Back pain part 2

In this conversation, the hosts discuss various topics. They mention that reaching the sixth episode of a podcast puts them in the top 90% of podcasters. They also talk about a finance tip for earning extra cash using a Chase bank account. The hosts then discuss back pain, mentioning that it's a broad topic and that they will be doing a part two. They mention that there are myths and misunderstandings surrounding back pain and discuss the idea of lifting with a bent back. They mention that some of the strongest lifters in the world lift with a flexed spine and that there is no evidence linking a flexed spine to a greater incidence of back pain. They also discuss the importance of understanding the anatomy of the back and the practical side of lifting. That's very formal, Dave. How are you? I'm good, thank you, mate. How are you? Yeah, very excited to get into the sixth episode. You just told me a stat about where we're sitting amongst the podcasters in the world. Well, I've heard this on another podcast and apparently when you get past episode five, you are in the top 90% of podcasts that get started. So we're getting there. Yeah. Wow. I think that's worth celebrating, right? We've got over the first hurdle. We had our ups and downs and you did admit to the little misdemeanor last week that we may or may not have had your mic on and had to re-record your podcast. Yeah, and I think Dave really liked it the second five rounds, so it was so good we had to do it twice. So today's going to be me picking back up on back pain because I think we had a few questions in and about that. It seems to be a topic that's really got the juices flowing. Yeah, I think it was a really broad topic to go over and we didn't fully do it last time round. So yeah, I think it's fair to do a part two, isn't it? I think so and I think our kind of aim for people is to keep podcasts relatively short and sweet rather than them being really long. Yeah, we're aiming for a commute time really, or as long as you listen first. So we'll keep it to two minutes today. So yeah, we'll go for part two on that in a minute, but first up I think you've got another tip for the listeners, finance tip. Yeah, so I'm keeping the theme of personal finance. In the previous tips I've given, I've gone through credit cards, I went through transferring your current account, all with the thought of trying to make our listeners a little bit of extra cash. So to round it off, to do the triple, I am sticking with the theme and going with potentially my last bank tip just because I've kind of done them all now. But this is another one that I've personally used and as you know, I've got like 10 current accounts. But this one is, it's one where if you're not that comfortable getting a credit card, which some people aren't, which is totally fair enough, this is sticking to current accounts. And as I said last time, you can have as many current accounts as you want and it's not going to affect your credit rating unless you get an overdraft with it. So don't be scared about having like one or two and thinking it's going to affect something, like it's going to damage your financial score or whatever. So this is a bank account by Chase and I got this account, so it's only been in the UK for like two years, right? I got it on the first day it came out because I was quite excited about it. You're a trendsetter. I know, I really am. And so it's owned by J.P. Morgan, so J.P. Morgan Chase, it's a massive bank in America. They came over to the UK, but the thing that I love about it, okay, is that you get your current accounts, you get your debit card and they, for the first year, you get 1% cash back on everything, okay, up to £15 a month, caveat. But obviously, if you spend below £1500 a month, which I think most people do, you know, excluding a big holiday here and there, you could be earning extra money. So I would say like on average, let's call it £1000 a month, you're making £10 extra just from your daily spends, right? And that's £120 a year for the first year. Don't pay anything for the current account opening, it's super easy, it takes about 15 minutes. But yeah, I've got a thing with people using current accounts that don't give them anything because I think if you're going to be spending money, at least get something back for it. These banks are trying to take things away from people. So don't be scared to transfer, just jump in, start using it and you're going to get extra money from it. And they also do other deals, I think that you can get 5% on roundups. So if you round up your spending every single time, you'll get like a little bit of extra cash as well. And they also have a decent savings bank account attached to that. It's all in the app, giving you like 4.1%, which isn't too bad at the moment. And then obviously, because it's owned by JP Morgan, and JP Morgan also own Nutmeg, which is something I spoke about last week, you can invest directly through the app. So it's kind of like your all-in-one bank account, but it doesn't do credit. So you can't get an overdraft yet, you can't get anything like that. But yeah, well worth using if you want, you know, if you spend an average £1000 a month, you're going to get a bit of extra cash back just for doing nothing really. Sounds good. Nice quick one. Yeah, I just want people to be richer. Seek professional help. Brought to you by JP Morgan. We're going there, aren't we? No, we definitely are. But hey-ho, should we crack on? Yeah, so I think we need to talk about back pain, part two? Again? Part two. Part two. Right, back pain part two, Dave. I'm excited. I can tell you are. Yeah, I feel more at ease than I did last time. It's a lot overwhelming to me last time. You were very scared, and I don't know why. I was very scared about back pain. It's a scary topic, but I think the last time we obviously spoke about more the anatomy behind the back and what structures are made up by it and then where the different pains come from and all this kind of stuff. I think this time, where we've had questions in, it's more about the practical side of it and where I guess the everyday person who's going to the gym or wants to know where back pain kind of comes from, from lifting and that kind of stuff. I think that's what we're getting into, right? Yeah, I hope so. I think it might be a potentially contentious or controversial topic to a degree because there are arguments and there's a lot of myths and stuff on social media. I think it's a topic that's poorly understood even by some physios. I hear that patients get told things by physios that I would never dream of saying to a patient, and that's still happening. Name one. Okay, nice. The one I hear a lot of is don't lift with a bent back. Don't lift with a flexed spine. Yeah, I mentioned this one last time. Yeah, and we talked about it briefly in the first ever episode about myth busting. I'd say that's one of the big ones that I hear a lot of and we definitely can get into that. Yeah, I want it to be a bit more practical. I think you have to understand the anatomy and I would say if you haven't listened to the first part, it can feel a bit heavy, but possibly important to go back and have a listen and understand about the anatomy. The anatomy is not controversial, right? You can't argue what structures make up the back. That's cut someone open and you can see them, but the more practical side and the research in and around what causes the pain and what things are good and what things are bad is a lot harder to quantify. Okay, so I think a good place to start with this one, more because I'm most intrigued about it, is going to be to do with lifting, as you just mentioned, and lifting with a bent back and why you should, shouldn't, and potential causes of pain behind it. So, oh yeah, let's start there and see where we go. Okay, so I think the thing I would like to say initially is I really want to reduce the fear around people lifting with a flexed spine or a bent back. There's this obsession with a neutral spine that, you know, keep your shoulder blades in the back pockets of your jeans, pull your chest up, and you have to, whenever you deadlift, keep that position and that posture and if you don't you will die and your discs will herniate and you're going to give yourself radiating symptoms and all of those things. And so there's a few myths I'd like to dispel in and around that. So number one, if you go and search some of the strongest people in the world, the strongest deadlifters in the world, I don't know if you've ever watched, you know, lifters like Eddie Hall or the guy called John Hack, who I think weighs just over 80 kilos, like 82 and a half kilos or something and lifts 360 kilos off the floor. Say it, say it. Just a casual, I know it's nothing to you, but some of our listeners that might be a little bit of weight. Yeah, yeah. They're not used to, you know, the big boy stuff like you are. If you look at their lifts, they don't look pretty. Yeah. Right? They kind of like, especially when you think about like Eddie Hall, it's very like get it up at any cost kind of thing. And if we were then therefore, and I think the thing is, we can go into this a bit more, but if we were to absolutely demonise a flex spine, like go, you can never do that. Well, these fucking guys do it with the most load of anyone and their discs aren't popping out and they're not, they're not dead. Where do you think it came from then? Like, where did the stigma behind a bent back? I'm going to use a term that's used in the scientific literature, but I'll explain it because I know you're just going to look at me like, what the fuck are you on about? There's no in vivo evidence that people with a flexed spine have, when they lift, have a greater incidence of back pain. What does in vivo mean, Dave? So in vivo means in living studies. So like, there are in vitro studies. So in vitro, I always, I think I got taught in vivo sounds a bit like living and in vitro has a T in it, like a test tube. So there's in vitro studies, which show anatomically and biomechanically, if there is flexion through the spine, there is more like shearing forces. So more force that will be acting on the disc. Do you remember those little like gel sacks in between the vertebra? So are you basically saying that when you've got a bent back, it is putting more pressure on the disc, but it's not necessarily going to do anything? So theoretically, it has more force going through the disc. And that's therefore where people have started to go, well, there's more force going through the disc, so it's dangerous. And then there's a lot of evidence of like, I think there was a guy called McGill, and this is a really old study, but it's the type of thing in scientific literature, people pick up on things that were done ages and ages ago and use it for 40, 50 years. And it's not dispelled necessarily, but like cadaver studies, so like a dead spine, and they did multiple flexions, and it eventually caused the disc to herniate out. What they don't tell you is A, that spine is not in living matter, it's in vitro, and therefore doesn't necessarily carry over to a living organism. And I think it was 18,000 flexions of the spine that caused this to happen. And I think if you were doing a movement, any movement 18,000 times, you would damage a structure. I think that's fair. I think the other thing, you know, you said on the podcast that people kind of mutter in the gym, like, oh, I wouldn't be lifting in, like, not even the flex spine thing, but like, I wouldn't be lifting, I wouldn't be doing that if I were you. It's going to get you injured. An opinion that I heard quite recently was, people actually haven't been using the gym for that long. Like, gyms actually and lifting and strength and conditioning has only really been a field of study since the late 70s and early 80s. That's a good point, actually. It's very nice to think about. So you think about, you know, parents' generation, grandparents' generation, they kind of see this sometimes as this, like, new fad, and it's almost like, oh, we don't really understand this yet. And the evidence is relatively new, and it's not that well studied. So I think there's a bit of stigma around it. They all had proper jobs, didn't they? Yeah, exactly. Working in the field. And I think the other thing is the phenomenon of, like, reverse causation. If somebody comes to you and goes, I've got a sore back, and then somebody goes, oh, but that person lifts weight a lot, they go, oh, that must be the reason that they have a sore back. There are hundreds and hundreds of people that have a sore back from innocuous things like picking a sock up off the floor and get pain from that. But sometimes we correlate, oh, it's because that person lifts that it must be that they have a bad back. So it's often drawing the wrong conclusions. It doesn't mean that lifting can't cause you back pain. I definitely don't want that to be the takeaway from this pod, but there's no evidence, really, that it increases the risk of. In fact, we can go into the reasons why it probably decreases the risk of. But there is, would you say, a good form or not? Although it's not necessarily bad, you can have a good and bad form with it, right? That's a really good question. I think form is pretty subjective. So depending on your anatomy, form might be different for different people. And so if you are getting pain in a lift, for example, a squat or a deadlift, it might be because your form for your body isn't great. You might have real stiffness in your ankles. That might be your limiting factor and might be causing you pain when you squat. So we might need to either think about, okay, do we need to improve your range of movement in your ankles? Again, specific to you. And this is where I'd get a physio or something to watch your lifting and look at your body as a whole. And it might be, therefore, you might want to do some heel-lifted squats or something like that. But there's no perfect, like we said this a few weeks ago about posture. There's no perfect posture. But there's no perfect form. Your lifting technique might be causing you pain, but it might be specific to where you're tight and stiff. And yeah, people are going to be more comfortable lifting in different ways relative to them. Yeah. I've got two questions off the back of that, okay? So my first question is, is there a more efficient way to lift? If you are lifting in a weird kind of way, is it going to be detrimental to, say, trying to build muscle or gain strength? Sure. Okay. So I think the answer to this is yes. So performance, if you were looking for your max deadlift, and this is what we'll get into about the difference between what your aims of each lifting session are. But yeah, for a peak performance deadlift, if you're looking to get really strong, you want to be braced through your core, and like a more rigid spine, you are more likely to be able to shift more load. Caveats to that would be, if you're always looking for like perfect form, yes, if I was going for a maximum deadlift, and I was thinking about it from a performance point of view, absolutely, I want to make sure I'm braced. I probably want a relatively rigid back, which is why I'm never going to actually suggest you aim for loads of flexion coming through your spine. Don't be too paranoid about it, but not loads of like aiming for it, because you're not going to be able to pick the same weight up, because you're not going to be using the stronger muscles in your body. You're going to be using the thinner muscles in your back to try and get that load up and extend your spine to get it up, rather than using your glutes and your quads and the big muscles. The back just wants to be stable, and we lift with the big movers. However, on the flip side to that, although for a performance, that's our aim, we also want to think, especially for most people that want to be able to move well, lift objects off the floor. I often work with a lot of rugby players and think about, you can't aim for a rigid spine in all things of life. A really nice phrase I heard recently was, lifting in the gym is optional to get you strong. Lifting in life is kind of non-negotiable. It's going to happen. You're going to want to have to pick your kid up off the floor, bending down to put your socks on. If you're always thinking brace core, rigid back, yes, for performance that's great, but I also want to condition my body in the less efficient movement patterns. Otherwise, when I do lift, something mundanely in life, or in a sport where you aren't going to be in the perfect deadlift position all the time, because it's slow to get yourself in that position. You just need to be instinctively, go back to the rugby example, instinctively pulling the ball out. You need to have practiced actually lifting in a non-efficient movement pattern as well. Does that make sense? Yes. I actually, again, heard something about, especially for older people, where I guess your muscle starts to deteriorate. The things you really care about are picking up your grandkid, or even just putting the whole thing away into a high cupboard kind of thing. That isn't a straight back. As you say, it's the more standard life stuff, right? Yes. We can't ... If you only ever train with that straight back, then standard ... There's a guy on, I don't actually know his name, I don't really use TikTok or anything, but there's a guy who takes the piss out of these perfect movement patterns, and he kind of goes around in life like always in a perfect back to the posture thing, and lifting objects on the floor with a dead straight back. Like a robot, basically. It's just literally not a thing that happens. If you don't ever condition the smaller muscle groups that are responsible for extension of the back when you're bending forward and then coming up, those things are going to be weak as hell, and you're a lot more likely to then pick up injuries if you don't do that. So yes, in answer to your question, there probably is a more efficient way to lift. Okay. And so if I was coaching somebody, and their aim was to pick a heavy object off the floor, we're going for their max lift, I'm going to ask them to brace through their core. Doesn't mean that not doing it is dangerous with a lower load. Yeah. That leads me in quite nicely onto my second question. Keeping with the dead lifting theme, the use of belts when you're dead lifting, I guess, unless you're lifting, if you're trying to go for your PBs and stuff, is there any point in wearing one? Again, I won't speak too much about these because I'm not a power lifting coach. I would never claim to be. I'm a physio. I do quite a lot of strength conditioning work with my clients, but I don't work predominantly with power lifters that are shifting that much weight. For your general population, I would actually say, yeah, unless you're going for your PBs, I would recommend not using a belt because you want to be strong, and you want your body to be strong. Yeah. Aside from those people that are doing power lifting as a sport, I don't massively advocate belts. Because I guess it's transferring some of the strain over to the belt rather than using your own muscles, right? Yeah. Yeah. Yeah. Absolutely. Again, there's evidence about whether they're even helpful in those populations, but I'll park that, A, because it's a long discussion, and B, I don't know enough about it. Yeah. No, that's fair enough. I only ask because, again, it's one of those conversations you hear in the gym, and it's kind of anecdotally, I've heard people saying, oh, I'd never deadlift without a belt on, even if you're doing like 60 kilos or something. So that's interesting. That's really interesting. To shift the conversation slightly, Dave, we've just spoken about performance. I have also seen people lifting with a bent back. When would you actually ever advise that, if you would? Okay. So, yeah, I often get people to lift purposely through ranges of spinal flexion. So there's a lift called a Jefferson Curl, where somebody, YouTube it if you're unsure, but you're kind of bending forward and keeping your legs pretty straight, and you're literally almost segment by segment bending forward with like a kettlebell or something. I'm a massive advocate of Jefferson Curls, because it's loading somebody into spinal flexion. I'm actually also a massive advocate of teaching people with lower loads, so again, not for performance and for their max lift, but teaching people to do things like rotate. So lifting a weight and flexing their back and rotating is almost like a Jefferson with a twist. So we're going in different directions than just the standard perfect deadlift position. And the reasoning behind that comes back to most of my explanations around physiotopics building somebody's capacity up, okay? Their capacity for a particular activity. So I think it comes back nicely to what we were saying about life not being perfect straight back position, you having to lift in awkward positions. And we have to build somebody's capacity up through strength training, so that when they do those awkward positions, their body has adapted and is ready to do them. So I always use an analogy. I often talk about buckets and water, but I want to explain it with a couple of cups here, okay? It's a super simple analogy, but I just want to use a few visual aids. Yeah, I mean, I was wondering why you had multiple cups on the table. Yeah, and they're empty at the moment. So I'm going to make sure we don't absolutely ruin the studio, but I've got like an espresso mug here, okay? Now, imagine this is my body's capacity to lift in a flexed spine position, okay? So it's empty at the moment, and if I've got some water here and I fill it up, very quickly it's going to overflow, okay? Or reach its capacity. And I've only put that much water in. Now, lifting regularly builds your body's capacity to accept load and accept demand. More water. More water, exactly. So now if I obviously add any more of this in, this floor is really wet, we're in trouble, we're never using this studio again. However, by consistently loading my body close to my capacity limit, I grow my body's ability to accept demand. You get meniscus, don't you? So now, this is somebody who lifts regularly in that movement, and very quickly I've got a load more room to accept more load. And that might be more repetitions of an exercise, or it might be a one rep max that I've got more capacity for. And if I never train my body's capacity to bend forward and lift weight, it's going to look very much like the espresso mug. And when I do something in my day-to-day life, it's not hard to overspill that. And so I really encourage people, especially with backs, to improve their capacity for load, so that they can fill it with more water. They've got more ability to accept demand. Because if your capacity's this or lower, you're going to bend down, pick up a piece of paper, bosh, your back's gone. And now, this, obviously if I suddenly try and pick up, for you, 500 kilos, that's that capacity. And then you will probably injure your back. And so there is always going to be a biting point where an injury will occur, when demand outweighs the capacity that your body has. But you want to make sure that your back, in every single plane of movement, not just perfect deadlift posture, but bending forward, bending around to the side, rotating, you've got capacity for each of those things. You must be like water. You're just saying random Bruce Lee quotes. I'm glad you've got a quote, to be honest. Does that make sense? Yeah, yeah, yeah. That does make a lot of sense. And that's where I'd say, performance-wise, yeah, we probably want to have a more rigid spine, and we want to encourage that. However, for the everyday person, and especially people coming out of back pain, that fear of moving forward, they're never going to grow that capacity, and it doesn't take them long to become re-injured again. And we need to encourage them to be reloaded, to increase their capacity so they look more like a glass of water that can be filled up more than that espresso cup. Yeah, yeah. Did you like my props? I did, yeah. It's a good use of props. Yeah, do you think we should have a segment every week around just bringing props in? Yeah, maybe. Okay, cool. Yeah, that was really nice visuals, Dave, and we were actually trying to film that, so be on the lookout. We're going to send some videos of that if we didn't explain it very well. Yeah, apologies, that is a more visual, it's probably not a podcast-friendly demo. Maybe for YouTube. But, yeah, Scott and I are now trying to get our head around record, like if it wasn't hard enough to just record a podcast, we want to start putting some videos and stuff out there. So, yeah, apologies if that was just five minutes of nonsense for the listeners. So, I've learned it's okay to bend your back when you lift, because there's not necessarily a perfect form for anyone, right? It's individual to the person. However, if I do want to go and lift 500 kilos, then I should probably think about form. Probably, to give you the ability to do it. Yeah, to make sure I've actually got the odds in my favour, and maybe wear a belt as well. If I were you, I'd probably not lift 500 kilos, I'd probably start at 230. Yeah, maybe. But I think the main thing that I've learned, and I think what you've tried to get across, is really kind of dispelling the myth around, and the stigma around, lifting weight and doing your back out if it's bent, and all this kind of thing. And I think it's one that is such a big topic in most gyms and in life, to be honest, because you get it a lot, even at work. Like, if you're sitting at a desk and it's not quite right, obviously, if you sit for too long, it's going to hurt, but it's not necessarily a bad posture. And again, going back to the posture episode. But yeah, I think you've really kind of got down to the root of, don't always listen to almost wives tales, it's kind of the... Or people on Instagram. Or people on Instagram, where it's all about having a straight back, because the reality is, that's not true. Yeah, and I think a myth I want to dispel as well, is that it's easy to see if somebody is bending their back when they lift. Say that again. So obviously, if they bend their back loads, it's really easy to see if they are bending their back and flexing their spine. But there was a research paper which showed people had to be in like 36 degrees or more of flexion for somebody looking at them, a trained professional looking at them, to note that they had spinal flexion. So it's an obvious bend, right? Yeah. So your back is naturally always going to bend when you lift. Even if you're completely trying to keep it rigid, there's natural bend, it's impossible to not. And yet, it's actually quite a lot of bending before it's even noticeable. Yeah. So just stop stressing out about... It's really one of the most common things I hear in my clinic and day to day. I had a woman this morning, never met her before, and literally said the words to me, I put my back out. I know it's because I was in the garden and I didn't lift with my back straight. And so, let's reduce some of the fear and stigma around flexed spine. Number one, we can't see if it's flexed or not. And number two, kinesiophobia, fear of movement, yeah, can lead to pain and exacerbate pain more than other factors. And this is more of an opinion, but my humble opinion would be that one of everything we've said today. If you're lifting heavy, and a good place to start probably is to aim for a semi-neutral back and not be flexing through movement. But then add different loads, reduce loads, and make sure that you actually play around with those different movements because it will get you ready for life. I really liked what you said about the research with older people needing to lift their grandchildren and just do life. Because ultimately, when we're all 70, we're not going to care about our max deadlift, are we? We're going to care about getting up the stairs. Exactly, yeah. That's amazing. And lifting can, and the evidence does show and support that lifting sensibly and not being a dick can enhance your longevity, your movement patterns as you get older, and reduce your incidence of back pain. So yeah, get lifting everywhere, everyone, everywhere. Everywhere, everyone. Everything. That was weird. No, I kind of liked it. Go back to getting lifted, everyone, and everywhere. And everything. And everything. And I was going to say, you can't go wrong getting strong. I heard that. Nice. I like that. That's a good way to end it, actually. It's nice. So thanks, Dave. I've learned a lot today. I'm hoping the listeners have also learned something. But as always, I think you should probably sign us out. I think so. So that's back pain part two. There's also part one. There might be a part three. Who knows? We just don't know. I'm really keen, and hopefully in the next few pods, we've got some guests lined up, maybe. Big stuff. Exciting. Very big stuff. So stay tuned for that. But yeah, sign out from today. Although I am a physiotherapist, and I try and base the things I say in the best available evidence, if you're experiencing a problem yourself, it's probably best to be assessed in person by a physio. And a lot of the things I've said here are based on opinion and how I interpret the research. So if you're struggling, don't just listen to a podcast. Seek professional help.