Strength training for back pain - magic bullet or wishful thinking?
Muscle strength can be described as the ability of a skeletal muscle to overcome resistance through muscle contraction and thus generate movement. As muscles control many movements and must withstand high loads, high muscle strength leads to better and faster movements. Strength training is important for performance and health in sports and medicine.
Strength training for back pain - magic bullet or wishful thinking?
(This article was published on 27.09.2024 at Orthinform - Patient information: https://orthinform.de/patienteninformationen/krafttraining-bei-rueckenschmerzen-wundermittel-oder-wunschdenken).
Strength training can be organized in different ways: through resistance within your own body (body weight) and external counter-pressure, with specific variants such as powerlifting, CrossFit, heavy slow resistance, and equipment training.
Mind before Matter
From a physiological perspective, muscle strengthening means that, on the one hand, more existing muscle fibers are activated and, on the other, the muscle fibers can contract faster (dynamic strength) and more strongly (voluntary strength). This is a neurological phenomenon that is controlled by the brain (mind). The more control potential is consciously activated in the brain, the more the muscle tenses. The prerequisite for this is that the athlete or patient correctly understands the exact function of the muscle in terms of movement. Only when the movement is performed correctly and completely does resistance (matter) come into play in any form.
‘Strong joints - strong muscles’
Muscles, joints, and the corresponding bones are physiologically inseparable. If a joint is weakened for whatever reason, this generally and automatically leads to reduced muscle strength. Conversely, too little or too much strain on the muscles weakens the joints, which in turn leads to a reduction in muscle strength. This creates a vicious circle that can lead to back, joint or muscle pain caused by prolonged strain. Adequate strength training always takes into account the load-bearing capacity of the joint that is moved by the muscles to be strengthened. This is the only way to effectively improve muscle strength and mobility and reduce any pain. But this is easier said than done.
Power pairs - muscle chain - muscles never work alone
In order to train the muscles in harmony with the joint's load-bearing capacity, it is important to understand the muscles' control mechanisms. A good understanding of the muscular control of the shoulder and hip joints is particularly important in connection with back pain. These joints basically consist of two bony elements: One provides movement, the other has a stabilising function and provides motor support for the movable part. In the shoulder joint, the upper arm is mobile, while the shoulder blade is relatively immobile. In the hip joint, the leg moves up to ten times more than the pelvis.
Movement is only possible if the two joint parts ‘move’ in opposite directions. In other words, the less mobile pelvis or shoulder blade is stabilised so that it does not move in the same direction as the mobile arm or leg. In order to carry out these opposing movements correctly, the muscles responsible must work closely together but in opposite directions. They form a pair of forces by creating internal resistance against each other. In the shoulder joint, the shoulder muscles and the superficial back or shoulder blade muscles form a pair of forces; in the hip joint, the hip muscles and the abdominal muscles work together. If these pairs of forces function perfectly, the contact surfaces of the joints are optimally harmonised. This prevents stressful sliding movements in the joint, which can be detrimental to both the joint and the muscles.
When the two pairs of forces are combined, a chain of movement is created that balances the load and resilience of the spine and the hip and shoulder joints and alleviates or prevents discomfort.
One movement is not the other
Not all movements put the same amount of strain on the joints. Different lever and load arm mechanisms of the movements lead to large differences in the load-bearing capacity of the joints. The lower this load-bearing capacity, the higher the risk of discomfort or injury. Roughly speaking, movements along the longitudinal axis of the body can be subjected to the heaviest loads (just think of weightlifters and endurance runners). In second place are outward spreading and rotating movements or a combination of these movements. In ball sports, these movements are often the cause of injuries to the hip and shoulder joints. Movements such as moving sideways towards the center of the body or turning the arm or leg inwards are the least stressful. An additional high-load arm (e.g. due to weight or gravity) can further increase the load.
However, it should be noted that these are not fixed rules. Individual factors such as age or existing complaints can influence preferences for certain movements.
Strength is coordination
The closer the joint gets to the end position and the greater the strain on the muscles, the more tempting it is for the stabilising shoulder blade or pelvis to move in the same direction as the moving arm or leg. The muscles responsible for this must work closely together, which is a mental challenge. They also have to exert enormous force for the end-degree, opposing movements. These two tasks require maximum concentration.
Proper strength training is medicine
Although many studies show positive effects of strength training on muscle strength and endurance and some report a reduction in pain, the results for back pain are often disappointing. At the same time, low back pain is a common problem among strength athletes who lift weights to 4 times their body weight.
One medical goal of strength training can be to compensate for the age-related decline in skeletal and muscle mass, strength and power and to remedy or alleviate any associated complaints. As we age, muscle strength and power decline up to eight times faster than muscle mass and are more strongly associated with functional impairment and pain. Strength and performance are therefore not directly linked to muscle mass. Therefore, strategies to optimise muscle strength and performance, as well as the closely related joint function, are more important than simply increasing muscle mass.
You should also be aware that training is a long-term task in order to achieve sustainable results and prevent relapses.
Conclusion
The widespread perception that lifting heavy weights is the only way to build muscle and alleviate discomfort is difficult to deflect. However, it is more important to control movement by specifically strengthening the relevant muscles, taking into account the load-bearing capacity of the joints, especially in the case of complaints. It is therefore important to educate patients and athletes in the correct execution of strength training.
Exercise video
In these educational video and photos, you will learn how you can counteract your back or joint complaints relatively simply but effectively through correct strength training. To do so, click on the above link that leads to the original publication.
© Paul Geraedts (2024)