Don’t Let Back Pain Hold You “Back”

Your back is the foundation for any activity you do.  Like the foundation of a house, it can be forgotten about until a crack forms.  Once that happens, everything the foundation supports becomes vulnerable.  When you hurt your back, you realize that it is involved in virtually all your movements. Do not let back pain hold you back!  Know your body and take these precautions.

Basic Anatomy & Physiology:
Your spine is made up of a few main regions:  Cervical (neck), Thoracic (mid/upper back), Lumbar (low back), and the sacrum/coccyx (tailbone).  There are 24 individual vertebrae that stack to make up the cervical, thoracic, and lumbar regions and serve to protect your spinal cord. Between the vertebrae, there are discs that provide a buffer and contribute towards shock absorption, general flexibility, and mobility of the spine.  At each level, nerves exit the spine and go to different parts of the body.  This helps to identify the source of your pain.  Neck problems can shoot pain into different parts of your arms while low back problems can shoot pain down your legs.


Injuries at the Gym:
There are a few types of injuries we are going to discuss that can occur at the gym:  muscle spasms, strains, sprains, fractures and disc herniations.  Each of these injuries can cause pain to shoot into a different part of the body and can mimic a more serious injury.  Because of this, it is important to see a doctor for answers about your symptoms and not self-diagnose with a google search.  Most of these injuries can be treated or managed by a chiropractor, physical therapist, athletic trainer, or massage therapist.  When dealing with a sports injury, it is important to look for a few things in your healthcare professional:
Sports/exercise specific degree or credential
Experience successfully treating sports injuries
Have they ever seen the inside of a gym?
Do they practice what they preach?

1. Muscle Spasms
The least severe of these injuries is a muscle spasm (aka “knot”).  A muscle spasm is when a portion of the muscle tightens up.  This is commonly due to a light to medium impact, fatigue, overexertion, a lack of proper nutrition, or dehydration.  Many times, it is a combination of these causes.

A spasm is usually painfully annoying while limiting the range of motion and strength of the muscle.  It usually does not last more than a couple days but can last for up to a few weeks if it is bad enough and is not allowed sufficient time to rest and recover.  You can self-treat muscle spasms with light stretching, rolling out, and even some light exercise.  If that does not help, then you may need some deep tissue work by a professional to loosen up the spasm and get it to let go.

2. Strain
A muscle strain is another muscle injury that is more intense than a spasm (AKA “pulled muscle”).  A strain involves a partial or complete tear of the muscle.  If the muscle is contracting and basically loses the tug of war battle against the weight, then the muscle fibers can tear.  The more intense the strain, the longer and more difficult the recovery.  You may notice a ripping sensation or intense overstretched feeling.  There can also be bruising or swelling in the area.

Most strains will heal within 4-6 weeks.  Sometimes muscle spasms will form around the injured part of the muscle to protect it.  For mild strains, you can apply similar treatment methods as you would for a spasm.  You want to decrease the surrounding spasm, prevent scar tissue from forming in the muscle, and restore the normal range of motion while the muscle fibers are healing.  In general, ice and light movement are good for a strain at first.  As it heals you can increase the amount of activity you do.  If it is more intense, then you may need to see a chiropractor or physical therapist for treatment and rehabilitation.

3. Sprain
The tissue that connects bones together is a ligament.  The ligament helps to protect and stabilize your joints.  When a ligament gets injured it is called a sprain.  With a sprain, the ligament can be either partially or completely torn.  A sprain usually happens when you bend a joint in the wrong direction or further than it is supposed to.  The ligament gets stretched out and tears, just like a stretched-out rubber band.  A sprain can be caused by one event or a close series of small events.  You may notice swelling or bruising around that joint in addition to pain.

A mild sprain can heal in a few weeks, but most of the others will take 6-9 weeks.  Sprains do not heal as fast as muscle injuries because ligaments do not get as much blood flow to them as muscles do.  In the beginning, rest, ice, a brace or wrap, and light movement are a good place to start.  Like a strain, as it heals you can gradually increase your activity.

4. Fractures and Disc Hemiations
Back fractures (broken bone) and disc herniations are more serious injuries that require a doctor’s attention.  A fracture is usually accompanied by a cracking sound.  Activities that send vibrations into the spine such as walking, jumping, or tapping the bone will increase your pain a lot.

A disc herniation is the injury people are most worried about when they hurt their back.  However, it is far less common than a spasm, strain, or sprain.  Think of the disc as a jelly donut between the vertebrae.  Imagine the jelly getting pushed out of the wall of the donut.  This is what happens with a disc herniation.  The herniation causes a variety of symptoms by putting pressure on the nerves.  Some of the symptoms include numbness, tingling, shooting pain, and muscle weakness.  It is usually most noticeable when you bend or twist.  Keep in mind that just because you experience some of the symptoms it does not mean you herniated a disc.  Remember that the other injuries mentioned can mimic a disc herniation.

3 Ways You Can Avoid These Injuries and Stay on Track Towards Your Fitness Goals.
1. Balance Your Core Pillar
Contrary to popular belief, chest day is not every day.  Exercising the muscles of your abdomen, entire back, and chest play an important role in injury prevention.  When one side of your core gets more attention than the other, your injury risk goes up.  Balancing your core routine improves your body’s ability to resist against a situation that may lead to an injury.

How do you know if your core is balanced?  The easiest way to tell is to analyze your posture.  Most people have their head and shoulders rounded forward too much.  This not only means the muscles of the upper and mid back are weak, but also the pecs are most likely too tight.  Some of the exercises I find myself frequently recommending to patients are rows, lat pull downs, pull-ups/chin-ups, back extensions, and planks.  Think of all the different ways your back can bend and twist.  All those motions require muscles to make it happen, so be sure to exercise accordingly.

Strengthening and engaging your core not only protects your spine but can also improve your results in the gym (lift heavier and/or longer).  Think of it like this: Would you be able to jump further off of a dock into the water or out of a canoe?  You would go further off of a dock because it has a more solid foundation.  A solid core foundation works the same way during daily life and while exercising.

2. Lifting Technique
The common denominator for many of the exercise-related  back injuries I treat are a result of poor lifting technique.  Laziness, a lack of focus, and a lack of knowledge can contribute to poor lifting technique.  It is commonly from just a few reps at the end where their technique was compromised and their body decided to throw in the towel.  Squats and deadlifts are two examples of where one or two bad reps can result in a back injury.  Not to say those are bad lifts that should be avoided, but they should be done cautiously so that you can keep a mental note of what you are or are not doing correctly.

Avoid a back injury at the gym by using proper technique when lifting.  Do not sacrifice proper technique for more weight.  Focus on maintaining a straight position with your spine.  This will force you to engage your core to add stability to you back.  As you lean more in one direction or another, you make yourself vulnerable to injury.  A contracted and engaged core when you lift serves as a built-in back brace to protect your spine.

3. Take Time to Warm-up
Next time you go to a sporting event try to arrive a little early.  You will see the athletes going through different kinds of warm up exercises and stretches.  This helps them prepare their body, both neurologically and cardiovascularly, for the demands of the event.

There is a natural progression that should be followed when warming up.  First, start slow and simple. When you start slow and simple you allow for the body to gradually wake up and pull blood into the muscles being used without shocking your tissues.

As more blood is attracted to the area, there is an increase in muscle flexibility which results in better range of motion of your joints.  The blood is also used to carry nutrients to the tissues while removing waste products.  Think of it like the gasoline in a car.  The gas helps create the energy to go.  As the gas is used up, there are waste products in the form of exhaust that are pushed out of the car.  The efficiency of the body is dependent on both the nutrients coming in and the waste products being removed from the system.

The nervous system is the other important element.  Think of the nervous system as the computer and electrical wiring within the body.  When you turn on a computer, it usually takes some time before the computer is ready to function.  Your body works the same way.  As you warm up the nervous system, your coordination improves.  This plays an important role in maintaining proper technique as you exercise.

How do you apply this to your workout experience at the gym?
There are two main answers.  First, do a general full body warmup such as an elliptical or treadmill session for about 10 minutes.  The other answer is to do warm-up sets.

Warm-up sets are an important part of injury prevention.  Every exercise places different demands on the stabilizing and main muscles engaged, so each exercise should get a warm-up set.  Again, think about slow and simple.  This is not the time to push large amounts of weight quickly.  You are simply going through the motions of that lift trying to gradually engage all the muscles involved in the proper way.  This will allow you to take a mental inventory of the main muscle groups required and the stabilizing muscles that play an equally important role.

Going light, slow, and controlled will also give you a chance to make sure you are applying the proper lifting techniques.  If you are not doing the lift correctly in a warm-up set, then you definitely are not doing it right when you add more weight.  My general recommendation is to cut your starting weight in half or lighter.  Do 5-8 reps of this weight.  This is not meant to make you tired or work hard.  Your goal is to engage the proper muscles and make sure you are not compensating by doing additional leaning, twisting, or swinging to move the weight.  If you are doing these things, it is only a matter of time until you hurt yourself.  Be sure to control the weight you are lifting all the way up and down, and not let the weight control you.


To Sum It All Up
Be proactive about protecting your spine.  Strengthen your entire core, do not get lackadaisical with your exercise technique, and always warm-up thoroughly.  These are the keys to avoiding back injuries when you exercise.  Remember, an ounce of prevention is worth a pound of cure.


About the author
Dr. Stephen Workman is a chiropractic physician practicing in Cedar City, Utah.  Dr. Workman specializes in sport injuries and performance. He has treated many professional athletes, dancers, and musicians over the years. In addition to his Doctorate in Chiropractic, he has a Master’s degree in Sports Medicine and two Bachelor’s degrees in Human Biology and Exercise Science.  Dr. Workman enjoys all forms of exercise, sports, and outdoor activities. He is also a drummer and an avid foodie. Dr. Workman can be reached at DocSWorkman@gmail.com.

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