just one example of a belief that may hamper recovery. They often just need a period of ‘good behaviour’ combined with carefully graded exercise to get them pain free.

Another example is when people think that their back pain should continually improve and that it is a bad sign if they have a slight increase in pain on certain days. The truth is that recovery never follows a linear path. Your road to recovery is much more likely to look like a mess of spaghetti as Adam Meakins have shown in the diagram below.

It is normal to have good days and bad days as long as the bad days become fewer, less intense and are quicker to recovery from.

2. The participants were all taught lumbo-pelvic control. In short, this means that they were taught how to stabilise their lower backs and pelvises during movement.

3. Each participants' posture was analysed and they were taught how to correct their posture and keep their lumbar spines in a neutral position and not to overuse their back muscles when standing or sitting.

4. Strength exercises

Exercise intensity: 3 exercise sessions a week, load approximately 10RM, 3 sets of 8 repetitions

They used two different sets of exercises and alternated between them. They would for example do Set A twice and Set B once in week one and then switch to do Set A once and Set B twice the following week.

Warm-up before sets:

• Self-myofascial release of glutes by rolling on a hard ball

• Glute raises

• Multi-direction lunges

• Standing hamstring stretch

• Overhead squat

• Assisted squats

Set A included:

• Single leg glute bridges

• Goblet squats

• Planks

• Standing row exercises

Set B included:

• Deadlifts

• Step-ups

• Lat pull-downs

• Side bridges

• Press ups

Strength phase

This phase stretched from weeks 5 to 16. The exercises remained the same but the load changed to approximately 6-7RM, 2 sets of 5 repetitions done in 3 sessions per week.

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

You may also be interested in:

• Yoga vs. Pilates vs. Other exercise? What is the best exercise for lower back pain? Part 1: Pilates

• Yoga vs. Pilates vs. Other exercise? What is the best exercise for lower back pain? Part 2: Yoga

• Yoga vs. Pilates vs. Other exercise? What is the best exercise for lower back pain? Part 3: Other Exercise

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ReasearchGate.

References:

1. Welch, N., Moran, K., Antony, J., Richter, C., Marshall, B., Coyle, J., et al. (2015). The effects of a free-weight-based resistance training intervention on pain, squat biomechanics and MRI-defined lumbar fat infiltration and functional cross-sectional area in those with chronic low back. BMJ Open Sport & Exercise Medicine, 1(1).