Strength Training is the the treatment of choice for chronic low back pain.

Jonathon Sullivan MD, PhD, SSC, PBC

Back pain is ubiquitous in humans. Nine out of ten will experience back pain at some point in their adult lives. In a small minority of cases, back pain is a sign of something sinister--pneumonia, heart problems, infection, even malignancy. If your back pain is severe or associated with other symptoms like fever or tingling or shortness of breath, see your doctor. But the vast majority of back pain cases are due to a musculoskeletal problem--mechanical back pain.

Mechanical back pain comes in many different flavors, from facet joint tweaks to herniated discs to nerve root compression, but the most fundamental cause is simply...our timing. Our backs evolved to support a quadripedal lifestyle, but we decided to walk upright several eons ago, and our spine hasn't seen fit to evolve a more suitable structure for this locomotive modality. Perhaps in several million years it will....but that will be too late for us 21st-century schmucks. It appears most of us will miss out on flying cars, warp drive, and World Peace, too. Such is our humble lot: bipeds, stuck in earthly traffic, listening to news about a civil war in Syria or Chicago.

I occasionally get back pain, just like you. When I do, I take my NSAIDs and my acetaminophen, because I like to keep my pain and inflammation on a short leash. But at the age of 56, I have back pain far less often than I did in my 30s and 40s. That's because I now take a very effective preventative medicine: Iron. I train for strength, and I train my clients for strength, and I do it with exercises that make the back strong.

And it turns out that when your back is strong, it just doesn't get hurt as often.

When we properly train the deadlift, the squat, and the press, one of the many important things we're doing is improving the ability of our spine to transmit power, rather than bow to it. Consider, for example, the squat. The bar is held high on the back, just beneath the spines of the scapulae. The lifter descends to the bottom, and uses the powerful muscles of his posterior kinetic chain (hip drive) to come up again. The power generated by the legs and hips must move the load on the back, almost an entire spine away. This power must be transmitted through the spine to move the load, and for that to occur the spine must be held in rigid extension. This requires strong isometric contractions from the paraspinal muscles, to transform the spine from a chain of vertebral segments into a rigid rod. In other words, in the squat, the hips are the motor and the back is the transmission. If your squat gets stronger, your back has to get stronger, too. The same is true of the deadlift and even the overhead press.

The ability to stabilize the spine under a squat or a deadlift has direct

transfer to everyday life. A strong and stable back, capable of efficiently transmitting power from the legs and hips to a load on the back or in the hands, is less likely to flex or rotate in an untoward way under any loading, and therefore less likely to be injured.

Strength training probably reduces back pain in less obvious ways, as well. Training reduces systemic inflammation, improves overall mobility and balance, and promotes hypertrophy of bone and other spinal tissues. And I suspect that the powerful psychological effects of training also play a role--there is, after all, a significant functional component at work in many cases of back pain.

Whatever the reasons, one thing is clear: strength coaches observe an almost universal improvement in the quality, severity, and frequency of back pain in their athletes. This anecdotal data is born out by a great deal of published research data on the value of strength training for mechanical back pain.

Am I saying that training with weights will free you from back pain forever? That, of course, would be ridiculous. Training can't change the Darwinian reality that your back is not particularly well-designed for your bipedal lifestyle. What I can tell you is that proper strength training won't just make your arms and legs stronger. Proper strength training will make your back stronger, too. A lot stronger.

And, to paraphrase a great man, strong backs are harder to break, and more useful in general.

Jonathon Sullivan MD, PhD, SSC, PBC is the owner and head coach of the Greysteel Strength and Conditioning Clinic in Farmington Hills Michigan, which specializes in training adults over 50. He is the author of The Barbell Prescription: Strength Training for Life After Forty, with Coach Andy Baker.