WSBBP-E30 - Low Back Pain Syndrome
The Westside Barbell Podcast
Episode 30 - Low Back Pain Syndrome
Tom Barry: Welcome to Westside Barbell podcast. Today's topic is low back pain syndrome. We're joined with John Quint and Travis. Louie, I'd like to get you just to start off talking about the low back pain syndrome. What it is, and what you have done to rehab backs, and not even just that. But to keeps backs healthy, and not to have back injuries.
Louie Simmons: Well instead of low back syndrome, we prefer to have prehab for healthy backs. We don't have rehab, we like prehab. We like to keep our backs strong. Basically, a strong man or woman has a strong back. Many women have weak lower backs, and that pretty much sums it up. My experience starts back in very oddly, 1973. I had the highest total in the world for a while [inaudible 00:01:01]. No gear, and I broke my L5 and basically dislocated my SI joint.
Louie Simmons: I was on crutches for basically 10 months off and on. Finally came up with reverse hyper exercise, and that's what got me back on the road the health. I went back, that was '73. By '78 I was pulling over to 700, 198. That was basically the fourth, fifth best setup in the country, and I was always top five in the total in the squad.
Louie Simmons: 1983, I broke it again. A doctor, a surgeon here in town wanted to take out two discs, fused my back and take our bone spurs. I refused, and at that point I already was doing reverse hypers that's how I started. So I did acupuncture, acupressure, I stretched, and I rehabbed myself. Everybody knows, if you want to be successful in rehabilitation, you have to participate in your own rehabilitation.
Louie Simmons: So that's exactly what I did. I didn't go to anybody, I did it myself. So basically a lot of the problem with backs is a psoas problem. A lot of people treat low back pain over and over and over, chiropractors so. But it never gets better because the psoas is tight. I know John you might want to mention something about this. It basically pulls on the tailbone I suppose, right?
John Quint: Yeah.
Louie Simmons: It also can cause pelvic tilt. So build strong abs, you have the front of your abs, rectus abdominals, and the obliques are very important. Actually obliques produce higher inter-abdominal pressure than your rectus abdominals. Everyone, you know if you look at your greatest athletes, what's everyone mostly focused on? Of course it's the body, and they look at the obliques.
Louie Simmons: Great athletes have great obliques. I used to 180, I did side bends of 180. I did not have pretty obliques, but I had pretty big obliques. So I concentrate a lot of obliques, and a lot of abdominal trainings, never done good mornings.
Louie Simmons: So to start with when you pick a weight, what is the first thing you do? You take a breath of air, and hold pressure in your stomach. So to me, the strongest muscle in the body has to be the stomach. So how do you build the stomach, and make it healthy and have good mobility in the low back? I like leg raises, hanging and standing. When you do them hanging, or you can add ankle weights when you're very strong. Sit ups, incline sit ups, weight on the chest, weight behind the head when you're strong.
Louie Simmons: If you have a healthy psoas straight leg sit ups will have no effect on your back. They should have no effect. Always, if you do then you need to get someone, an ART person and get that psoas worked on. A lot of side bends, heavy dumbbells, kettle bells, barbell on your shoulders. Twisting, you can do it standing, you can do it sitting. Standing abs are one of my favorite.
Louie Simmons: I do a lot of standing abs statically on a lap machine. You basically stand up, face away from the machine, take a tricep rope, hold it against your chest, fill your belly full of air, and bend over. You're not involving the hip muscles, extensors and so forth at all. So it's all abdominal work, and that's one of my best types of abs I like to do.
Louie Simmons: Another for more advanced people is sled walking with a strap around the ankles. This has been tremendous for all of our athletes, power lifters, athletes of any kind, and makes very, very strong stomach muscles and hip muscles, which should work together. A lot of people want to develop, but the muscles have to work connectively. They have to work together, they just can't work out one muscle at a time.
Louie Simmons: A lot of real strong people look strong, don't necessarily are strong. It's not because they don't have the muscles, it's 'cause they don't have the coordination. You want to ... Travis I know you lived here, you made a lot of progress since you've came here. Can you just briefly say what you do for back health?
Travis: What I do, of course I do a lot of reverse hypers, upwards of about 100 reps. With that about 450 lbs typically was what I use on a typical day.
Louie Simmons: So you're doing about 45,000 lbs of reserve hypers right now. You need to squat right around 900.
Travis: Yep, exactly. So doing a lot of that like you said. A lot of oblique work is something I've been focusing on a lot more, it's helped me stabilize my squat. Straight legged sit ups on the [inaudible 00:05:35], things of that nature I've been doing.
Louie Simmons: Yep. John, I'd like for you to speak 'cause we started out talking about the psoas and what a problem area it can be. It can destroy people's backs. Year after year, they get worse and worse, even though they're getting back treatment. I like to maybe have you talk about that.
John Quint: Yeah so as a therapist, I'll talk about how I kind of use the reverse hyper from a therapeutic standpoint. So when you're talking about the lumbar spine specifically, there's five spinal joints. You want to make sure that they have independent segmental motion in between there. The majority of back injuries are going to occur when the lumbar spine goes into flexion.
John Quint: So the first thing I do when I have somebody that has chronic low back pain, acute low back pain, as I start work lumbar extension, 'cause that's the primary curve of the lumbar spine. So you always want to restore lumbar extension before you go into flexion, especially with the majority of injuries being in flexion based.
John Quint: So what I do is I put them on the reverse hyper because the reverse hyper puts them in a "neutral spine." Then from there you can start to work actual extension, and start to get the spine to actually be able to segment. When I mean segment, I mean the lumbar vertebrae is being able to move independently of one another. So kind of get that coordination back into there.
John Quint: Then on top of it it's a safe setting, because obviously your stomach is blocked from going into flexion, which is probably where you injured your back. You can start to restore that primary curvature in the lumbar spine. Start to get the discs to actually get fluid in there, 'cause you're starting to create that pumping mechanism.
John Quint: Generally this is always in an unloaded position. Then after that it's a lot easier to go in there and actually start to assess the psoas to see what's going on with the psoas, 'cause that should start to restoring lumbar segmentation. Should start to decrease that tone. Then you can go in there and start to check the psoas for mechanical connective tissue restriction, which could also be inhibiting segmentation.
Louie Simmons: So you use the reverse hypers actually if there person wants to gain range of motion?
John Quint: Yeah, I use it as ... just like anything, you could squat for endurance, or you can squat for max effort. I use the reverse hyper literally on a daily basis to teach people how to start to gain neurological control over their spine, because that's a thing. Is when that spine doesn't move, they don't know that it's moving. So let's say you have four segments that don't move, well now all that motion is going to go into that fifth segment that is moving, and that's where you have the issue at. So the first thing you want to do is, you want to go into safe setting, where you're not going to go into flexion.
John Quint: But like I said before, when you go into flexion, that's when that disc goes posterior and generally lateral. So when you're laying on there, you're prevented from going into flexion, and you can safely start to have them work extension. They can work disassociation, a lot of time you'll see people just kick their legs back, instead of take their tailbone and start to life it up.
John Quint: So you're basically constraining the system, cuing them so they can start to figure out how to use their lumbar spine. Then after that, then I go in and I make sure soft tissue works significantly easier.
Louie Simmons: Now we had an ultra runner here not long ago. A fellow ran three days, 70 hours straight. He has quite a problem for back injuries. Basically what you're talking about, correct?
John Quint: Right. So he had no hips and he had no lumbar spine. So he had an issue at that thoracolumbar junction, which is what you see a lot of lifters have. You don't see it here a lot, but I'll see it in the community that I work on as far as athletes. Where it's like, you'll see where it's like basically the lumbar spine, they have no musculature there. They don't have those thick erectors. But right when they get to that T12 area, their back is huge.
John Quint: Then it goes into like nothing. Well it's 'cause their spine doesn't segment. So if your spine doesn't segment and you go into a ... that's the reason why if anyone that I talk to that tells me, "Hey, I tried the reverse hyper, but it didn't work." Well it didn't work, it's not because the reverse hyper didn't work, it's because you brought a shitty back in there. So you better use that machine to actually acquire the back. So before you do it loaded, get the segmentation then go in there.
Louie Simmons: Yes. I know you do quite a bit with a dual pendulum. Can you explain why?
John Quint: Yeah. I like the dual pendulum because it just creates more disassociation. You can use one and the other, so the dual pendulum from an athletic perspective is kind of like the ultimate machine. Because you're not really ever doing, you know it's always one limb in front of the other. But yeah, that's going to start to create. So then it's like when you get into the arthrokinematics of the spine, if you have segmental flexion and extension, now you can start to get rotation in there.
John Quint: So let's say, even if it's not the dual, or the which one?
Louie Simmons: The dual pendulum.
John Quint: The dual pendulum, then you can start, if you're doing one leg at a time, now you're getting flexion, extension, and slight rotation in that spine. So you're just therapeutically ... you can either do it from a ... it's just like anything else. When you train abs you can train them really hard, or you can train them light just to get blood flow in there. But realistically it's your spine, so you better take care of it. You only have one. So you better make sure that you have segmentation in there, so that your discs can stay healthy so that when you go to squat, deadlift and all that other stuff, you're not putting all that load on to just one or two segments.
Louie Simmons: Right, your waist has four sides. Don't forget that folks, it's just not in the front. You have your obliques on the sided, and your lower back on the back. I know a lot of people use reverse hypers even all the time. They have basically a weak glute. But by using the dual pendulum, you can correct that because it is bilateral. And you can fix a bilateral deficit by using that very, very quickly.
John Quint: Yeah, that's the biggest thing is, you can use the reverse hyper, like if you're a coach or a therapist, you can use it as both a training mechanism, and you can also use it as an assessment mechanism. 'Cause as soon as you see them do it you're like, "Oh this person doesn't have a low back." So that's what a lot of people do. You don't just want to continue to load it, take them ... that is the perfect position. Because at one point we were all quadruped. So when you're in that position, you're going to be able to learn how to use your spine significantly better.
Louie Simmons: Exactly right. When I bring an athlete in here, I never just start them working out. I make them do an inverse curl, I want to check their hamstrings. I put them on a reverse hyper, check their low back, lumbar area and spinal rectors. And belt squat for their hips and glutes. So that's why we do these exercises. Like you said, it's basically a measurement of how strong you are in certain parts of your body.
Louie Simmons: When people come in, if you have a bad back or want to strengthen your low back, use light weights and very, very high reps. It will pump up that lumbar region down at the very low part of your back. If you want to build strong glutes, you have to use heavy weights. Like Travis, Travis you say you use 450 lbs, right?
Travis: Yeah, that's what I use.
Louie Simmons: When I train, the normal weight was 480 lbs. So we're right in the same ballpark. I absolutely [crosstalk 00:12:34].
John Quint: Yeah, and the reason why you want to use high reps on top of that, is because the disc is connective tissue. So it's avascular. So the reason why Lou says that is because you want to fill all that articulating musculature up with blood, and then basically the process of diffusion can occur where you're going to start to flush nutrients out and get fresh nutrients in.
Louie Simmons: Basically if you tear a hamstring you're black and blue, tear a pec you're black and blue. Hurt your lower back, it doesn't get black and blue. Like John says, very small blood supply in that area. You have to do monstrous heavy weights. You ever wonder why migrant workers don't have bad backs? Because they work them every day. Yeah. Tom, you have anything to say?
Tom Barry: I'd like to go back to the abdominals for a second. One thing I think I need to explain is, actually how to put air in your abdominals. A lot of people take a deep breath and their chest puffs out, but it's never through the stomach. I don't think ... a lot of people don't realize this, but from being around you so long, you constantly breathe in and out through your stomach. I'd like if you could just educate people why you do that, where you learned that from, and you fill your belly full of air, not your chest.
Louie Simmons: I learned it as far back as 1970, because of Tai chi. Just for relaxation, and minimal concentration. You're so busy, I'm not getting into Tai chi, and I'm not an expert, but I've always done it for my sport, not practicing for Tai chi. But you start out breathing in for three seconds, and out for three. Then you graduate to six and six, nine and nine, and many, many times I could do 18 in and 18 seconds out.
Louie Simmons: It's very common, you can actually change your heart rate by doing this. But when you wear a belt, a lot of people, like a girl visiting today from Sweden, she's got a bad habit of wearing the belt so tight she can't expand her stomach. We see this all the time. You learn when you put a belt, you want to try to break the belt. Have you ever wondered why your strongest power lifters or even strong men have enormously strong, big stomachs.
Louie Simmons: What's the biggest thing on a tree, trunk or limbs? The trunk. So you have to have that midsection, it has to be big. It might not be as aesthetic to people, but you have to have a very strong stomach and big one. I have a very big one. I haven't lifted really for seven years, my stomach is still enormous. But it's also still strong.
Tom Barry: I big thing too, I remember reading the Book of the Five Rings Musashi has in there, when you're wearing a robe, you always wear the robe tight enough so you push your belly against it all time, 'cause if not the rope would fall off. So it goes back to then how important stomach training is.
Louie Simmons: It's funny in this culture, everybody wants a small stomach, suck your stomach in, and that's why they've all got bad backs. 85% I think of people have some type of back issue, is that correct John?
John Quint: Yeah.
Louie Simmons: About 80, 85.
John Quint: Probably higher than that honestly.
Louie Simmons: Yeah, we don't have any. I had a poor kid come in today on a visit from India. And he couldn't deadlift 225 lbs. He has a bad back. I didn't know it that he was that honestly weak. So we sit him outside with some girls I have, and I made him drag a sled. I said, "You have to build a base before you even attempt to lift weights. So build a base," he did that and about work and hanging ... he did leg raises on a special machine, and regular abdominals, and some reverse hypers. I have to build a base before I would even let him lift weights.
Louie Simmons: I want get back to another piece, the reverse hyper like you said, you pretty much said it all rehydrate. Remember light weights, high reps will blow up the low back. Heavy weights going to blow up the hips. Something else people don't do correctly. Whenever you do reverse hypers, you want to put your toes and hells together on a strap model. You squeeze as hard as you can, and it's exactly like squatting or dead lifting.
Louie Simmons: Many, many times I thought I was going to pull an upper hamstring from doing heavy reverse hypers. It's just like squatting and dead lifting when you do it that way. You want to squeeze together as hard as possible. If you can get up and just swing it, it's not a ... even though it's a pendulum, you have to raise it. You try to hold it, even though you can't lift heavy weights for a split second, you've got to fight it down about two thirds, then relax and it'll pull you under. That's where it opens up the disc and allows it to flood into the back.
Louie Simmons: Another piece, a very popular piece here. A lot of people want to know why Westside produces so many strong people. So produce strong people you have to have high volume. How can I gain volume without the wear and tear on my back? The best way is for the lower back is the principle power lifting, squatting and dead lifting.
Louie Simmons: So it's hundreds of thousands of pounds of reverse hypers. Like you said, you do 4,500, but you do that again at least twice a week, and you do hypers two other times. So you're doing somewhere probably 150,000 lbs of reverse hypers.
Travis: At least.
Louie Simmons: So direct work on the lower back that much, and we get in our ATP which is a version of a belt squat. We do a lot of static holds. We walk in there, we do step ups. But when you're in there, it actually with the belt around your waist, it can correct so called pelvic tilt. It can pull the pelvis into correct place. So you do all this enormous work, you put a person in for two minutes, they almost die, is this right Tom? And yet, tomorrow they didn't know they did anything.
Louie Simmons: They'll pump them up so much as they've never been in their life. Then tomorrow they're fine. Now if you did that with good mornings or something, two or three days later you're still paralyzed. But we do all this work, there's one thing you've got to learn as the jujitsu masters say, "Learn to train smarter not harder." We've got people that are so hard headed and refuse to do, and they hurt 85% of the time. Then other people are never hurt. It's very viable to learn.
Louie Simmons: In 1982 I broke my lower back the second time, that's when I went to [inaudible 00:18:31] training. I realized I knew nothing about training. Anyone can do the barbell exercises. But how do you apply science to training? That's what changed me, and it's changed a lot of people now at this point. Tom, have you got-
Tom Barry: I think a big thing about that is, especially when we have a lot of people who come here after they're injured, or when they're injured. They get a hyper and their back pain eventually goes away. But then they call us up and they're like, "Well, my back's starting to hurt again, what should I do?" Inevitably they've stopped doing their hypers.
Tom Barry: So you've rehabbed yourself from the hyper, but even for you, if you stay on every day, because it's like medication. If you have to take it to stay relatively pain free, I think a lot of people don't understand that if you screw yourself up, you've screwed yourself up. There's no going back, it's done. So every day is a process, every day you have to do something for that. Because doctors are wanting to give you a drug every day, so why not avoid the drug and just do rehab, or just go on a hyper. But I think people really truly underestimate after an injury, how you have to stay on it, otherwise you're going to go backwards real quick.
John Quint: Yeah, I think that's 100% correct. 'Cause it's like the minimal effective dose. A doctor's going to prescribe you a chemicals means. Well you take them and have a physical issue. So you have to have a physical dosage. So it's kind of that minimal effective dose.
Tom Barry: It's just masking it.
John Quint: Exactly.
Tom Barry: Yeah.
Louie Simmons: Well of course I'm 70, my neck is destroyed and my knees are destroyed. But I have already done 100 reps this morning with 350lbs. Tonight I'll do more.
Tom Barry: That's 100 reps straight, right?
Louie Simmons: No. I do two sets of 40s and 30 reps. I've done 60 reps in one set very strict with 350.
Tom Barry: Yeah.
Louie Simmons: I like ultra high reps. It's lactic acid [inaudible 00:20:20]. That's what you do John, you're a body builder. When that pain starts to come, you've got to get it. I try to explain to people about working past it. They don't like it, but when I squat, we used to squat with three guys and basically about minute and fifteen seconds I would have cramps down my spinal rectors, not in my hips. You could shoot me in the head and I'd be more brain dead than I am now. But all I had to do is take out a bar, and the work would go right into those cramps, 'cause that's what's doing all the work.
Louie Simmons: If you don't actually train at a faster pace, you're never going to get extremely strong. If you go on and do X-amount of work, if you squat 500lbs, you're going to use a certain amount of muscle fiber. If you take a complete rest that they tell you in a lot of books, you take a complete rest, do the same way you see muscle fiber.
Louie Simmons: One method again where muscle fibers are [inaudible 00:21:08]. That's what bodybuilders do.
John Quint: Yeah, exactly.
Louie Simmons: Yeah. So you have to do it. Is it painful, yeah. Is it fun, for me yes it was fun. I like pain, I don't mind pain.
Tom Barry: Plus your training is done in under an hour.
Louie Simmons: That's right.
Tom Barry: People forget if you keep adding in them minutes before you know it you've 30 minutes of workout, you're doing nothing. An hour and thirty. And I don't know who in this day and age has that much time to fucking stay in the gym.
Louie Simmons: There's people in the gym for three hours and they're doing nothing. It just drives me crazy. Travis, when we see people coming, Tom, we see ... I watch people come in Tom, I watch people come in work on a classic work up to 550 squats, took them an hour and a half. I've got 1000 lbs squatters, we're done squatting in 20 minutes, and I'm talking three or four of them. It's up, it's boom-boom-boom-boom-boom. We're out. Then it's into the deads, and that's only 20% of our work. Then it's on to the belt squats, and reverse hypers and reverse curls, sled poles and so forth.
Louie Simmons: Another exactly, like I just mentioned before about a healthy back. You just can't maybe ... you know if you're at the point where you're hurt, if you have a sled then pull a sled. There's no loading on the spine at all. It will build up from your calves, your hamstrings, your glutes, your hips and your abs. You get very, very strong, then it prepares you to lift weights. Heavy sled dragging I swear made me stronger than barbell training. And people don't want to do it because it's hard.
Louie Simmons: But on a max effort day I would go outside and pull a sled. So they're in there maxing out and repping, and I'm pulling a sled. I'd peek in the door, see what the hell they're doing, then I'd pull the sled back down. One time I had severe rib injuries and I couldn't squat for six weeks. So I did glute hams, pulled a sled, reverse hypers, and always do abs.
Louie Simmons: So we had guys come in from the Steelers and [inaudible 00:23:00] university, and two guys 1000 lbs squatters at 920, they told me they had 920. They said, "Come on, you've got to squat with us." I'm going like, "How am I going to get out of this, because they're visitors." So then I did five doubles of 485 and 375 a band. I did that workout like I never missed a step. I never missed a workout. It was actually comparatively easy, and I hadn't done any squatting for five weeks.
Louie Simmons: We had a makeshift deadlift contest with two South Africans. I come in pulling sleds for about three or four weeks. Pulled 75 dead lifts. It's the sled. Sometimes the simplest thing is the most complicated thing to understand. But you want a simple ... you've got to walk before you run. You start out crawling, and then learn to walk, and then you can run. The basic things is the key to everything.
Louie Simmons: No one has fundamentals anymore. The whole of America doesn't have fundamentals in life in general, but they don't have fundamentals in sports. I hear this in jujitsu, boxing, [inaudible 00:24:05] boxing. When they come here, everybody wants to be a top [inaudible 00:24:08] power lifter. But you gotta build a big base if you want a tall pyramid. So we work on big bases, that's why we don't get hurt.
Tom Barry: It's because people always see the end process, and that's where they want to start. They want to start at the end which is the successful phase. They don't want to go through, just like build your general GPP base. That's just society in general nowadays.
Louie Simmons: A manual laborer's going to be stronger than a business worker. If you brought them in, had a weightlifting content the manual laborer would beat him every time.
Tom Barry: It comes back to work capacity. I think people underestimate the central nervous system all the time. Because once you guys are strong, you're strong. Then once you keep that 20/80 rule, we've got 20% of our workouts are on the compound movements, but 80 is the accessory. So you keep up that accessory work with the sleds, you're not going to go backwards.
Louie Simmons: So you build up all your weak muscles, so they balance out and you don't get hurt.
Tom Barry: Yep.
Louie Simmons: Yeah, just a few tips. When you're in a gym, don't turn a radio up. Don't use smelling salts. Don't pick your favorite song. Don't do the same exercise over and over and over, that's the law of accommodation. When you go at it and try to get psyched up in the gym, now you're doing a contest max when it should be a training max. Basically I used to like to run my mouth a lot. Get myself in over my head. So I had to take big weights, but I never got my drilling ever rolling. Never had a drilling rush.
Louie Simmons: So we've seen this over the years, and it does not work. Don't get your favorite song. If I jumped on your ass and punched you, would you turn your favorite song on before you punched me back. I doubt it. So just learn the difference between training and competing. We compete in a gym, but we compete with a low adrenaline rate, and we've got a lot of really strong guys, and they don't burn out. For the most part.
Tom Barry: I heard a thing on the work capacity, back to the lower back, if you're not putting all the emphasis in your stomach and lower back, well then something's going to give out because they're always ... even for benching, everything you do, your trunk is always being used. So if that's not most worked out muscles in your body, then you're going to be injured. There's no way around it. I think work capacity, people just don't understand it.
John Quint: Well think about it too, it houses your central nervous system. So as soon as you start to lose joint function in there, now you're starting to lose receptor feedback. So it houses your central nervous system, so you should have function in those joints. 'Cause if not, you're not going to have the neural drive output, you're not going to have the input from as far as actual information coming into the system. I mean, I know it sucks, and it's not the best thing to do, but you should probably invest in a spine. You only have one.
Louie Simmons: Yeah. You're right. If you want to be stronger and stronger, you've got to raise the volume, it's the only way to do it. All the people out there that are boxing fans, you take an amateur fighter, he fights three rounds. How did he ever get to four, six rounders, eight rounders, 10s, and 12s? Work capacity. Because maintaining three rounds all the time, he's never going to fight a championship fight. He has to reach work ... and how did he do it? Through spatial means.
Tom Barry: Yeah, okay. I think that's a good little podcast. I'd like to thank John, Louie, Travis. This is another bite sized podcast, we'll be back to you with the next one shortly.