Category Archives: back pain


if you have back pain you need to learn how to stabilise your spine . One of the hall marks of good stabilisation is the ability to both contract the abdominal wall and breath at the same time. Poor spine stabilisers, in effect, switch between bracing their spines or breathing. In short can you brace your abs ( not suck in!!) and continue to breath?

If not,  train yourself to breath freely while maintaining an isometric  contraction in the abdominal wall.

RED FLAG: Is your back pain “serious”

In many cases, careful management deals with back pain. There is however a species of back pain that  I’ll flag up to you now. The items listed below are “RED FLAG” symptoms which means see your doctor or A & E NOW;  go in and say , “I have back pain symptoms that I think are Red Flag symptoms”

  • fever of 38ºC (100.4ºF) or above
  • unexplained weight loss
  • swelling in the back
  • constant back pain from which there is no position of  ease
  • Chest pain
  • leg pain
  •  a change in toilet patterns
  • numbness or tingling  around your bottom and privates.
  • pain that is worse at night

These are known as ‘red flag symptoms’ and could be a sign of something more serious.

That said, I was checking the NHS  website today (23/7/2020) and it made this  distinction


  • your painkillers are not helping
  • the pain is no better after a month
  • a very high temperature or you feel hot and shivery
  • unexplained weight loss
  • a swelling in your back
  • the pain is worse at night

Go to  A & E or call 999

  • numbness around your bottom or genitals
  • cannot pee
  • lose feeling in 1 or both legs
  • cannot control when you pee or poo
  • got it after a serious accident, such as a car accident

Is sitting a lethal activity? [Research]

A reflection by Crossfit trainer Steven<
Post image for Is sitting a lethal activity? [Research]

Cracking article in the New York Times on research into inactivity, especially related to ‘chair & desk’ culture.

I have been considering for quite a while the idea of a stand up desk, at least at home. My miserable seated posture and the back and neck pain I experience from sitting for hours a day should have been enough to spur me into action. And then I read this:

This is your body on chairs: Electrical activity in the muscles drops — “the muscles go as silent as those of a dead horse,” Hamilton says — leading to a cascade of harmful metabolic effects. Your calorie-burning rate immediately plunges to about one per minute, a third of what it would be if you got up and walked.

Oh dear. Dead horses?

‘Is sitting a lethal activity’, New York Times, 14 April 2011

Edit: There is also an earlier article with moar science in it: ‘Stand up while you read this!’, New York Times, 23 Feb 2010

Sitting is killing you

An interesting reflection by Crossfit trainer Colin Mennis

No Sit

As I write this I am standing at my kitchen counter as you read this I want you to stand up and even walk around, it could save your life (unless you are outside, then don’t)

Recent studies including some historical reviews of lifestyle changes have concluded that inactivity is killing us. In fact it is regarded in some circles as the most serious threat to our health, more than sugar, fat, smoking and alcohol.  Just take a look these facts:

  1. Sitting for 6 hours a day will increase your chance of death within 15 years by 40% compared to someone who sits less than 3 hours per day. EVEN if you exercise.
  2. Studies have shown obese people sit 2.5 hours more than thin people per day.
  3. Despite more people exercising than ever before obesity has doubled since the 1980’s. Our sitting time has increased by nearly 10%

Studies have discovered some amazing facts about cellular damage due to inactivity. After just 7 hours of sitting we show the first early signs of insulin sensitivity. Our calorific use can drop as low as 1 per minute. Fat fighting enzymes drop by as much as 90%. There is twice as much cardiovascular disease among those with sitting jobs than those with standing jobs.  A great study on the old London buses clearly demonstrated this back in the late sixties comparing the drivers health with the conductors.  And I will repeat exercising regularly will not help you.

As health professionals we advise exercise and eat less and well for weight loss and better health.  Homeostasis, what a pain. Studies have shown that people who take up exercise and/or diet for weight loss become less active throughout their day. They start sitting and lounging around for longer. Yes they can feel overtly tired and feel the need to rest but the body is also working away against your ambitions. It does not like change and you will subconsciously do less and less to maintain the calorie in/out balance. Some people have even been shown to put on weight while dieting because they are burning so few calories!

As health professionals we need to be informing clients and making them constantly reflect on their activity levels during the day.  Maybe add an activity diary to that food diary. Those clever little wrist bands that monitor movement, I thought they were gimmicks, but maybe not? People need to know to stand whenever they can. Configure their desk so they can stand more, use stairs, walk up escalators and stand up when commuting.

I exercise regularly with biking, running, strength and metcon training but none of that will undo the damage caused by the hours on end I sit at my desk or on the tube. So I have made changes, you should too.

Sorensen test

All through our sessions we stress proper squat form: bum back, weight on your heels, lordosis

You have to remember what joint to bend first on your legs when carrying load. You have three joints, which should move first? Think of it this way; whatever joint moves first, takes the whole weight of the move upon it. So think it through: should you move your ankle joint first? Have  a look at that tiny, dainty joint– not really that good a choice. How about getting the infamous injury-prone knee to be the focus of all the stress your body and a bar can generate? Or how about, initially, using your massive hip joint? (a tennis-ball sized joint buried in a secure acetabulum,  supported by a a massive bum muscle. ( And of-course, I’m not saying your bum is too big).

But here’s the “thing”: God knew you would be confused as to which joint to use, so she “flagged it” with a giant arse-shaped “post it note” in case you forgot. This is the joint strong enough to take all the grief when you begin to squat. Hence  we say “bum back” first..

Anyway, lets talk about the  Sorensen Test

The race has always been on to firstly predict,  then inoculate against,  back pain. A test known as the “Sorensen test” based on the work of Hansen in 1964, has been popular since 1984.

According to Demoulin et al 2006  ”The test consists in measuring the amount of time a person can hold the unsupported upper body in a horizontal prone position with the lower body fixed to the examining table”

The test is accepted in its discriminative validity, reproducibility, and safety. However debate continues to surround its ability to predict low back pain. No firm explanation, beyond “women rock” , has been offered as to why “chicks” can hold it longer than guys.

Naturally motivation and discomfort tolerance are confounding factors.

A interesting review is available in PDF form at Isometric back Extension tests: a Review of Literature Maureau et al Journal of Manipulative and Physiological Therapeutics Volume 24 • Number  2001, But in essence,this report says this….(yawn….)

For men, the mean endurance time is 84 to 195 seconds; for women, it is 142 to 220.4 seconds. For subjects with LBP, the mean endurance time range is 39.55 to 54.5 seconds in mixed-sex groups 80 to 194 seconds for men, and 146 to 227 seconds for women” whether thats remotely useful lm not sure, but if you suffer or are prone to lower back pain, (you tend to know by your appalling posture), im going to suggest you move this figure up.

Demoulin C, Vanderthommen M, Duysens C, Crielaard JM.  2006.  Spinal muscle evaluation using the Sorensen test: a critical appraisal of the literature. Joint Bone Spine. 2006 Jan;73(1):43-50.

Preserving and improving your back

Post image for Preserving and improving your back

From day one   with us, we emphasise holding a lordosis . We want you to lock your “core down” hold it tight and use it as a lever point for your hips and shoulders to work.

To get the  Backaholic  benefits  you must understand and implement this idea fully. It is not acceptable to lift with your lower back. Period. Not when going for a PB,  not because “well thats how I cycle” , not because  ”well thats how I  sit” not  because ” well I feel comfortable stooped over”.  Lifting means lordosis, lifting means no movement in your back.

You may wish to twist your back for a stretch relief, you may have your back collapsed in a scrum, you may want to roll your back up to land a  dive forward roll, or tuck in the air. You may want a hunched back to pursue a  yogi lifestyle  ( the bendy religion, not the cartoon bear) or to be accepted by other Pilates practitioners as they imprint their spines on the floor.

All of this you can do.  Simply don’t delude yourself that its healthy or good for your back.

Our job is to make you focus on impeccable back  form during our skills and strength and then pressure test  it during the  workouts.

All the time we want to  add to your “Back Bank Balance”.  Every time you lift correctly and with good form you start saving up “Back Bucks”. Every time you  sit correctly  you add to your balance. Every time you slouch,  or use your back to lift, you spend your savings. Too much spending, with no saving, normally ends in tears!

So some  extra concepts.

Most people believe that backs have a set breaking point. I  had the privilege of listening to Stuart McGill who suggested that your back does not have a fixed breaking. The more you slouch, the more you lift that Deadlift with  L 2-5., the more you reduce the  capacity of your back to resist breaking. I think McGill prefers the term “failure tolerance”.

The back  switches everything on in a  natural  lordosis ( not jammed right to the extreme of lordosis). When you use a kyphotic posture to lift, you get  ”Myoelectric  silence in the back extensors, strained posterior passive tissues, high shear force on the  lumbar spine. A neutral spine gets everything onboard working  for you. (Page 93 Ultimate Back Fitness and Performance)

The back has a super useful  muscle architecture; the iliocostalis lumborum and longissimus thoracis fibres when in lordosis  seem to run at  45 degrees  to the spine  which means they brace the back against shear ( about 70%). In kyphosis, its reduced to a measly 10%

To this  lordosis  you need to bring  the ability to engage all the core muscles. We don’t mean the obscure muscles that “guru’s” claim to super isolate like Mutifidus or the TVA. You need everything. Thats why God put them there.  The Lats, the “core” , the rectus abdominis, , the obliques, the fascia. You want it all.! To get this , you engage your lats…its easy, and you brace your core!  Your torso when lifting …. that doesn’t collapse or wiggle. The hips and  shoulders, they do the hinging!

Elsewhere we will talk about some additional super useful exercises we will set you to work on at home: the stuff that promotes a  protective lordosis and builds back endurance: But for now, when we say, get your lumbar curve in, seriously  dude, we mean it!

A heart in my hands: Anatomy for beginners

Post image for A heart in my hands: Anatomy for beginners

in 2010 Andrew Stemler and Kate Pankhurst  took a series of courses in anatomy which utilises human cadavers. The location of the hospital has been kept confidential in respect of the Human Tissue Act, and names have been changed. The following is a personal account of our first practical lecture, and contains graphic descriptions of human remains which some may find disturbing.

The locker room is like any other. You’ll find one just like them in every gym, sports club, swimming pool. This locker room is different. Instead of chlorine, there’s another chemical smell, not unpleasant, but you can’t quite put your finger on it. And in the middle of the room, piled on top of each other and still shrink-wrapped in plastic, are three coffins.

Andrew and I, part of a small group of students drawn from various physical therapies, chat nervously while putting away bags and coats. We stow into pockets the items we’d been advised to bring: tissues and olbas oil. We’re told the cadavers can get pungent when they begin to dry out, so a whiff of Vicks can be a welcome relief. I’ve brought both – and I cling to them as you would a crucifix under a circling vampire. It’s a pathetic defense between my innocent experience of life up to now – and the imagined horrors that lie beyond the anatomy room doors.

A few weeks ago  we were offered a series of cadaver anatomy lessons, culminating in two days of actual dissection. “Wow, awesome, yes!”, we cried. How incredible and exciting – a once in a lifetime opportunity. We paid up, booked the time off work, and gave it hardly another thought. Until today.

Now it all seems too real, in this locker room, waiting for our hostess Molly (a bubbly Pilates instructor, today rocking a low-cut long dress and flying jacket) to check all was ready for us. She has a gift for setting people at ease, and with some final words of reassurance, she leads us into The Room.

Our eyes flick around furtively. This is no basement morgue: It’s on the 14th floor of the building and unexpectedly bright, but the wind outside keeps up a howling background monologue. A big room, and around the edges we glimpse a dozen metal gurneys with a white bundle on each. Strange bundles, different sizes and shapes – but nothing that looks obviously like a body. A relief. I’ve only ever seen one dead body before – many years ago and dressed and peaceful in his coffin. It was an unnerving experience for a teenager, and I never imagined willingly doing it again. But this is another thing entirely.

We’re instructed to put on plastic coats and purple latex gloves, and sit in a semi circle to await further instructions from our teacher. The Professor is a reassuring, avuncular man in white coat and bushy mustache. Like a tidy Einstein. He begins with a summary of the Human Tissue Act, which states that those who leave their remains for medical study must do so in writing. Unsuitable donors include those who have been significantly affected by certain diseases, amputees, have donated organs or undergone an autopsy. The result is that all the volunteers were between 80 and 100 years old at death, and with the added filter of religion and culture, are almost exclusively white Anglo Saxon Christians. He makes a final point from the Human Tissue Act: that all human remains are to be treated with dignity.

There follows a whistle-stop tour of anatomy, using a dangling skeleton. The ones we use on our massage course are plastic, with missing fingers and legs bent out of shape. This one is obviously of better quality. A closer look reveals marvellous detail in the teeth and jaw – and then it hits me. This is a real skeleton. Everything in this room is real. My stomach flips over.

Our anatomy discussion has thawed us somewhat, and helped us acclimatise to the fearful environment. But at long last, the Professor invites us to gather around a nearby gurney. This is the big moment, and another frisson of excitement mixed with deep unease gets hold of my guts. I secretly search for Andrew’s hand as we approach one of the white bundles we saw earlier. We students exchange nervous smiles, but the eyes tell it all.

The damp white cloth is peeled back to reveal a torso.

Just that. No head, arms or legs. And it’s a brown, leathery colour. It looks like it’s made of rubber, so I retreat a little into the safety of unreality. It would almost be underwhelming, but for the fact her chest (it is a lady) has a deep incision down her sternum, and the skin is tied together with string. In neat bows.

The Professor undoes the top bow, and carefully lays back the flaps of skin. The pectoralis majors and minors are revealed. All are paper thin and delicate – not the rippling, juicy pecs you see on bodybuilders. These too are carefully set aside, and the anterior ribcage is removed in one piece. We stare down in amazement at the contents of the thorax.

There’s no wasted space in your body. The heart and lungs nestle together like chocolates in a box. The professor removes the organs (each carefully tagged to prevent being mislaid) and holds them up in turn, pointing out vessels and nerves and chambers. Fascinated now, the students ask questions, marvel at the size and intricacy of the parts. The professor dares some courage, and invites us to carefully feel into various cavities. In my turn, I poke a reluctant finger into a space by the ribcage. Cold, unpleasant, as expected. But okay. No need to faint.

After some time in fascinated discussion, the Professor turn to me and says casually “I’ve taken my gloves off. Would you pick that up for me please…” With a deep breath, I comply. Between slightly trembling hands, I find myself holding a human heart. It seems huge and heavy. The lady was elderly, and her heart had swelled in her declining years. He indicates the atrium, the ventricles, the aorta, the vena cava – an incredible thing that had beat a million times in life. It kept her alive for almost a century, and most certainly broke a few times. And I’m holding it in my hands.

The heart is reverently passed around the group, as are the individual lungs (one lung is much bigger than the other). Finally, all are tucked back into the thorax and the ribcage replaced. Then it was the turn of the organs below the diaphragm to be revealed. We see the stomach, liver, gall bladder, intestines, womb, ovaries. The Professor wants to show us a male specimen too, so moves off to a large freezer-style chest with a prominent label announcing its contents: “PELVIS”. I hadn’t noticed the coolers before, but there are several: “SPINE”, “LOWER LIMBS” and most disturbing, “HEAD AND NECK” We have five more anatomy lectures to come, so there seems little doubt we will be working our way through all the storage chests.

Three hours have disappeared. Fascination has triumphed over terror, so I’m much more confident now. There’s something I’m compelled to do before leaving, so I return to our patient lady specimen. I fold back her pectoralis and skin, and carefully do up the string ties again. A bit like doing up a cardie, against the chill.

That word: awesome. How overused is this faux Americanism, especially in Crossfit? “Awesome workout!”, “Awesome effort!” But it is a word I will snatch back and use to describe this experience. I am filled with awe, with pity, with respect – gazing down on these specimens of humanity who were once just like us. They lived, they laughed, were lonely, had kids, grew old and died. And somewhere along the line, signed a paper that meant, after they’d burned up their existence, their tired outer shells could be divided and examined by people like me. The responsibility is overwhelming.

We leave the hospital, taking a short cut back to the station through a cemetery. It’s a sunny autumn day, in this park with angels and crosses to each side of the path. Andrew’s hand feels warm and alive in mine. My thoughts sound like such cliches when written down: Our time is short – take care of your body, it’s an incredible machine for producing and prolonging life. Feed it well. Give it challenges to overcome and make it strong. Don’t abuse it, at least not too often or for too long. Give it rest and care and comfort and love.

That’s the thing about cliches. They’re so true.

Back Pain, Pain killers

I think its pretty essential, especially when the pain gets acute to be able to switch it off, otherwise you start getting psychological issues too, like depression and misery. Pain wears you down!

This blog article will grow over the next few weeks as we ask, whats the best over the counter pain relief you can get! If you have  insight, please put in in comments. I must admit, I found Naproxen, not that good ( although its a prescription drug)

Obviously, see your doctor and don’t get addicted and get to understand “Red Flags”

The value of Aerobic capacity

This post may sound like  a throw back to the  aerobic era of the 80’s and 90’s, but based on over 15 years of clinical training experience, I’d say its an error to factor out of your training an effective aerobic component.

It should always be there.  In the issue of bad backs, its essential that you commit to regular physical activity,  preferably outside.  At the very least, if you are walking around with a locked down core,  a natural curve in your back, you are not sitting slumped!

This does not mean hours of Long Slow Distance, but it certainly means 20- 30 minutes of low to moderate  back sparing “cardio” every day. This could be cycling to work, a fast lunchtime walk, or a jog or a run. There are lots of  benefits to underpinning cardio activity, but, when you are suffering from back pain, a few natural endorphins  pumping around won’t harm you