Tuesday, December 6, 2011

James Steele on low back pain

I have previously pointed to James' recent peer reviewed paper on evidence based weight training

Here is a video of him speaking earlier in the summer on low back pain:


djpope said...

Good point about the gigantic cost of low back pain! Preventative care is the future! Good stuff.

JamesSteeleII said...

Hi Chris,

Thanks for sharing!! Hope all is well.


primalliving said...

Very interesting stuff, which runs counter to a lot of the previous info I've come across (and implemented successfully with clients) regarding low back pain.

Previously I've subscribed to the theory that a lot of lower back pain comes from "glute amnesia", and the lower back muscles working over time substituting lumbar extension for hip extension.

I've found a lot of success treating people with lower back pain by teaching them to deadlift correctly. Of course, it could be that some/all of the improvement has actually come from increased strength in the lumbar muscles, rather than activating the glutes, rather than the increased mobility and improved motor recruitment patterns?

A couple of queries/thoughts:

1) James talks of a Paleo perspective, but then when looking for traditional movement patterns looks to the rice fields of Asia. Surely you can't actually get more neolithic! Maybe squatting all day isn't actually any better than sitting all day, but then perhaps paleo man didn't do either?

2) Med Ex back extension as best solution?

I am sure that using this machine is very effective at sorting low back pain, but I am dubious to it being the best/only means, or a realistic practical solution for the masses.

James mentions that general exercise/stability protocols have also produced results, but it is hard to compare - I think a more structured comparison would be interesting (not that I am suggesting either of the former would be sensible approaches!).

Though I am a big fan of HIT, and think for the most part machines are the best route, not everyone has access.

James, have you seen the bodyweight lumbar extension exercise Doug has on his Youtube page? What is your opinion on this?

Also, my feeling re the deadlift is that though it may not produce optimum stimulation to the lumbar musculature, it does certainly provide a training response, whilst simultaneously teaching people good lifting technique, and being highly accessible - All you need is a barbell/kettlebell etc.

Perhaps from now on, however, I shall use a combination of deadlifts and low back isolation HIT (+ mobility and soft tissue work + lifestyle change) and see if I get improved results!

JamesSteeleII said...

Hi PrimalLiving,

Thanks for the comments.

Although many exercises i.e. deadlifts can be beneficial I don't think that I am convinced by the explanation that it is due to improved recruitment patterns except perhaps in improving pain experience during that specific movement. This is partly because the MedX does work and is clearly not due to any skill transference. I think that much of the benefit coming from other forms of exercise is a combination of a general conditioning response in the musculature and a combined psychological empowerment effect aiding to alter perception. The Medx Protocol obviously also has this empowerment effect and so I don't the benefit is solely from the strengthening. In fact thats what I am looking at currently i.e. it's other effects in my research.

Regarding your thoughts and questions,

1) I used this example as it was similar in context to Esther Gokhale's water chestnut gatherers example where she claimed that because they were lifting correctly they had no pain. She seemed to be coming from a traditional/indigenous populations context, which is what I had a look at. Many other traditional and indigenous populations have also shown high back pain prevalence and I've blogged about them.



The research into the rice farmers was an example I gave because it was similar to the example Esther gave but contradicted her conclusion. It found that the extension weakness was associated with back pain suggesting that the movement was likely not the most important factor in causing injury.

The high rates of prevalence in almost every population of people I could find all with entirely different habits and lifestyles suggested to me that the most common factor and thus potentially the most important was that they were human. So I began to look at some of the Paleo anthropological record to see if I could ascertain any reason why humans and their specific anatomy may be predisposed to such high prevalence of back pain.

2) I agree with the issue of access, especially in the UK. There are 5 locations that I am aware of that have a MedX lumbar extension in the UK, though there may be a few more that are not very well marketed. Contrast this with the Florida state area on its own which has over 50 sites with the equipment or Germany which has as many as it has Kieser Facilities which is a lot.

I'm hoping that the research I am doing will stimulate further interest in the benefits it offers so that maybe clinics and gyms begin to consider including them in their facilities, even if just the exercise versions.

Anyway thanks for the comments and feedback, much appreciated.

John D Wilson said...

One statement didn't quite ring true for me - which was to the effect that the body preferentially uses the larger muscles. This resulted in amplifying the need for a lumbar isolation machine.

I disagree. In my experience the body tends to use the smallest muscle group available.

Watch a first time tennis or golf student. They swing almost entirely with their arms. Same with someone trying a clean or snatch for the first time.

Then watch someone like Nadal, or McElroy generate the power with the hips (glutes, hams, etc).

A top Olympic lifter's arms seem to be along for the ride so to speak.