I often get asked by back- and neck-pain patients how they should be working out at the gym or with a personal trainer. While there are no published and tested guidelines, what follows is what I have learned through years of trial and error as someone who has both issues and who likes working out. Like anything else, please check with your own healthcare provider to ensure you’re healthy enough to work out or lift weights.
First, “no pain, no gain” was a marketing slogan from Jane Fonda’s 1980s work-out videos, not solid medical advice. Poor Jane ended up with bilateral hip and knee replacements. Hence, if at any time during your workout you’re getting pain, respect it and back off, don’t push through it. To explore that further, if the pain is just from muscle failure due to weight and repetition and is nothing more than muscle soreness, that’s fine. However, if the workout is aggravating a known painful condition, then it’s time to back off. For example, this week, I had biceps and triceps soreness from a big bi/tri workout. That was different from pain in the back of my left shoulder with a cable exercise that I knew wasn’t good, so I canceled that one exercise.
Here are my top 7 tips for working out with back and neck pain or problems:
- No deadlifts or squats with weight, no flexion and/or rotation with weight. I could fill a whole practice with people who blew out a low-back disc with deadlifts or squatting too heavy. Let’s also add Olympic lifts into this category. Flexion with weight is how low-back discs are damaged, so these activities are out. Squats without weight or with light weight (body weight or up to 20 pounds) are fine.
- Stretching is key. Get stretched out before you work out, especially opening the chest and hips and getting the head back. My old man stretch is a good start. consider buying the bible of stretching by Bob Anderson to learn more.
- Core first! What I mean here is that for every exercise you do with your arms or legs, one should be done with the core. Core exercises include bridging, chops with a pulley, ab work, hip abductor and adductor exercises, chest rotation, engaging the core during arm or leg work, and so on. Core stability lifts are a great way to involve your core and reduce your lifting weight. As an example, rather than chest presses on a bench, lower the weight and bench on a Swiss ball (see pic above).
- Train into symmetry. Everyone has a weak side or area. You should be focusing on these sides or areas and making them your least common denominator. Meaning, if you can row with 80 pounds on the right but can only do 40 pounds on the left, you have no business trying a row with both hands at 80+ pounds. First, you need to get your left-sided row up to 80 pounds.
- Train into a normal posture. When the weights go up, we all tend to lose good posture. Our heads come forward, our chest collapses, and we give into gravity. So training with mirrors is critical, as you need to keep your head back, chest out, back curved, and posture straight from a left to right standpoint at all times. If you can’t do this, lower the weights and increase the reps until you can, and don’t up the weights again until you can keep this perfect form.
- Lower the weights until the core is normally active. What I mean here is that your core will sometimes go into overdrive as you lift heavy. As an example, when I lift heavy, my left neck (scalenes and SCM) will tighten. I automatically know that I’m overloading what my neck can handle, so I back off or readjust my shoulders to try to take the neck out.
- Use treatment to facilitate your workout. This means that your workout should be as pain-free as possible (other than normal muscle soreness from failure). As an example, my left flank will act up sometimes while lifting. That’s my left latissimus dorsi and posterior rib muscles going into spasm and not being properly stretched. I use a foam roller when that happens to get that loose and those muscles turned back on. The same with my outer left thigh, where I use a quad and psoas stretch to get that right. Why take the time? Because lifting while these muscle areas are painful and offline increases the risk of injury. While these are simple examples, another more complex one is the irritated nerves in my lower back that were causing heavy legs. For that, I needed to have one of my partners inject high-dose growth factors around those nerves. Either way, getting out of pain was a critical part of advancing my workout.
The upshot? While I know this is a quick list, I hope it helps you or your personal trainer have some guidelines and rules to follow. You can work out and get strong with back or neck pain as long as you follow some simple rules! If I had to boil it all down to one sentence, it would be, “Listen to your body!”