The low back and low back pain is a hot topic these days among Strength Coaches, Trainers and exercise enthusiasts. As well it should be because low back pain is a huge problem that effects just about everybody at least one time in their life. That’s why I, like many other coaches, read as many books as I can on the subject of low back pain.
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One of the best books I’ve ever come across in regards to low back pain and research on low back pain is - Medical Management of Acute and Chronic Low Back Pain: Pain Research and Clinical Management Series, Volume 13 – By Nikolai Bogduk BSc(Med) MB BS MD PhD DSc DipAnat Dip PainMed FAFRM(RACP) FAFMM FFFPM(ANZCA).
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If you don’t know? – Nikolai Bogduk is the worlds number one Functional anatomist and has been since the early 90′s. You can view a list of all Bogduks books and research publications here at BioMedExperts.com.
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This book is unlike any book I’ve ever read and really is responsible for my current approach to training and my overall philosophies about science in general.
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In this book, Bogduk analyzes and compares 100s of research studies on low back pain. What he concludes with shocked me and will shock you too!
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In the first part of the book, Bogduk systematically invalidates and rules out many highly quoted research studies for one reason or the other. He then compares the findings of the “valid” research studies left to find commonalities in the findings about what causes low back pain, what are the best treatments for low back pain and what we should do to prevent low back pain.
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By the way, Bogduk defines back pain as pain arising from the tissues of the axial skeleton or body wall, “perceived in an area not more than a hand’s breadth either side of the lumbosacral vertebral column.” (Medical Journal of Australia, 3 Feb. 1992.)
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Interestingly enough, after over 250 pages of some seriously scientific bedtime reading, the Worlds #1 Anatomist concludes that because most of the current research on low back pain has drastically inconsistent findings – We really don’t know a damn thing about what causes low back pain or how to prevent it!
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Now, this book was published in 2002 so many may say it’s out of date. But, even after the eights years since his book was published, Bogduk still conveys the same message that much of what we believe about what causes and prevents Back pain is not trully evidence based.
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This is why I don’t just follow one researcher or the other. Nor do I ever just throw out stuff that I know works because one study says it maybe no good. Because another study will come out saying something completely different. This is what Bogduk found when he wrote this book and is still finding to this day – One researcher says this. But the other researcher says that! The science almost always conflicts itself. You read the research, you know what I’m talking about…
Some folks who have herniated discs get pain, but others do not! So, does a herniated disc cause back pain? Maybe? – Maybe not!
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Some folks with degenerative disc(s) have pain, but other do not! Does degenerative disc(s) cause back pain? Maybe? – Maybe not!
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Some folks with Spondy get pain, some have spondy and fell nothing! So, does having Spondy cause back pain? Maybe? – Maybe not!
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Some folks have tight hips flexors and get pain, others test tight but have zero pain. Do tight hip flexors cause low back pain? Sometimes yes and sometime no!
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Some folks who exercise get back pain but others who don’t regularly exercise get low back pain. So, is back pain caused by activity of lack there of?
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I could go on but I think you get my point! The truth is, after reading this book, it changed my outlook on everything thought I ‘knew”. I realized that I really had no right to argue or look down on anyone who does things different than me because everything I “knew” was really based on nothing more than my personal experiences, opinions and my own interpretation of research.
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My approach now is simple – I have a system that works for me. Sometimes I don’t know why it works, but I don’t really care because it works!
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.
If you don’t know? – Nikolai Bogduk is the worlds number one Functional anatomist and has been since the early 90′s. You can view a list of all Bogduks books and research publications here at BioMedExperts.com.
.
This book is unlike any book I’ve ever read and really is responsible for my current approach to training and my overall philosophies about science in general.
.
.
In this book, Bogduk analyzes and compares 100s of research studies on low back pain. What he concludes with shocked me and will shock you too!
.
In the first part of the book, Bogduk systematically invalidates and rules out many highly quoted research studies for one reason or the other. He then compares the findings of the “valid” research studies left to find commonalities in the findings about what causes low back pain, what are the best treatments for low back pain and what we should do to prevent low back pain.
.
By the way, Bogduk defines back pain as pain arising from the tissues of the axial skeleton or body wall, “perceived in an area not more than a hand’s breadth either side of the lumbosacral vertebral column.” (Medical Journal of Australia, 3 Feb. 1992.)
.
Interestingly enough, after over 250 pages of some seriously scientific bedtime reading, the Worlds #1 Anatomist concludes that because most of the current research on low back pain has drastically inconsistent findings – We really don’t know a damn thing about what causes low back pain or how to prevent it!
.
Now, this book was published in 2002 so many may say it’s out of date. But, even after the eights years since his book was published, Bogduk still conveys the same message that much of what we believe about what causes and prevents Back pain is not trully evidence based.
.
This is why I don’t just follow one researcher or the other. Nor do I ever just throw out stuff that I know works because one study says it maybe no good. Because another study will come out saying something completely different. This is what Bogduk found when he wrote this book and is still finding to this day – One researcher says this. But the other researcher says that! The science almost always conflicts itself. You read the research, you know what I’m talking about…
Some folks who have herniated discs get pain, but others do not! So, does a herniated disc cause back pain? Maybe? – Maybe not!
.
Some folks with degenerative disc(s) have pain, but other do not! Does degenerative disc(s) cause back pain? Maybe? – Maybe not!
.
Some folks with Spondy get pain, some have spondy and fell nothing! So, does having Spondy cause back pain? Maybe? – Maybe not!
.
Some folks have tight hips flexors and get pain, others test tight but have zero pain. Do tight hip flexors cause low back pain? Sometimes yes and sometime no!
.
Some folks who exercise get back pain but others who don’t regularly exercise get low back pain. So, is back pain caused by activity of lack there of?
.
I could go on but I think you get my point! The truth is, after reading this book, it changed my outlook on everything thought I ‘knew”. I realized that I really had no right to argue or look down on anyone who does things different than me because everything I “knew” was really based on nothing more than my personal experiences, opinions and my own interpretation of research.
.
My approach now is simple – I have a system that works for me. Sometimes I don’t know why it works, but I don’t really care because it works!
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And this is exactly why of the hundreds of coaches out there “in the know” I choose to spend a good portion of my time taking your advice and testing it out.
Appreciate the recommendation, will check it out.
Cheers,
Adrian
p.s. You should do a review of Bret Contreras “Advanced Techniques in Glutei Maximi Strengthening.”
It is unfortunately only available by ebook but it changed my whole outlook on hip training as you describe Bogduk’s book has done for you
Hey Nick!
Have you read “Low Back Disorders” by Stuart McGill?
Jim C
Health Researcher
Champaign, IL
As a young man,30 years ago, I didn’t know from back pain. I was a contractor/building mechanic and steam fitter all heavy, arduous work. Never got a back pain, I always worked out too. As years went by and I became quite sedentary I got all kinds of back pain,lumbar and thoracic, and pain into my foot as if on fire, could barely walk for a long time and of course resting was not the answer and the doctors didn’t have any answers. I started walking, (as much as I could every day) jogging, running, sprinting calisthenics, lost 50lbs, 237 to 178lbs. Time: 2 1/2 yrs. Started weight training then, 3 years ago to put on some muscle. From almost a total invalid , once I got into training, no more back pains which had been crippling for a very long time. Now, you couldn’t keep me off the track or out of the gym with a gun. You’ve done a lot to help/teach me coach Nick and Alli too. So that’s my story in a nutshell of a long history of low back pain and radiating down the leg/foot and mid-back, where I could barely breathe without pain. thanks for all your help, guys, sincerely, gene s
Yes, I’ve read all Stu McGill’s stuff 3x over! I love his stuff and refer to him allot!
Hey Nick,
Firstly I will go out and take a look at the book. It seems like some seriously scientific stuff!
If I understand this post correctly you are saying that what is the true cause of back pain is unknown. What about repetitive stress of flexion and extension? was that ruled out at all as a key factor in low back pain or is it still put under the category of an unknown factor?
Also could the population of people who get back pain from working out get the pain from preforming technique oriented lifts(deadlift, clean, squat, etc..) poorly? I know it seems like a no brainer but im having a hard time wraping my head around someone getting back pain from exercising correctly.
Thanks
Rich,
You ask great questions! The same ones that I always ask these researchers when I meet them. And, I’ve met and spoke with many.
But, the honest ones, with no ego, will readily admit that no one really “knows” the cause(s) of back pain. Nor, do they know why many low back pain cases seem to resolve themselves within 6 weeks w/o any intervention at all.
Yes, excessive spinal flexion or extension or rotation and/or some combination has been shown to lead to disc wear and tear. Also, excessive static spinal flexion (sitting for hours and hours) has been shown to create back trouble. But, no one knows how much is too much? PLus, there are many folks who flexion and extend all day and never have any back pain.
In other words, we think we have idea’s about low back pain but know one has been able to repeatedly prove one thing or the other. So, until that happens. everything is just guessing.
I will posting more about Low Back pain in upcoming posts!
Thanks for reading the Blog and taking time to write your comments and questions!
Coach N