Podcast 32

The Secret to Strengthening Your Lower Back and Eliminating Lower Back Pain

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SHOW NOTES

In part two of the interview with Dr. James Fisher, we explore what it takes to actually strengthen the lower back and why exercises like the deadlift are not effective in targeting your lower back muscles. Find out how some people can experience significant lower back strength gain in as little as ten weeks with only 15 total minutes of muscle tension (60 to 90 seconds per week!) and why stretching without strength training can actually make your lower back pain worse.

• The lower back is a notoriously difficult to train muscle group, which is why so many people are walking around with weak lower backs that are easy to injure and irritate.
• Fisher did some research with professional athletes to measure the effectiveness of certain exercises in strengthening the lower back and found that exercises that didn’t isolate the lower back didn’t make a major impact. However, lower back isolating exercises had a greater impact over more general exercises like the deadlift.
• The lower back needs an isolation exercise and preferably one that doesn’t also load the gluteal muscles. These exercises are best done with lower back specific pieces of equipment.
• In terms of overall strength, people who do lumbar exercises see significant increases in strength. Dr. Fisher has seen lumbar strength increases as high as 200% over the course of ten weeks, as well as improved lifestyle function, with a training frequency of once per week.
• Lower back exercises are typically just one set and roughly 90 seconds of muscle tension.
• The lumbar muscles are an example of how you can use your muscles and still lose them due to the deleterious effects of aging. You need to use specific muscle fibers in a specific manner in order to build the strength in your lower back.
• Stretching can be taken too far if you are not also strengthening the muscles involved. Making your spine and back more mobile without making it stronger can make things worse for you in the long run. Things like yoga should be supplemental to a proper strength training regime.
• Lower back pain often restricts range of motion, but there are still opportunities to train the muscle group without a full extension. You can start small and expand the range as you get stronger.
• People with lower back pain also tend to be cautious about moving their lower back, especially during exercise. This is why lower back machines that control the range of motion are effective. They maintain safety and stability while loading the muscles properly.
• In terms of age, lower back exercises are suited to pretty much everyone in society except for certain individuals; ex. If you’re pregnant, a small child, or have an injured spine. Once you’ve ruled out those conditions, you can safely and confidently strengthen the lower back.
• The more we know about our body, the more we know how to fix it. Helping identify the source of lower back pain, as well as what isn’t the issue, is all part of the journey of alleviating pain and improving quality of life.

We are talking about 100 to 150 % increase in strength as being probably quite normal over a 10 -week training intervention. And that’s training once per week. That’s not training every day or multiple times a day or anything like that.

Welcome to the Strength Changes Everything podcast, where you get information about living a strong and healthy lifestyle. I’m Amy Hudson, exercise coach, franchisee, along with my co -host, co -founder, and CEO of The Exercise Coach, Brian Sagan. I’m so happy you joined us this week for part two of a two -part interview series with Brian and Dr. James Fisher, where we are discussing all things low back. If you missed last week’s episode, part one, I encourage you prior to listening to today’s episode to go back and listen to part one of their conversation about the prevalence of low back issues among so many people in the population and some of the causes that we know lead to chronic low back pain in many adults. In today’s episode, we will be talking about the role of strength training when it comes to low back health. The low back is a notoriously hard to train muscle group.

And so that is part of the cause of why so many people are walking around with a weak and vulnerable low back that doesn’t take a lot to injure or to irritate. We’re going to learn about what we can do to strengthen and fortify that area of our body to increase our quality of life and to see dramatic improvements. I can’t wait for you to hear their conversation in part two of the low back episode between Brian and Dr. James Fisher. Let’s roll that interview.

Well, transitioning to addressing the root consideration of weakness. Let’s talk a little bit about the best ways to strengthen these muscles and then what’s possible a more specific approach to strengthening and so I’ll just throw out there a few different things, more conventional weightlifters might do something like a deadlift, or your average exerciser might do something on a ball and try to do some type of extension of their back. I think you touched on this earlier in the show, but help our listeners understand what may be the strengths and weaknesses of different types of what are termed lower back exercises, and maybe just lead us towards what you’ve seen as a necessity for optimal strengthening from your research.

Yeah, absolutely. So about 10 years ago, I published a paper where I compared two groups of trained males, one trained using a specific lumbar extension exercise, that isolated the low back and trained those muscles specifically. And the other group trained using Romanian deadlift, which is a deadlift, which has a lot of hip extension. It’s not such an upright position, it’s very much a bent forward position.

And so for our listeners, that’s someone basically just bending over and picking up a barbell bending over and standing back up.

And it’s done with good posture, it’s done with good trunk control and they were trained people, so they’re experienced at this. And after 10 weeks of training, what we found, 10 weeks of training once per week, so it was very much a minimal dose approach. We found that the group that strengthened, the group that did specific low back training strengthened their low back. The group that did deadlift training did not show increases in their low back strength. What was quite interesting is we also found that people that increased their low back strength, also increased their deadlift. So we saw that crossover effect as well.

So we certainly know that the low back does play a role in some of these other exercises and strengthening it can improve those exercises, but specifically those exercises tend not to strengthen the low back in isolation. Now, some of the other more recent publications that we’ve had have talked about professional powerlifters, very strong athletes with incredibly high squat, back squats, deadlifts and bench presses. So people you would expect to have an incredibly strong low back based on the exercises they perform. And we found that they actually didn’t have, that their low back strength wasn’t actually much more than just the lay population. which again suggests that those exercises don’t do sufficient to stimulate the low back muscles, that they increase to a certain extent, but beyond a certain point, those exercises simply don’t train these lumbar muscles.

So with that in mind and getting to the point, really this muscle needs an isolation exercise and it needs to be quite specific to the lumbar extensors. You mentioned the idea of doing an exercise over a Swiss ball or a fit ball and one of the big problems with a lot of these exercises is they still rely on gluteal contraction. They still rely on derotation of the pelvis. So if I lie on the floor and I do a dorsal raise, then I will contract my low back to some extent, and it’s probably better than nothing, but I will also get a great contraction in my glutes because my glutes are attaching my pelvis and my femur to create that hip extension. So that’s not what we’re trying to do. So really what we want to do is any exercise where we can avoid that hip extension component in some ways that can be done by managing the exercise accordingly.

And in other ways, it’s best done with specific pieces of equipment. So specific resistance machines.

Sure. And when someone is able to utilize a machine that really specifically isolates the lumbar musculature, really specifically fosters the loading of those muscles through true spinal extension, what difference does that make?

What have you seen in terms of the strength response? Yeah, we’ve seen quite phenomenal increases. So first of all, this tends to work in about 80 % of the population. So there are some people who do lumbar exercise, and it just doesn’t seem to do anything for them. And we would call them non responders, they might not respond well to many types of exercise. That’s not to say that it’s necessarily bad for them, it just might not be as good as it can be for other people.

but in the 80%, which is by far the majority of people, we see increases as high as, well, I personally have trained people where they’ve seen a 200 % increase in strength in around 10 weeks. And that’s a phenomenal thing. And what that’s coincided with is the decrease in any disability, the improvement in their function, the improvement in their mental wellbeing around that, and so forth. And in fact, in patients like that, that we’ve worked with, after a certain length of time, they often come in and say, oh, my back’s a bit sore today. And I sort of go, all right, OK, well, you know, what’s happened? You know, what’s what’s gone on?

They said, oh, I did six hours of gardening yesterday. And of course, if you do six hours of gardening, you would probably get some muscular soreness in your low back anyway. But the point is that they are now functioning back at the level they want to be functioning at so they can return to the activities they want to do. And that’s the main thing, because it’s not just strengthening the low back.

for the sake of strengthening it, strengthening it to improve our quality of life. A 200 % increase in 10 weeks is just off the charts. That’s just profound.

Is that the type of thing that you can see in other muscle groups or is it really something that’s a function of this, this situation the low back is in this deep disuse atrophy of the lower back? Well, yeah, no, it’s absolutely a product of the disuse and the atrophy of the low back. And the best way to think of it is when our astronauts return from a microgravity environment where they’ve had severe muscle wastage, when they return to strength training, they can probably make similar increases across other muscles, maybe not quite so high. But, you know, a lay person or a trained person will never see a 200 % increase in any other muscle group. That would just be unheard of. And that’s quite an extreme response.

But we are talking about 100 to 150 % increase in strength as being probably quite normal over a 10 -week training intervention. And that’s training once per week.

That’s not training every day or multiple times a day or anything like that. Oh, wow.

That 10 weeks you’re saying was a once per week dose of lower back exercise.

Yeah. But that’s the frequency once per week. What about the the volume of the exercise, meaning how much of it in an exercise session was performed? Do people have to do like 10 sets of 20 reps and take an hour and exercise their back for an hour once a week?

No, we typically do one set, in fact we only ever do one set of a lumbar extension exercise to the highest effort the person can manage through the full range of motion that they can move through and it typically takes between 60 and 90 seconds of muscular tension and in fact what we’ve found with a lot of our patients is after a certain number of weeks of doing this they then sort of say oh you know what else can we do can we try this exercise can we try that and we end up with with kind of

a research study where we’re trying to look at people with low back pain, and we end up with, you know, a series of sort of personal training clients who want to work out every week. Wow. Yeah, 60 to 90 seconds, one time per week for 10 weeks, 100 to 200 % strength increase and in 80 % of people a real impact in terms of quality of life. That sounds really pretty amazing. And of course, I am, I’m familiar with those findings. And in fact, we’ve based largely what we do at the exercise coach on this research and more.

And so I can absolutely validate what Dr. Fisher is saying. And we have seen people experience the same thing, because we do use actually a technology that is a patented technology designed to specifically isolate and address the lumbar muscles. And we see exactly this type of result. And it really strikes me, the lower back, it’s again, a case of people, I’ve said before, you know, that people can use them, meaning their muscles and still lose them. And and when I’m talking about that, usually I’m talking about people who are active, and yet are experiencing the the deleterious effects of the aging process. And they say, I’m active, what’s going on?

And our point is, well, you’re using your body, you’re using your muscles, But you’re still losing strength and muscle mass because you’re not using some specific muscle fibers in a specific manner and there were specifically talking about the fast twitch muscle fibers a type two muscle fibers here with the lower back. It’s similar in that you can be doing weightlifting, you can be very active doing exercises, you’re using your body, yet you’re losing the function of your lower back, because again it requires this specific approach to to address and preserve or increase that function. Yeah, absolutely. Absolutely. And one of the other interesting things around this is people often talk about mobility and about stretching they get when they do stretches. And that’s their way of, you know, perceiving that they train the lumbar extensors in the low back.

And I’m not against people doing what feels good for them. But what we should do is we should look more generally at the joints that we’re training the muscles to move. or stabilize and identify whether we want mobility or stability. And I tend to teach my students that from the ankle upwards, we want alternating mobility and stability. In the ankle, we want a great degree of mobility. In the knee, we want stability to avoid injury.

In the hip, we want mobility. And in the low back, we want stability. Now, with that in mind, whilst I say I’m not against people doing stretching, I think that the stretching can be taken too far. We can do too much to try to mobilize our spine. And if we do too much mobility work without strengthening the muscles, then we can be making it worse in the longer run. So I think that’s something to be really kind of cautious of.

Now, some people have heard that and said, oh, so I shouldn’t do yoga. And I can say, no, I think probably more people should do yoga, actually, because yoga can definitely help with mobility.

And yoga is also geared around spinal stability. But I also think yoga should be a supplement to a good strength training regime, which includes strengthening the lumbar muscles. I would agree with that. And as we’re getting to a close here today, I want to be respectful of your time. And so I’m just going to telegraph the things that are rising to the top of my mind here. Maybe we could touch on quickly.

And so it would be first of all I think you’ve done some research looking at even doing this specific isolated lumbar strengthening through limited range of motion and so maybe you can touch on that and then just general thoughts on the safety of doing I mean, you’ve said once a week training 60 to 90 seconds, and you’ve said it’s demanding exercise. So maybe we can just touch on who’s this safe for? Is it safe? And then the third thing would maybe be a part of that safety was, is age.

Are we talking that this can be effective for people in their thirties and forties, or is this also people in their fifties, sixties and seventies? So I’ll try to keep us organized there with those three, but go ahead and take them in whatever order you want to, if you can. So the first point you raised was range of motion. Now, obviously, people with low back pain certainly have a limited or tend to present with a limited range of motion. And with some patients, we’ve gone to the extreme of even simply having them seated in the machine and do an isometric contraction against the pad. And from there, work into a small range of motion and gradually expand that range of motion to the point that they’re comfortable with over consecutive weeks.

I don’t think we need to work through extreme ranges of motion. We can certainly work through a limited range of motion and still see strength increases. With the low back, if we work in a limited range of motion centrally, that tends to be quite good across the full range of motion.

If we only ever worked in full flexion, that probably wouldn’t do as much for us in full extension. So we probably want to try to work through the full range of motion, but certainly somebody who doesn’t have good range of motion in their back shouldn’t be concerned about it, because this tends to be something that can increase with exercise. I mean, maybe touch on safety because we’re talking about the lower back and people who have had some problems with their lower back. They might be apprehensive, but it sounds like we’re saying we’re going to do intensive exercise with the lower back.

So should they be confident about that? Why can they be confident about doing that? They should absolutely be confident about it. And it’s completely normal to be apprehensive about this type of exercise. We very much take care of the muscles that that surround the spine, whether it’s the low back or the neck and so forth. And that’s a kind of an almost subconscious thing.

And people with low back pain are even more cautious. And they’re right to be. With the machines that we tend to use, and the more specific the machine, the safer that somebody is, because it only moves in that plane of movement. It’s restricted at either end, so they’ll never move outside the range of movement that we want them to move. And they are perfectly safe. We’ve never had any issues with any patient across hundreds and hundreds of people that have come through our laboratory doing this exercise, and I’ve never heard of anybody else.

I think things become more risky when we start to do things that are less controlled, like a dorsal raise or leaning over a Swiss ball.

If we suddenly have a shooting pain and fall to one side, we’re far more likely to have an injury or an acute episode with our back.

So I think safety is really important and is recognized with the use of these machines and the trainers, of course, with the supervision.

Yeah. And controlled speed of movement itself, the prescribed speed of movement being slow and controlled, that can also contribute to safety, right? Absolutely.

So the muscle is maintained under tension.

It’s never moving explosively or trying to catch a weight that it’s moved too fast to begin with or anything like that. So that’s obviously really important and really well controlled in the exercises that we prescribe.

Sure. And how does the element of age factor into this conversation? It really at any entry point that you’d like to discuss just the lower back and age? Yeah, so I think the low back should be trained for everybody in society. So I don’t think there’s anybody realistically too young, certainly pre -pubertal children might not be well suited to the machines simply because of their stature.

But from adolescence upwards to anybody who still has the function to do that kind of exercise, whether they’re 100 or 120 years old, I think it’s a positive thing for them. There are, of course, contraindications to anybody who’s pregnant wouldn’t move into extremes of flexion because of the fetus. I mentioned sort of 10 to 15 % of low back pain is a part of specific causes. So if, for example, somebody has had a herniated disc, then a disc bulge to the posterior of their spine, well, lumbar extension exercise is a contraindication for those people. And this might be a reason why people who are experiencing chronic low back pain should seek medical guidance first. But once we’ve ruled out any of those other potential conditions, and it’s a low likelihood that they’re experiencing those conditions anyway, then we can safely and confidently move on to strengthening the low back.

And I mentioned cognitive behavioral therapy and understanding and making sense of the pain.

Well, the more we know about our body, the more we know how to fix it. And that’s a mental thing as well as a physical thing. So if somebody is presenting with low back pain, helping them identify what the cause of the pain is and eliminate what the cause of the pain isn’t can be part of that journey of reducing the pain, improving the mobility and function and quality of life and so forth. Sure. And we’ve worked with people in this manner who are in their 60s, 70s, 80s, and have just seen profound results, as you’ve discussed.

And they’ve been able to tolerate it quite well.

And someone who’s been experiencing that disuse atrophy for that many decades a very low baseline. And so we’ve tended to see that they’re the people who experienced those really, really off the charts strength increases. Yeah, that’s right. Yeah. Well, Dr. Fisher, this has been great.

Thank you so much for your time today. Early in my career, I was actually introduced to some technology that was designed, as we’ve been talking about, to specifically isolate and target the lumbar muscles in a very intensive way. And that had a major influence on my perspective and my practice in the fitness industry when I learned and saw that people could have these profound, positive responses to such a small amount of exercise done so infrequently. and in a manner that was really, really measurable, which was exciting. And that was 20 years ago. That’s actually part of how I think our paths cross.

And eventually I learn about your research emphasis using this type of equipment and all of your other research.

So it’s just a delight to get to speak with you today.

And I so appreciate all the work that you and your colleagues have done. And it’s had a huge impact on our business and brand and many people across the U .

1. and all the way to Japan we’ve performed millions and millions of exercise sets with people and many of them a specific intensive isolated strengthening for the lumbar muscles so there are many people out there that have you to thank for some confidence and education that that stands behind the work that we’re doing with them. Well it’s great to see you guys doing the work that’s the main thing so you know. Well Thank you again, and we will hopefully have you back on soon to talk about another topic and just wish you well, and we’ll talk soon. Thanks very much, Brian. You too.

Thanks a lot. And that wraps it up for the conversation between Brian and Dr. James Fisher. the low back. I hope you gleaned as much wisdom as I did from this episode. I’ve truly enjoyed listening in and we always are grateful to Dr. James for being a guest on this podcast. He brings a lot to the table and really helps us to understand some important areas of health and how to feel our best when it comes to muscle and strength and its role in our quality of life.

We will see you next week on the Strength Changes Everything podcast. Have a great day, everybody.