How To Build A Strong Back (And Why It’s Important)

Having a strong back helps improve your quality of life.

A strong back allows you to perform daily tasks with relative ease and is protective against injury.

The “back” isn’t an actual body part, but rather a descriptive term. In this article, it means the area from the base of the neck to the top of the pelvis.

Functionally, we can divide the back into two parts:

  • The lower back, which is primarily involved in lifting, carrying and supporting our upright posture
  • The upper back, which provides a foundation for the shoulder girdle and supports our head and neck

In a way, the back also encompasses the “core” and the “shoulder”, which is a good reminder that these are all labels that we give to the body – it functions as a whole, and the separation is only in the way we think about things.

So with that in mind, we can still use these concepts to help us build a strong back.

You don’t need expensive or fancy equipment. Muscles only respond to tension, which can be generated in a number of ways, with or without external weights

Barbells, dumbells, kettlebells, resistance bands, along with pull up bars and suspension trainers to leverage your own body weight are all fantastic ways to develop back strength, and of course, you have specialised machines that can help develop a strong back.

The key is to find an approach that works for your body and your situation.

Top Reasons To Build A Strong Back

  • The act of strength training is protective against back pain (1)
  • Strength training for the upper back was the best intervention for pain in desk bound office workers (2)
  • A strong back helps maintain your optimal posture (more on posture here)
  • The mid back is a common site for osteoporotic fractures – strength training prevents this (3)
  • After the legs, the back muscles are the biggest and strongest in the body, training them expends a lot of energy, helping maintain body composition and blood glucose levels (4)
  • Strong backs look good (don’t underestimate the importance of a positive self image)

Pull, Lift, Carry

There are 3 main actions you can perform with your back muscles:

  • Pulling actions, where you pull yourself towards something, or something towards you. Examples include chin ups, rows and climbing. These movements tend to develop predominantly upper back strength by working on the muscles the move the shoulder blades and arms.
  • Lifting actions, which are those actions where you pick something up (usually from the ground). Examples include deadlifts and power cleans.
  • Once you have picked something up, you can also carry the object for time or distance. Both lifting and carrying exercises develop both lower and upper back strength by working the muscles that stabilise the spine. They usually develop leg strength as well, so are very efficient exercises.

The Best Pulling Exercises

There are a variety of ways to train the pulling movement.

When you consider the freedom of movement the shoulder girdle has, it allows a high number of variations.

The Movements

The shoulder blade (scapula) has a number of ways it can move, but when it comes to pulling, the 3 we are concerned with are:

  1. Retraction: squeezing your shoulder blades together, as in when you perform a rowing action. Examples would be all the row variations in the world!
  2. Depression: pulling your shoulder blades down, as in when you pull yourself up to a bar/ledge. Examples would be chin ups and lat pulldowns.
  3. Upward rotation and elevation: when your shoulder blades turn upwards and raise, as in when you are pulling something in front of your body to your neck. Examples of these are upright rows, shrugs, high pulls, cleans and snatches.

For most people, I like body weight pulling exercises, like chin ups, inverted rows and climbs, though these are often very challenging and hard to scale down for beginners.

Where To Start

In the gym, cable rows and pulldowns, along with barbell and dumbell rows are the go to, with a large number of variation available via hand position, body angle and line of pull through the shoulder.

In practice, a $6 band from Kmart can be a great tool to enable you to perform pulling actions. Loop it around a post and pull it toward you. Loop it around your feet and pull it up. Loop it around a rafter/beam/tree branch and pull it down.

Do More Reps!

As a rule of thumb, pulling exercises are better as volume exercises, not intensity.

That is, perform a higher number of reps per set on average.

You can still load pulling exercises quite highly, but the combination of distraction force through the upper limb and ambiguous end point make it hard to do so as effectively as deadlifts, presses and squats.

Often Overlooked

One class of exercises that are often overlooked in both rehabilitation programs and fitness programs outside of the weightlifting/powerlifting world are shrugs and high pulls.

These train the upward rotation and elevation motion in the shoulder blades (shrugging), which strengthen the trapezius muscle.

A strong trapezius muscle supports healthy shoulder and neck function, but unfortunately, because many people with neck pain report a “tight” trapezius, these exercises were vilified. What was missed is that in these people, their trapezius feels “tight” because it is weak, and strengthening relieves their symptoms.

My Personal Favourites

So while my favourite pulling exercises are:

  • Chin ups (palms facing toward you) and pull ups (palms facing away from you)
  • Inverted rows (elbows high and elbows low)
  • High pull/upright row

In a perfect world, I would help all my clients develop competency and strength in these movements. But because I live and work in an imperfect world, and time, equipment and money are often limiting factors, the exercises I use most in clinical practice are:

  • Band pulldown
  • Band row
  • Band upright row

Deadlifts

The deadlift is a fantastic all-round back strength exercise. It also concurrently helps develop strong legs, particularly the posterior chain muscles, including the hamstrings and gluteals.

It involves picking up a weight implement (barbell, dumbell, kettlebell, etc) from the ground and then lowering it back down again.

There are countless deadlift variations, but my favourite is the barbell deadlift from blocks.

Rogue Metal Deadlift Blocks (https://www.roguecanada.ca/rogue-metal-pulling-blocks)

A close (equal) second is the trap bar deadlift and the kettlebell deadlift.

Why do I favour the barbell deadlift from blocks over other deadlift variations to build a strong back?

  • It allows us to infinitely and incrementally load the pattern, compared to kettlebells, which come in large jumps (usually 4 kg) and only go up to 48 kg in pro-grade style or (very large) 92 kg classic style.
  • We can control the range (rather than lifting based on the height of the weight plates) and ensure the movement is performed within a range that is safe for an individual’s mobility and strength.
  • It is better than a rack pull because the moment arm (from the centre of the bar to the load, not of the load on your spine) is larger (allows better leverage when starting the lift) and as a bonus, protects the bar.
  • Compared to the trap bar, the straight barbell requires a more bent over position, creating a large anterior shear moment on each vetebrae, which the back muscles have to resist, which develops high levels of strength in the spinal stabilisers.

The main downside to the barbell deadlift from blocks is it is more technically challenging/less intuitive than the trap bar or kettlebell deadlift. However, even though these are simpler, and some might argue more “functional” in that they require you to stand between the handle (like a wheelbarrow) or have the load between you (like lifting a heavy bag of fertiliser), I feel like they understimulate the back and posterior chain (relatively).

A second issue is equipment, while most gyms, and many clinics will have a barbell, not many have access to proper lifting blocks. A compromise is to use aerobic steps or weight plates, though they are just that, a compromise.

In reality, you can use a variety of deadlift variations, it doesn’t really matter, as long as you are developing the strength to pick things up from the ground.

Typically, deadlifts can be performed heavy for lower repetitions, or lighter for higher repetitions. They lend themselves well to both applications.

Not Quite Deadlifts

There are a number of exercises that have a similar pattern to the deadlift – the hip hinge movement – that aren’t quite the deadlift.

Think of exercises like:

  • Good mornings
  • Kettlebell swings
  • Back extensions
  • Reverse hypers

These are all great exercises.

They definitely have a place as deadlift alternatives or additions to deadlifts.

The reason I list them as a second tier, is because for most people, I seek maximum training economy, and with that in mind, deadlifts are more than enough stimulation. I would mostly use alternatives when deadlifts are not appropriate:

Loaded Carries

Loaded carries are an under utilised exercise in both performance and rehabilitation.

They are simple movements, but are definitely not simplistic.

Loaded carries can be performed in a few ways:

  • Bilateral loading
  • Unilateral loading

And with the load in different positions

  • By sides (farmer’s walks, suitcase carries)
  • In the rack position (with kettlebells or a barbell)
  • Yoke carries (across the shoulders)
  • Overhead

The most important thing to ensure with loaded carries is to retain postural integrity. The idea is to train dynamic stabilisation under load, not test your limits of how far you can carry a heavy object.

A good guideline is to work with 75% of your bodyweight for farmer’s walks. This might sound light for experienced athletes, but remember, we are trying to build strength, not test it. Building strength can be done with sub-maximal loads, and it allows for faster recovery and better movement patterns.

Conclusions

Pulls, deadlifts and carries are more than enough to build a strong back.

However, there are many other variations of exercises that can be used too.

I’m not in the business of vilifying movements, and given the low activity levels of the majority of Australians, almost any movement is good movement.

Whichever movements you choose, for most people 2-3 times per week is the optimal frequency to develop strength, while the exact amount volume of work you do is individual, the idea is to do more over time.

What I have listed here are the best back exercises for the majority of people, the majority of the time.

While in theory, structured exercise is not essential for health, when it comes to developing a strong back, the simple truth is that the majority of Australians are not physically active enough to develop and maintain adequate strength throughout their lifetime, and so need a structured program to make up for it.

Do you need a stronger back?

If you feel like you could benefit from increased back strength and a holistic exercise program, then contact me to arrange a consultation. This can be done in person or online, depending on your location.

 

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 

 


 

 

 

References

(1) Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials

(2) Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial

(3) Heavy resistance training is safe and improves bone, function, and stature in postmenopausal women with low to very low bone mass: novel early findings from the LIFTMOR trial.

(4) Effects of Different Modes of Exercise Training on Glucose Control and Risk Factors for Complications in Type 2 Diabetic Patients

Does Sitting Cause Low Back Pain?

Sitting And Low Back Pain

Sitting is the new smoking. – everyone

You’ve heard it. You’ve read it. Somewhere in your brain is the meme that sitting is the new smoking.

Yes, sitting for long periods without moving is unhealthy, mostly from a metabolic point of view, but does sitting cause low back pain?

In reality, like all things related to pain, it’s complex, and as a result, the research seems to be mixed, which is a far cry from what you’ll read in most health articles posted online, in newspapers and magazines.

What Does The Popular Media Say?

It’s really common for articles in the popular media, both online and offline, to say that sitting causes low back pain. (1,2)

Most say that the incidence of low back pain has increased because of increased sitting time or via mal-adaptive processes (like muscle shortening) as a consequence of sitting.

You will read about how sitting shortens hip flexors and hamstrings, about how sitting compresses the spine and the discs and about how sitting weakens “the core”.

Because these mechanisms sound plausible, and because they are repeated so often, they are gradually accepted as fact, without much further questioning.

Unfortunately, what makes sense in theory doesn’t always pan out to work in the real world, which is why we use the scientific method to try and determine cause and effect.

This is important for two reasons:

  1. If we determine that sitting causes or doesn’t cause low back pain, then we can act on this information accordingly.
  2. If we determine a causal relationship between sitting and low back pain, we can then look at why this might be happening, in order to better treat it.

What Does The Research Say?

When we look at the research around sitting and low back pain, the results are mixed.

One study (3) took a group in 1993 and followed up at 5 year intervals until 2012. They looked at mental health, metabolic health and musculoskeletal health. They found no association with occupational sitting and low back pain.

Another study (4) I looked at objectively measured sitting time as a risk factor for low back pain. This is important, because most studies rely on self-reported data, which is typically inaccurate. The authors found that total sitting time (most studies just measure occupational sitting time) was associated with low back pain intensity, when other factors were controlled for. This means that the more these people sat, the more intense low back pain they experienced.

The third study (5) I looked at wasn’t a study, it was a review. A review is when researchers look at all the studies on a certain topic that meet certain criteria, and then compile their results.

Aside: a meta-review is when researchers review all the reviews on a topic to get an idea of what “works”. This is regarded as the best form of research evidence, because it is more robust and has more statistical power (is more likely to be correct).

In this review the authors reached the following conclusions:

Although occupational physical activities are suspected of causing LBP, findings from the eight SR reports did not support this hypothesis. This may be related to insufficient or poor quality scientific literature, as well as the difficulty of establishing causation of LBP. These population-level findings do not preclude the possibility that individuals may attribute their LBP to specific occupational physical activities.

So as you can see, from my small sample, one showed a link, another showed no link and the review found no link, but also acknowledged potential issues as to why this is so.

So, Does Sitting Cause Low Back Pain?

As you can see, the results were not conclusive. Even if increased sitting time is associated with low back pain, it doesn’t mean it causes low back pain.

This is because, pain is emergent, not dependent.

An emergent property is a property which a collection or complex system has, but which the individual members do not have. A failure to realize that a property is emergent, or supervenient, leads to the fallacy of division.

What this means, is that pain arises based on many factors, that are unpredictable, so to try and isolate one variable, like sitting, as the cause, is impossible.

No one thing causes pain.

A “More” Plausible Explanation?

If we look at why somebody might experience pain after sitting, we have to ask:

Was it the sitting, or something the sitting did?

Do people who experience low back pain from sitting also experience low back pain from other activities?

What about positions that replicate sitting, but aren’t sitting?

If they do, then what do these activities have in common?

Finally, is there ways they can sit that don’t cause them pain?

Most of the time, we will find that sitting is not the sole cause of low back pain, and when it is apparently so, it’s likely that there are still other factors at play.

One way to explain why we get pain in certain positions, is to understand the sensitivity of peripheral nerves.

When we occupy any position, particularly when pressure on the body is involved (sitting, lying etc), there is a compression of body tissues taking place, including the peripheral nerves.

When we apply pressure to peripheral nerves, they deform.

This deformation causes altered neural blood flow – rabbit models show a reduction of up to 70% of their blood flow when a strain of only 8.8% is applied.(6)

This could feasibly be a driver of nociception (bearing in mind that pain is produced by the brain, there are no “pain signals”) which could result in a pain experience.

So instead of thinking that sitting causes low back pain, it is probably better to look at the function of your body as to why you don’t have the capacity to sit for extended periods, and address those issues.

Conclusions

Just because sitting doesn’t necessarily cause low back pain, doesn’t make it harmless. Sitting has many pronounced negative effects on our metabolic functions, and movement has many pronounced benefits, including reduced incidences of pain (7).

Additionally, if you understand that no one thing causes pain, you will be in a much better position to deal with pain when it happens.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

References

(1) Heal your lower back pain with these 5 yoga poses

(2) Proper sitting

(3) Occupation sitting and cardiometabolic, mental and musculoskeletal health

(4) Sitting time (measured) and low back pain

(5) Occupational physical activity and low back pain

(6) Structure and biomechanics of nerves

(7) Physical activity and chronic pain (in mice)

Exercise For Low Back Pain

Fit girl lift weights at fitness gym center. Deadlift workout.

Any article about exercise for pain needs to cover one important fact before it goes on:

The body will tend towards self-correction/health/resolution, if, and that’s a big if, the right conditions are present.

The biggest challenge facing an osteopath, or any other therapist, is finding, or more likely, stumbling upon, the right conditions for the individual seeking help.

Whilst there are general guidelines to abide by, every one of us has a unique set of experiences, thus different stories, explanations, treatment techniques and movements are required to facilitate a recovery; not to mention all the environmental factors that come into play.

This article intends to discuss the general principles that should underpin your actions when exercising for/with low back pain.

Where Most Back Pain Exercise Programs “Go Wrong”

Most back pain exercises or exercise programs are based on the notion that pain is the result of specific factors, and that these factors can be specifically identified and then specifically addressed.

There are a variety of factors that can contribute to low back pain, but aside from a history of previous episodes of low back pain, nothing drastically stands out as being identifiable. (1)

As an aside, this perhaps points the finger at us, therapists and rehab professionals, who are not doing a good enough job in the first place (on a population, not individual level).

It is also highly important for sufferers of low back pain to understand, as many people decide to cease treatment/rehab as soon as their pain is gone, rather than concluding the full course of treatment and restoring “lost” function.

Unfortunately, it is very difficult to specifically assess and as a result, address them with targeted exercises.

So knowing that specific factors may be hard to identify and treat, it seems more important to build resilience with a complete mobility, strength and conditioning program.

Take home point number 1: exercise programs for low back pain should not attempt to be specific, but rather improve all physical qualities.

There Are No ‘Good’ And ‘Bad’ Exercises

Another misconception surrounding exercise for low back pain is the concept of ‘good’ and ‘bad’ exercises.

Generally, if you are reading a fitness article, the concept of “neutral spine” is mentioned quite a lot. Lifting should always take place with a neutral spine, regardless.

If you are reading a rehab article, limits might be imposed on external loading, as in, any lifting above 10 kg is bad, and must be avoided.

Or you might read a medical article which mentions you should simply avoid things that hurt.

All of these comments have a place, and are neither right or wrong without any context to define them.

A ‘good’ exercise is one that you can do safely, is suitable for your current ability, is able to be gradually progressed and fits in with your needs and wants (aka your goals).

Take home point number 2: blanket statements and absolutes do more harm than good. There are times when a moderate approach doesn’t work and more extreme action needs to be taken, but it is rarely either or. Exercise selection is based on your needs and wants, not an arbitrary definition of good and bad.

Self-Limiting Movements

This is a concept that was popularised by American physical therapist Gray Cook, in his book Movement.

Self limiting movements/exercises are those that have an inbuilt “coaching mechanism”, meaning doing them forces you to increase your awareness with movement, and often times with these type of movements you can only perform them correctly, or not at all.

Utilising self limiting movements as part of an exercise program for low back pain allows you to safely challenge your body and brain, leading to improvements, without the risk of overdoing it.

There are many different examples of self-limiting exercises. The specifics are not as important as being able to move with increased awareness and a low risk. This is a big focus of our exercise programming for low back pain, especially in the early stages.

Take home point number 3: a good exercise program will provide both a challenge and the option to “fail safely” – thus reducing the fear associated with facing more demanding movement challenges.

Our Approach To Programming

There is no one way to program exercise for low back pain. As long as the programming is underpinned by sound principles, and not “technique based”, then it should be sufficient.

We strive for more than sufficient, we strive for optimal.

As such, over the years our approach to exercise programming for low back pain has been refined to what it currently is. Chances are, in another 5 years it will be further refined, but the vast majority will be consistent, as it is all principle based.

First, we consider the body as a whole. We don’t only do “low back” or “core” exercises, but rather we devise a total body program. This is the underpinning principle of osteopathy, and is also applicable to exercise programming.

Second, we ensure that of physical qualities are developed in the right sequence.

If we start with osteopathic manual treatment in the consultation room, we then progress to mobility and flexibility exercises.

These will usually start on the ground, as this provides the most stable environment, thus is the least threatening.

Considering pain occurs when there is a perception of threat by the brain (if you haven’t already, have a read of Pain Basics), this is one of the best ways to regain movement and avoid inefficient compensation patterns taking over.

From there you are looking to build “motor control” – this is simply the ability to control movement well.

We can call this stability, but that implies static positions and discounts the movement component. This is actually achieved simultaneously with improving movement/mobility/flexibility.

We can consider mobility as “end range strength”, and we are simply progressively challenging you so that both qualities improve.

Once you have achieved adequate movement and control (adequate is based on your individual needs), if you want and/or need, we would add load. This might be in the form of external resistance, increased leverage challenge or even changing the tempo.

Only when you are moving competently under load do we add a conditioning component – that is, more volume of work. This is the challenge of fatigue to your new found movement abilities, and if done correctly, is the difference between breaking down when the going gets tough and being able to withstand (almost) anything.

Take home point number 4: whole body, principle based programming that utilises appropriate methods of progression yield the best long term outcomes (based on clinical experience and research) (2) for sufferers of low back pain.

Conclusions

There is a well worn quote:

Methods are many, principles are few. Methods always change but principles never do.

This served as inspiration for this post – there is no point showing you how to do an exercise with no context as to whether it is appropriate for you or not.

Rather, it is important to have an understanding of why you are doing something – even if you only care about the “what”.

This understanding means you will not chop and change based on the latest article in your newsfeed.

It means you will take the time to get things right, knowing that making progress is all the matters, even if it is “slow”.

It also means that you have a better chance at a good outcome and are less likely to become a statistic of low back pain recurrence.

Reducing the article to four sentences, we would end up with something like this:

  1. Do something you enjoy doing, that has intrinsic reward – there are no “good” or “bad” exercises.
  2. Ensure you take a “whole body” approach to exercise. Don’t simply focus on “low back exercises”.
  3. Start slowly, progress gradually.
  4. Vary the stimulus over time, but not too much or too often (or you won’t elicit adaptations).

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

References

(1) Incidence and risk factors for low back pain: http://www.ncbi.nlm.nih.gov/pubmed/24462537

(2) Resistance training and low back pain in active males: http://www.ncbi.nlm.nih.gov/pubmed/20093971