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

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


Having strong, well balanced legs are a key component of having a healthy, high functioning body.

Our legs are anatomically suited to producing both high levels of force and for walking and running long distances.

This means we need to develop both functions – strength and stability through full range of motion along with the endurance to be able to walk and/or run for distance.

You can build strong legs using expensive gym machines, time tested free weights, with your body weight or using a combination of all three.

Lots can go wrong with your legs:

  • Ankle sprains are the most common lower limb injury (1)
  • Knee injuries are common in athletes and ACL tears are one of the most debilitating sports injuries you can suffer, with females especially susceptible (2)
  • Additionally both the patellar and Achilles tendons are common sites for tendinopathies
  • The knee and hip are most common sites for osteoarthritis (3)

Strength training can be used to both prevent and manage all of these conditions, but done improperly can be a cause of injury itself.

Benefits of Strong Legs

Some of the specific benefits of developing strong legs include:

  • You live longer (4)
  • Greater independence as you age (4)
  • Decreased lower limb injury risk (5)
  • Decreased risk of falls (6)
  • Improved endurance performance (7)
  • Improved speed and power
  • Increased lean body mass – decreased risk of metabolic diseases (8)
  • Improved rehabilitation outcomes after injury (9)
  • Strong legs look good

The 3 Stances

Before we go into how to build strong legs, it helps to understand the different ways we can load the lower body, and the different effects each has.

As humans, we can essentially adopt 3 foot positions.

Most people will favour one side when standing, accelerating, jumping and landing, or just getting through the household chores, which can develop functional asymmetries.

Functional asymmetries are side to side differences in mobility or stability that are not associated with your body’s structure. Functional asymmetries are a modifiable risk factor for future injury (10).

To minimise functional asymmetries and develop strong, well balance legs, requires working in each of the 3 stances.

Bilateral Stance

Bilateral stance involves both feet being on the ground in the same horizontal plane, without movement. It is the most stable, and hence strongest position, and we can lift the heaviest loads in bilateral stance.

Split Stance

In a split stance, both our feet are on the ground, but in a different horizontal plane. Split stance requires the leading leg to be stable through the hip and knee while the trailing leg must display mobility at those joints. You see a split stance being adopted when we need a blend of stability and mobility, for example, if you were chopping wood or throwing a ball.

Single Leg Stance

Single leg stance is displayed when we have one foot completely off the ground. This can be for a moment, as in when we are running, or when we need increased mobility, like when we reach for something on the ground.

Single leg stance requires high levels of stability in the stance leg and trunk to allow you to express the mobility it facilitates.

Use Single Leg Exercises First

Before undertaking a strengthening program for your legs, it’s wise to have an assessment with a qualified and experienced professional.

A good assessment acts like a road map – showing you where you currently are and where you need to go to improve your function and strength.

Most people will tend towards either being stiffer and more stable or flexible and less stable. Typically, we will see the most benefit from developing what you lack – so a stiff person will benefit from developing flexibility and mobility and vice versa.

If the assessment reveals you have a functional asymmetry, then a good place to start your leg strength program is with single leg exercises.

Single leg exercises are a great way to develop the required flexibility and stability at the same time, and help balance out differences between each leg that may have developed over time.

It’s best to start with a split stance, which gives you a nice blend between stability and mobility, versus true single leg stance, which requires stability levels beyond what most possess without training.

Examples of split stance exercises are:

  • Split squats (where the feet remain in contact with the ground throughout)
  • Lunges (where one foot leaves the ground momentarily)
  • Step ups

You can build tremendous strength with single leg exercises alone, but it is still important to develop strength in a bilateral stance as well, in particular with the squat pattern, which is a fundamental human movement.

Squats For Total Body Strength

The squat is simply the best lower body exercise you can do, if you can do it properly.

Squatting demonstrates ankle, knee, hip and spine mobility and trunk stability in the most fundamental human movement pattern – it’s how we first get up from the ground to be able to walk.

It is well worth the time and energy to develop your ability to squat well through a full range of motion.

For rehab patients, I like to teach the squat from the bottom up, which is after all, how we first learnt it. I find that by getting someone into the bottom position of a squat comfortably, the rest takes care of itself.

Surprisingly, my older patients do really well with this method as well, as they are already close to the ground, the risk (and fear) of falling is much lower. Once they are familiar with the bottom position, it is a matter of getting strong enough to stand up.

The most common issues with the squat tend to be at the ankles, followed by the hips.

To work around this, you can begin squatting with your heels elevated while you work towards an unassisted squat.

Conclusions

Strong legs are for more than just fitness fanatics, they are crucial to living a healthy and active life.

It’s important to not only build strong legs, but develop balance and mobility that allows you to move freely.

To do this, it’s important to have an assessment and develop a plan that meets you where you are at, and takes you where you need to go.

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

Not all programs are designed equally though, so for the sake of safety, efficiency and effectiveness, it pays to seek out qualified professionals to help guide you, especially in the early stages of building leg strength.
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) Incidence of Lower Extremity Injuries in US Emergency Departments

(2) Epidemiology of Lower Extremity Injuries in US High School Athletes

(3) Epidemiology of Osteoarthritis in Australia

(4) Leg Strength and Physical Function In Older Adults

(5) Strength Training Reduces Injury Rate in Elite Junior Soccer Players

(6) Effect of Leg Strength on Falls and Balance of the Elderly

(7) Effects of Strength Training on Endurance Capacity In Top Level Athletes

(8) Increased Leg Strength per Body Weight Associated with Improvements in Metabolic Syndrome in Japanese Men

(9) Merits of Exercise Therapy Before and After Major Surgery

(10) Prediction of injury by limited and asymmetrical fundamental movement patterns in american football players

 

Exercise For Fibromyalgia

 

Couple walking on the beachFibromyalgia is a common and debilitating condition.

It affects around 2-5% of the population. (1)

It is under-diagnosed, because of the vagueness of many of the symptoms. For those who do get a correct diagnosis, it can take years.

Fibryomyalgia was originally though of as a rheumatic (joint) condition.

Now, research has shown it is mainly a problem with the central nervous system (the brain and spinal cord).

Due to the lack of understanding of the condition, there aren’t many treatments that provide good, long term, results.

Currently, the best treatments for fibromyalgia are (2):

  • Exercise
  • Stress management and relaxation techniques
  • Cognitive behavioural therapy
  • Manual and physical therapies
  • Certain medications

The Benefits of Exercise for Fibromyalgia

Of the treatments above, exercise is low cost, available to all and has minimal side effects. This makes it an excellent primary management strategy for chronic pain.

Exercise has the potential to improve fibromyalgia. It works by a combination of both specific and non-specific effects.

Some of those effects are:

Decreased Pain

We don’t know exactly how exercise helps pain. We do know there are probably a few different effects involved.

One of the main ones is descending modulation. This occurs when the brain secretes natural pain relieving chemicals. Commonly known as endorphins, they target different nerve receptors, inhibiting potentially painful messages.

 Improved Cellular Energy Production

Suffers of fibromyalgia often report increased fatigue. To make matters worse, many have difficulty getting restful sleep.

Exercise can help increase mitochondrial density (3). Mitochondria are the cellular power plants. They convert glucose into ATP, which cells use to fuel their activity.

In theory, increasing mitochondrial density should improve cellular energy production.

In practice it’s kind of like installing a bigger engine in your car. It has the potential to make it go faster, but everything else need to work well too.

Better Hormonal Balance

Regular exercise improves hormonal balance. It decreases catabolic stress hormones and increases anabolic sex hormones.

This balance is thrown off in people with fibromyalgia.

Better hormone balance leads to a more positive psychological state, improved emotions and healthier physiology.

It’s not hard to see how this could benefit a chronic pain condition like fibromyalgia.

Stimulates the Lymphatic System

Many people are aware that exercise improves blood flow. But, few know that exercise also improves function of the lymphatic system.

The lymphatic system is the body’s “waste management system”. It has a network of vessels all around the body, like arteries and veins. These vessels remove cellular and immune system “waste” from the local area.

When you are sick, your lymphatic system becomes more active, and you can often feel your lymph nodes.

Of interest to fibromyalgia sufferers, the brain, hormonal and immune systems are connected. One of the ways they communicate during an immune response is via the sympathetic nervous system (SNS). (4)

It’s a complex relationship, but the stress hormones can both improve or inhibit immune functions.

With fibromyalgia, one of the mechanisms involved is an overactive SNS.

By stimulating the lymphatic system, we can influence the SNS. However, we have to do it in a way that does not cause a flare up.

How To Exercise With Fibromyalgia

Exercise with fibromyalgia is often challenging for two main reasons:

1. Pain (both during and/or after)

Pain is an obvious barrier to exercise for someone with a chronic pain condition. Sometimes though, you need to endure the early pain to get a bigger benefit in the long term.

To deal with this, research on chronic pain suggests a pacing approach. Pacing means doing a little at a time, within your limits, and increasing that amount at a gradual pace.

A good exercise program for fibromyalgia should have pacing built in. It will also have a “plan B” for those days when you feel terrible, and don’t want to do anything, but know you should.

2. Fatigue

Fatigue is the second big issue associated with fibromyalgia.

As mentioned, exercise can potentially help reduce fatigue in the long term.

In the short term, focus on pacing during exercise. In pain management terms, pacing is where you work within yourself and gradually increase the amount over time.

Then afterwards, look to enhance your recovery as much as possible to help minimise accumulated fatigue.

If you avoid common exercise mistakes, you can get the benefits of exercise for fibromyalgia whilst minimising flare ups.

What Type of Exercise Is Best?

There are many types of exercise, which can be organised into 4 broad categories: flexibility training, motor control/skill training, cardiovascular/endurance training and strength/power training.

Each of these has potential benefits for sufferers of fibromyalgia, but overall, there is no clear consensus on which is best, so it is safe to say that the best exercise is the type that gets done and is enjoyable, while producing the least negative effects.

Cardiovascular Exercise

Cardiovascular exercise is a great place to start with fibromyalgia. The majority of research looking at exercise for fibromyalgia has studied various forms of cardiovascular exercise.

One of the downsides of cardiovascular exercise is the potential fatigue it creates. That can be minimised with careful planning and paying attention to biofeedback during and after sessions.

This allows appropriate scaling of volume and intensity, as well as an optimal rate of progression.

The beauty of cardiovascular exercise is that there are a variety of ways to perform it.

Some include:

  • Walking
  • Running
  • Cycling
  • Swimming
  • Rowing
  • Elliptical machines
  • Skipping
  • Rebounding

Remember, always start well within yourself, and progress slowly. It takes patience, but it is the best way to avoid flare ups.

Resistance Training

Resistance training offers complementary benefits for fibromyalgia. Increased strength helps to maintain function throughout your life.

Resistance training is also very scalable, making a pacing approach easy to implement.

Recent (2017) research showed that strength training is both safe and effective for people with fibromyalgia.

Strength training is safe and effective in treating people with fibromyalgia, and a significant decrease in sleep disturbances occurs after 8 wks of intervention.

Strength training can be performed at home, with body weight exercises or using home based equipment, in a gym or at a clinic. There are many forms of strength training, but the principles are the same: progressively load the muscles with increasing resistance over time.

Flexibility Training

Flexibility training is another good option for suffers of fibromyalgia.

It has a myriad of benefits, most relevant to fibromyalgia are decreased stress and increased cellular energy production.

Stretching is requires no equipment and can be performed anywhere, at any time, to varying intensities. This makes it a fantastic intervention for people with limited access to transport or those who live in unsafe environments which prohibits outdoor activity (extreme weather, crime etc).

Conclusions

A good approach, depending on your personal preferences, would be to incorporate a variety of exercise activities. This gives you benefits in multiple areas of health and function, increases enjoyment (variety) and minimises potential overloading issues.

The most important factor, is to apply pacing principles to your chosen activity.

If you do that, with activities that you enjoy, you can’t go wrong. While you may have the occasional flare ups, over the long term, the benefits are much greater.

 

 

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) RACGP – Fibromyalgia

(2) Fibromyalgia – Treatments and Drugs

(3) Exercise and mitochondria

(4) The Sympathetic Nerve – an integrative interface between two supersystems: the brain and the immune system

(5) What Is the Effect of Strength Training on Pain and Sleep in Patients With Fibromyalgia?