The spine is needed in every movement we do, which is why we get more questions about back pain and back issues than almost anything else.
In this two part series, Jarlo and Rose look at the spine and answer some of the most-asked questions.
In Part 1, we cover:
- basic anatomy and actions of the spine
- why so many people have back pain and spine issues
- protective mechanisms, how our brains perceive threats and produce pain to protect us
- nocebos, how anxiety and fear perpetuates the pain cycle
- how new sensory inputs can dampen pain and help us keep moving
- How to Maintain Your Spine Health
- Overcoming Chronic Pain with Exercise
- Hip Mobility FAQs
- Todd Hargrove – Better Movement
Transcript for Spinal Health Part 1 – Low Back
Jarlo: Hey, everybody. This is the GMB Fitness podcast. My name is Jarlo Ilano. I’m one of the co-founders of GMB Fitness. I’m here with my friend, Rose Calucchia. She is a lead GMB trainer for us, also on staff. And we’re here to talk about … What are we going to talk about today, Rose?
Rose: We are going to talk about the spine specifically the lower back.
Jarlo: To the lower back, yeah. We’re going to go over, I think through the first half of this GMB Fitness podcast. GMB Fitness of course stands for Grapes, Melons and Berries. That’s Grapes, Melons, and Berries Fitness. The first half we’re going to come and do a general overview of the spine and then do the low back specifically. And actually this is part one or either going to do a two and a three or just a second one on the neck and upper back. But I think it’s really important that we have a good overview of the spine in general and talking about the troubles we can have with it and pain, because super important.
Jarlo: Rose was just saying about 90% of the emails and the comments we get from people that have problems are spine problems. And that actually really fits in with, correlates with just in general, like back pain is a billion dollar industry. The statistics are wild. It’s something like 80% of us are going to have back pain at some point of our lives. And unfortunately, a great percentage of that is chronic and people having it for years and years and years. And we’re going to talk a little bit about that.
Spine Anatomy Overview
Jarlo: I don’t want to go into a massive anatomy and physiology thing, but just in general, we can talk about the spine. When we talk about the spine there’s the vertebrae. It’s divided into cervical, thoracic and lumbar. Cervical is the neck for seven vertebrae there. Then we’ve got thoracic, which is upper, mid-back. There’s 12 vertebrae there. And then the low back, which is lumbar into the sacrum coccyx tailbone, we got five vertebrae, sometimes six. Then you’ve got the sacrum tailbone. The reason most say healthcare professionals talk about it like that is because bones are easy. Your bone just got your skeleton and it’s easy to divide things that way. And then also you can help people with understanding of what they have there, whether it’s the spine, spinal column protects the spinal cord.
Jarlo: The spinal cord is all the movement from your brain to the spinal cord, all movement and sensation our nervous system. And so that’s one of the reasons why we have the bones there, it’s a protective housing for that. Now, also think about all the things that we have to do in our body. We have to turn ourr head, we have to rotate our torso. We got to bend forward. We got to go bend backwards and side, all of these things. That’s why between each vertebrae there’s … No, this is really complicated. Joints. There’s the joint that they call the intervertebral joint, which is between the bones and you have the discs and you have all that fluid. That’s a joint, but then you also have the sides. On the sides of the joint, the facets and all of these things. I’m not going to say the technical term, but so that you can move side to side. You can move rotation wise, you can bend forward and back.
Jarlo: And then the reason we also have those is because they have attachment points to lots of muscles, like small muscles, bigger muscles all across to the ribs. It’s super complicated. It’s super complicated. And that’s also why that leads into why people have lots of trouble and lots of pain with it. And because it’s complicated and then also, because it’s complicated when some like a doctor or therapist, or any healthcare provider tries to explain it to you like that, you don’t get it. How can you get it? I just tried to tell you this, in the last five minutes, but had to undergrad, grad school, continuing education. You’re going to go into your doctor’s office and he or she’s going to try to explain it to you in like 10 minutes, like I just did. You’re not going to get it. So, it makes it worse.
Rose: Right. I was going to say like, there’s probably a lot of us who maybe got a little glazed over just now listening to all those things because it’s really complicated.
Jarlo: That’s the interesting thing too, because I have been doing a lot of pain science research over the years, but I’m taking it as a formal class. And one of the aha moments for me was the presenter or the professor talking to us says. “When you educate patients, we’re really used to describing anatomy, describing all these things, but that’s wrong. You shouldn’t be telling because you’re actually making it worse for them because it’s hard to understand.” One analogy is like when you go to your mechanic, do you want to know the vagaries of the internal combustion engine, exactly what’s wrong with it? No, you want to get your car fixed.
Rose: Just fix it.
Jarlo: Right. We should be educating our people about pain and why you might be having it, what you can do about it versus, “Oh, here, look. The spine got the disc and got the zygapophyseal joints, got facet joints. Some other joints you have in the neck, but you don’t have in the low back, all that kind of stuff. That’s not helpful. That’s not helpful. That’s why like in these series of podcasts that go really general about it, but it’s important I think because right now we’re just trying to learn about it and then you can go and you can look more of it. But I think my point here with saying it, is that it is so complex and it takes a long time to learn.
Jarlo: Just knowing the basics is good enough. And then actually going drilling down is very important, if you’re a surgeon. It’s very important if you’re trying to do things with it, but it’s less important when you’re having pain and you’re trying to figure out what to do. The strategies are more important than the actual anatomy and mechanics of it.
Causes of Low Back Pain
Rose: Okay. That’s good to know. And from there, can we talk about the things that go wrong? Like why do so many people suffer with lower back pain? What are things … We’ve talked in previous podcasts about the difference between repetitive strain versus overuse. We can talk a little bit about that, but we also hear herniation, bulges, SI joint pain, like all of these things. What are the causes behind some of these stuff?
Jarlo: Sure. Well, and this is important, but it also requires a history of it. And it sort of makes sense because when we talk about things like that, you even mentioned the SI and discs, you would think, and it’s common sense or just intuitive that there are pain generators. You sprained a ligament, you strained a muscle, your disc bulges, and that’s true. It’s true. It’s the nail in your foot analogy. You step on a nail. Yeah. Pretty sure that’s the nail making this a problem. But the thing is, is that injury and even like bad injury, even like tearing a muscle or breaking a bone, the pain isn’t correlated with the severity of the injury.
Rose: What’s it correlated with?
Jarlo: It’s correlated with how your brain filters that input as a threat. It depends on what your brain thinks is a threat to you. You have all of these stories that you’ve heard of people not knowing they were hurt or injured until later on.
Rose: Right. Or even you hear that certain people you’ll give MRIs to and they have all kinds of herniation or bulges, but they have no pain. And then somebody else has like one little one and is in a ton of pain.
Jarlo: Right. And that’s not to say that that pain isn’t real for that person.
Rose: Right, it’s totally real.
Jarlo: It’s totally real, but there’s something in their system. And again, this is really complicated where their brain perception of that threat is dialed up higher. And there’s a lot of things going on with that. The environment of when you got injured, your state of mind when that happens, your overall body condition. But a lot of it, this is to say that it’s not all in your head, but what it is, is that it’s more complicated than just, I got a herniated disc. Well, I’m glad you brought that up because that is massive to actually see an MRI of all these problems like, oh yeah. I can look at that. Look at that. And look at that bulge, look at that tear.
Jarlo: You can actually see it and you’re not even a trained radiologist. You can see it. And you’re like, “Oh man, that’s why I’m in pain.” It’s something that it makes sense, we want to know why. But then it’s also good to know that you can see that thing and like, “Oh, this is another person.” Looks like yours, it’s bad. Yeah. You can see it. It’s bad. And it’s like, “Oh, they don’t have pain.” Then you can go, “Oh, it should be empowering.” Or like, “Oh, there’s something there.” This is kind of rambling, but this is what it is. It makes sense that you’re just like, “Oh, there’s pain generators. You broke your bone. That’s a big one.” Yeah, man, that hurts. It’s massive. Of course it hurts. Of course it hurts. The trouble is after it heals, some people, it still hurts. Some people it’s done, you don’t hurt anymore.
Jarlo: What’s the difference there, it’s not tissue damage. The initial stuff, the nail in the foot hurts. You take the nail out, heals up. It’s better. Some people later on still feels like the nails still in their freaking foot.
Rose: Right. We get emails all the time from people who are like, “I did this, I had this injury, but everything’s healed now, but I’m still in pain.”
Jarlo: Right. You know the whole Phantom limb pain thing? That’s a massive clue. Just a little bit of background. This Phantom pain is when say amputees, people that had limbs amputated, either surgically removed or traumatically removed, they have pain still. Some of them still have pain where their hand was, where their foot was. It can’t be like a damage thing, because that’s gone, it’s gone.
Rose: Right. It’s got to be neurological in some way.
Jarlo: Right. And that’s another thing too. This is such a complicated topic, but you can’t just go, “Oh yeah. It’s just nerves.” It is nerves for sure. And it’s the brain and all that, but it’s everything around it. That’s the thing with the spine. Again, it’s so complex. There’s so many things going on with it. And it’s also in everything we do is involved. You can’t lie down unless we’re talking about this and like in a float tank, totally submerged, everything’s affecting you as soon as you sit up. As soon as you sit up, it’s not like you sprained your wrist and you’re like, you can’t use that wrist. I’ll brace it up. I’ll splint it. That’s cool. It doesn’t work that way for your neck, your mid-back, your lower back.
Rose: Right. There’s always forces on it.
Jarlo: Yeah. And so like the pain generating things. Let’s bring it back to that. What is it? Well, it goes back to this thing of what is your brain perceiving as a threat? And I think we talked about this a little bit before, but a lot of the times we’re amped up. It’s sort of like allergies. Everyone’s has allergies right now because it’s spring. That’s the immune system thinking this allergen is a threat. Then that messes you up because you’re sneezing. It’s worse than to think. It wasn’t that much of a threat. That little bit of pollen wasn’t going to kill you. But that’s the same thing with your brain and pain as a protective mechanism. It’s like, “Oh, you overstretched your back a little bit.”
Jarlo: But maybe you’ve had pain before. Maybe it reminds your mind, reminds your brain again off something where it “had a really bad time with,” and so it just flipped that on. It just goes, “Okay. Oh, that’s it, don’t move now.” You get these spasms. Everyone, hope not everyone, but I’ve had them where your back just goes oh. And then just gradually just cramps up and you can’t move.
Rose: It’s like a vice grip, yeah.
Jarlo: Right. Your brain is just trying to put a cast on it. You sprain your ankle, it swells up. Your brain perceives pain in the back. Well, it’s going to splint it. That’s why it causes a lot of problems is because again, it’s complex, get all of these things, got all these small muscles along the side, and you got all the big ones around there. It’s an involvement in everything you move, but your brain says, “Oh, don’t move.” That’s why you have a lot of it. And so when we look at it and you go to the doctor, you go to your therapist and you go to whoever you go to. Then they do some tests and then they do all these things. They’re like, “Oh yeah.”
Jarlo: They want something to point at to tell you, “Oh, it’s your disc. It’s probably your facet. Maybe it’s because your muscles are like this.” Because they want to help you and you want to know, so they’ll tell you that. And maybe it is, but it’s not the whole thing. It was sort of like the trigger.
Rose: Right. Exactly. And that might not be why you’re having such extreme pain.
Jarlo: Exactly. And then also, why would that trigger such pain in you, but somebody else could have the same thing and it’s like no big deal.
Rose: Right. Totally. Okay. We could geek out on pain all day. You and I can talk about this forever, but-
Pain and When to See a Doctor
Rose: Forever, but let’s talk about some concrete things that people can take away from this who are maybe in pain right now and want to be getting out of pain. First of all, let’s just start with, how do you know when to see a doctor? And I know we’re recording this in the time of a pandemic when all of us are sheltering in place. And so it’s not easy to go out and access healthcare at this time. In general, when is it a good idea to see a doctor versus when can you self-treat at home?
Jarlo: Right. And so this is super important, especially now. And here’s a little bit of a tangent. With the whole COVID thing we’ve be reading about is younger people having strokes because of this. Have you heard of that?
Jarlo: Well, first of all, it’s bad, but also one of the reasons why it’s that bad is because when you’re younger, you don’t think there’s going to be a stroke. You’re in your 30s and 40s. These signs of when the stroke is happening, you either ignore or you don’t know. Like weakness, facial weakness or just body weakness on one side. Slurring. All of that stuff that are signs of a stroke. And then if you were 60, 70, 80 either you or someone with you would go, “Oh man.” And they call 911, but they’re not doing that. And so that’s worse. That’s a good example of these red flags. Red flags for pain are not just numbness, but complete loss of sensation. Not like when someone says, “Oh, it feels a little numb.”
Rose: Or tingling.
Jarlo: Yeah. That’s not what we’re talking about, like straight up loss of sensation. Straight up weakness, meaning you’re dragging your foot. This is low back here oriented. You’re dragging your foot. Foot drop means you can’t lift your foot up. Your toe stops-
Rose: Can’t flex it.
Jarlo: Can’t flex it, can’t lift it. That’s massive foot drop because that means there’s nerve occlusions and impingement. That there’s something happening there. Okay. Also, and this seems while I’m saying, but like bowel and bladder problems either incontinence or pain in there. I’m pretty sure you would be calling someone right away if you have that, but those types of things. Also pain that is just straight up unrelenting fully. Like doesn’t go down at all. Now, sometimes that’s the reaction and some people have it and again, not related to something that’s really bad, but I don’t think you can decide that in the morning.
Rose: Yeah, better be safe.
Jarlo: Better to be safe. Those types of things. It has to be pretty massive.
Pain and When To Move
Rose: Okay. Then if we don’t need to see a doctor, which I would say a lot of people probably don’t based on those symptoms, we typically think that like we have pain and we need to stop doing everything. Especially when it comes to like the back, the spine. I have a long history with neck stuff. Don’t worry, we’ll talk all about that in then the next one. I can jump in on it. So, I understand. And I’ve had back stuff happen before. I understand how stressful it can be and how panicky you can feel when stuff happens. And you’re just like, you want to freeze up and not do anything. And is that the right way to go? When is movement appropriate?
Jarlo: Right. And I think with what you just said, that’s something important to talk about is like the pain itself creates stress and anxiety, but also too, that stress and anxiety can create more pain. So, it becomes this loop and it’s not just psychological. Even if there was a just psychological thing, stress, anxiety, all of those things are accompanied by hormonal changes. Cortisol increases, noradrenaline, all of that stuff. And it’s fully proven that those hormonal changes increase your pain. They do. It’s a physiological thing. Your nerves get more sensitive in that chemical mix. And also too, when that chemical mix or these kinds of inflammatory chemicals, all of this stuff that people talk about with swelling and all of that stuff too, that also creates more pain in itself.
Jarlo: Or creates that perception of threat to the brain because there’s actual nerve changes. So, imagine there’s signals to the brain that aren’t pain signals really. There are no straight up pain signals. What they are is information. It’s information to the brain. But if it’s flooded with all this bad information, then it’s going to think of a threat. Right. This is a long way of saying that what can we do right away? Well, we don’t want to say, “Just move and bear with it and just fucking go through it.” Because that’s not good. That’s not right. That’s just creating more of this bad information, bad news to the brain.
Rose: Okay. Let’s stop there for one second, because I feel like this is really key for everyone to hear about the whole work through pain. If it’s not that bad, keep going. Why is it so important not to do that, based on what you just said?
Jarlo: Because it becomes this loop of associating pain with movement. And if you associate pain with movement, then it becomes this sort of body memory and your brain is like, well, that movement always creates pain. It’s going to think that, if we’re going to answer from our side of the brain and go, it thinks, if you over and over again, this movement is associated with pain. Why wouldn’t it think that?
Rose: By stopping to do the thing that like pushing through the pain if you scale back, stay and safe ranges of motion, we know about brain neuro-plasticity. We can actually like change that-
Jarlo: Right. And that’s a super important empowering thing because it’s not just work through the pain and you’ll manage it and you’ll get through it. And then it won’t bother you as much. No, it’s actually, if you move within a certain range and give something, my friend Todd Hargrove calls, good news. Todd Hargrove, he wrote Better Movement, Move Better, all these books. Great. We’ll put it in the show notes. But he had a really good phrase that I liked, and it says, “You have to give your body good news.” And continue to give it good news with lots of reps, so it pushes away that association of pain with movement. And so one of the things there is, okay, so you’re saying I should move, but I have to rest. And I think that’s one of the thing there too is you should do as much as you can, as pain free as possible.
Jarlo: Now, if there, and we’ve talked a little bit about that, say when a person says, “But I’m always in pain.” So, there’s your baseline there. You move as much as you can, until it goes up past a bit, then you stop. Let’s say you’re always at a four out of 10 pain. I’m always in pain then and I should never move. No, it’s like, you should start doing things. But if that creeps up into a five and a six and you stop, let it go down, try again. But as soon as you move, it jumps up right away, then that’s it, you stop. There’s also this thing, and I don’t know if it has to be done with everybody or everyone should do it called graded motor imagery where you think about moving.
Jarlo: There’s lots of studies on visualization and motor control and all that stuff. And I think we even, you can see them in some of the popular literature. If you’re thinking about moving and you’re thinking about doing things, your body actually, some muscles are activated. You have some neuro input of even just practicing a movement in your head.
Rose: I feel like I’ve experienced this because I teach so many like-
Jarlo: That’s a good one.
Rose: … hand stand and tumbling classes that I’ve been able to pick up some moves that I don’t touch for years because I’m watching them happen all the time.
Jarlo: Yeah, watching them. And then going through with them in your head. This could be another podcast, but there was a lot of studies. One of the classic ones was basketball free throw shooting. They put a group of, I think it was kids. Might’ve been college, college age people that actually physically practice the free throw. Then they taught this other group to visualize it. And they had nearly the same progress.
Rose: Yeah. That’s crazy.
Jarlo: Yeah. And it’s not just, again, not just in your head and visualization, your body actually does things. When we talked a little bit about these postural muscles, like the transverse abdominis and the tinnitus, all of those things. There’s research saying that before we move, before we actually reach our hand out or put our leg out, those muscles fire, as soon as you think about it. Actually kind of woo-woo, but it seems like before you even think about it because it’s subconscious. There’s always the delay. Our brains are always on the delay. We think we’re thinking about it in this millisecond, but no, it was actually something that happened even before. When I first came across it, I was like, “Eh, thinking about movement, whatever.” But if you’re in serious pain and you can’t move at all, that’s awesome to know that you can do these visualizations and thinking about the imagery of moving can be helpful. It’s massive and empowering.
Rose: Okay. Something that you just said I want to branch off from which you talked about, like you’re about to move something and your muscles and your core start to fire. A big thing with people with low back pain, we hear all the time is that they’re told their core is weak. They need to strengthen their core to support their back. Is it like we can just do crunches and planks and that’s going to solve the problem. Can you talk about that relationship between the core and the back and like what that really means to-
Jarlo: Yeah. Again, this is part of the thing that seems like common sense. So, we have these small muscles in our backs and multifidus that are in the groove and the spine transverse abdominis, which is below your six pack, wraps around your spine like a corset. That’s the one where you breathe out or your brace. I remember back in the early ‘90s and through there, this was big and therapy and then went over into the personal training world. It’s like, “oh, you got to work on your core. That mean transverse abdominis, bracing, multifidus.” And sort of makes sense because of, yeah, we can brace all those areas in our spine, then we can protect it.
Jarlo: Yeah. Well, the research is yes, that motor control is off. When you have pain and you look at people who have low back pain, it seems like that stuff is not firing correctly is not firing before, like this speed forward like it should. Yeah, let’s train it. Let’s train it. But the research later on, it’s like, we got flipped. You have poor motor control and these things aren’t firing well, and these muscles aren’t working well because you have pain. It’s not that it’s not the either/or. It’s not like you have weakness and then that’s causing pain.
Rose: Right. That’s what we always think, is your core is not working. Your core is weak. That’s why you have back pain.
Jarlo: Right. But that’s also not to say that you shouldn’t work on it because you should. It’s supposed to happen. The reasoning behind it now isn’t that you fix this, you’re going to fix your pain. Is that you have pain and this is correlated with it. And it’s not the way it should be. You should work on it because it’s going to decrease all the bad news that’s going your spine. It’s also going to help the way you move in general. You’re supposed to have a good core strength and stability to be able to move and do things. Does that make sense?
Jarlo: It’s just reframing it. Don’t think, “Oh, I got to do lots of crunches and clenches and side planche.” Planks, not planche, if you can do planche, that’s pretty good. You have to do this and get strong. There’s lots of strong freaking people with pain. And I’m not saying I’m like, I’m super strong, but I was like that for a long time too. Again, this is the nuance. We’re not saying, “Don’t work on your core. Don’t work on anything.” We’re saying, “Realize what you’re doing, what you’re doing it for.” You’re doing it for so that you can move better because it’s really important to have that. You can see that. Would you rather have a floppy torso and would you rather have that or would you want it to be nice and strong and solid when you need it to so that you can do other things. That’s why we’re training it.
Jarlo: And then that correlates to improved decreased pain because now you’re able to move more and move well, move better and do more of that. Then you’re replacing all that bad news with the good news of movement. That’s one of the things.
Disc Bulge and Herniation
Jarlo: Let’s go back to a little bit more like the specifics. Say you have a disc bulge or someone told you, you have a disc bulge.
Rose: Or a herniation.
Jarlo: Or a herniation, or a slip disc, all these bad things. That’s another thing too, so much nocebo out there. Nocebo means the words that actually harm you because this information that as soon as someone tells you that, then you have this, “Aw man.” That’s what nocebo is. It’s not like we want to lie to people and say, “Oh, you don’t have a herniated disc.” But you want to tell them what it really means. What it really means is that in some positions there’s going to be more say stress or more inputs to your brain that comes from that area. We’re talking about the herniated disc, but let’s just talk about something that’s maybe a little bit more common for everyone to figure, you broke a bone. We’re not saying, “Oh, that broken bone is just all in your head and that pain doesn’t exist.” No, we’re saying you have to take stress off of that area leave it alone for a bit and let it heal and then do as much movement as you can.
Jarlo: The same thing with a herniated disc. The position there that could bother it more where you have less tolerance for, and we’ll talk a little bit more about tolerance later, is sitting, bending over, lifting, prolonged sitting in the car where your legs are up. That’s why driving is the worst for disc stuff because you’re sitting in a bad most, yeah we’re going to have to talk about ergonomics, but most cars you’re in this position that puts so much intra-abdominal pressure. And your leg is out, which also stretches those nerves out and creates even more. Your tolerance is low and then you’re putting yourself in this the worst place. That’s why it’s good to have that kind of information about herniated disc or if you have a stress fracture, that’s another thing too. That’s actually more common than you would think in the low back. You’ve worked with a lot of kids and teenagers. They’re really prone to that. Runners, gymnast all of that stuff, acrobats it’s just because that’s a straight up overuse thing there. Right?
Jarlo: That’s why it can be important to know these things, but also it should be tempered with, that doesn’t mean that you’re going to be in pain forever. And it doesn’t mean you’re screwed because the body does heal.
Rose: Right. And it doesn’t necessarily mean that your course of treatment is going to change. Like if you have a herniation or you just have some pain in your back but there’s no herniation, you’re probably going to treat it similarly.
Jarlo: And that’s the thing that people also think, “Well, if I have this, then I have to have this really specific course of therapy or rehab or exercise.” And actually most of it looks the same and you would think of it – It shouldn’t look the same, because it’s all different, but that’s not true what it is, yes those injuries and all of these things are different. But the reason why the good treatment, good therapy, good rehab, good movement looks the same. It’s because that’s what we want. We want to improve how you move your whole body, not just this one area, because all of that is what decreases your pain gets you more tolerant because that’s,
Jarlo: I think let’s talk a little bit more about tolerance now. They’re going back to, in therapy and especially when I went to school and got out of it, really like area focus. It’s this low back problem that’s caused by this facet and then I have to do this, this, this, and this.
Jarlo: Not saying it doesn’t work, it does, especially if you have a good patient therapist relationship, you’re doing all these other things, you’re doing what you need to do. But also later on, we got away from that and we talk more about movement tolerances and stuff like that. For the low back, especially it seemed very simple, but some people don’t tolerate flection, bending over, sitting that well. And then some people don’t tolerate extension, meaning standing up tall, walking, bending backwards. And so that led us to go. It doesn’t mean don’t do those things, but it means you have to find a way to gradually improve how they can do it or how they can handle it.
Jarlo: If you know your flexion intolerant, that means you have to set yourself up in a good way where if you know, you got to be sitting for a long time, well, adjust the chair and you do the ergonomic things so that you can sit in it and do your work and not kill yourself. Right. If you know your extension tolerant, that means, well, if you’re standing up … So this is the whole thing like, “Oh, you should stand instead of sit.”
Jarlo: Maybe. More important it’s better to not stay in one position.
Rose: Right exactly.
Jarlo: That’s the thing.
Rose: Move around.
Jarlo: So, if you know, you have trouble standing. That’s why there’s perching, perching is when you’re on a bar stool.
Rose: Mm-hmm (affirmative).
Jarlo: Perching, it’s that halfway or midway or three quarter way between sitting and standing or also why some people have, if they have standing desks, they also have a stool or something where they can put their foot up just a little bit. Those types of things, and I was that was a revelation. Its like, “Oh, we can really focus on what’s you’re less tolerant for.” So, we acknowledge that. It doesn’t mean we get rid of it, but we find ways that you can tolerate it more and then gradually build it up. That’s the thing we’re trying to gradually build up what you can do over time, that’s the key. And exercise does that, movement does that, exercise builds your tolerance.
Rose: Wait, wait, wait. This is the gold moment of this podcast right here people.
Jarlo: Is it?
Rose: Yes. Say that again. Say what exercises.
Jarlo: Yeah exercise builds your tolerance. It builds your ability to be resilient and handle all of these things that before was or maybe currently is perceived as a threat by your brain and the trouble is. And again, we can talk more about pain all the time, but in chronic pain people what’s happening is that tolerance is lower. Now, it’s not this whole pain threshold thing, which I hate because I have a high pain threshold or this person must have a low pain threshold. That’s not what it is. What it is, is there’s a certain level of activity either it’s sitting, walking, lifting weights, whatever locomotion, right exercise or if you go to it and beyond it, your brain thinks that’s a threat there’s pain there.
Jarlo: And then people that have chronic pain, that ceiling is lower. You have to be really aware the best thing and the most empowering thing to know is you can raise that ceiling, the brain by neuroplasticity, the brain changes, growth. That’s totally true. It just takes time, repetition, patience where you can, is this an actual thing where you can decrease your pain, improve your tolerance. It’s not just in your head. But if you have a herniated disc, you have this, you have that. It’s a little bit harder to deal with.
Rose: Right. But I really like that, that we often think about exercises, getting in shape or being fit or all these things, which are true. But also it makes our bodies more tolerant for everything.
Jarlo: This the whole exercise, the fountain of youth thing because it totally is the best medicine. We’ve talked about this all the time. The difference between someone that’s 60 years old, which is not that old can’t move, can’t get up and down. I’m not blaming their lifestyle or anything like that, but compare them and I’ve seen this. This is not just like made up story. 90-year-olds in hospitals who the only reason they’re in there is because they fell and broke something. Otherwise they’re spry and a lot of that is how active they were and continued to be. It is, man. If there’s a magic pill, it’s exercise.
Rose: Okay, so let’s-
Jarlo: Or movement. Everybody is like, “I hate exercise, hate the word exercise.” All right call it movement then. Jesus Christ.
Answers to Common Questions
Rose: You need to move. Let’s talk about the movement component for a second. I’m on the support staff at GMB. I get a lot of emails from people who are either in pain or had injuries or are currently dealing with injuries. And I want to kind of go through some of the questions that we get which I think your answers will help a lot of people.
Jarlo: Hit me.
Rose: And the first being, we talked about planks and crunches before, but why does something like locomotion? Our bear, our monkey, our frogger, the movements that are in our elements program and are now in our new mobility program as well. Why are these so helpful, almost more so than just a basic core program like that is like planks and sit ups and that stuff. Why are locomotion movements so helpful in back pain?
Jarlo: Right. Well, we talked about this a little bit earlier. It’s because it’s not just that one core muscle or two core muscles or three core muscles that are the cause of your pain. And that right there is the answer. It’s if it was then all you’d have to do is crunch. Like you said, then they wouldn’t even be looking for other things to do. Because, the emails that go all man I’ve been doing crunches and planks and all of these things for months and it’s not helpful. And so the distinction there is locomotion, you’re actually moving around and it’s good information for your brain. That’s the whole thing, replacing bad news with good news. We’re replacing those associations of pain with movement, with movement that is new novel. That’s another thing, a lot of research and actually good trainers and good systems out there realizing that it’s new movement that’s really helpful.
Jarlo: That’s why the worst thing before was all of this balance ball stuff. Remember when they were like, “You got to do all of these,” you’re standing in a ball or you’re squatting, people throwing balls at you and all that stuff that’s the extreme of this sort of novel movement. It doesn’t have to be like that. But it can be as simple as say doing the bear, say you’re on all fours, you got your butt up in the air and you’re moving around. And then you’re thinking about how I’m shifting weight side to side. You’re moving forward. That’s new information for the brain because we don’t walk around, chances are we all don’t walk around on hands and feet all day unless you’re a baby. That’s one thing is this new information. And if it’s done in a way, again that doesn’t have a lot of pain or maybe you start with pain and the best things, you start with pain, you do it. And it decreases. That’s the best.
Rose: We all want that. We all want that.
Jarlo: Right. As you do it, not even like, “Oh the day after,” but say we start it and it improves. That’s why I always say in our programs, the warm up,t’ the 10th repetition of it should feel better that your first then you know what you’re doing right. And flexibility work are saying the same thing for doing some dynamic contractions should feel better at the end. The same thing with the locomotion, if you’re doing it. And you’re like, “Oh, this is a little weird.” And we get lots of feedback from it. Like, “Oh, I started it. And then 10 seconds later it’s better.” That’s that new information that you want to give to your brain. That’s sort of the big answer to why locomotion, like bear, monkey, frogger and all this stuff seem to really help people almost right away.
Rose: And is it okay for people who have previous injuries to their back, current injuries, they’re recovering from, are our programs safe for them to use? Like our Mobility program or our Elements program, which is probably where we recommend you start.
Jarlo: Right. It’s a good question. And the answer for a lot of it is yes because not just the exercises themselves, but also our method as to how we tell you to do it. We don’t go no pain, no gain or work through it. We always say there’s adjustments to be made. You should continue to move and do the things and if you there’s a pain with it or have any bad sensations, you adjust it. Either you stop, do less and do sets of it where you have breaks in between. That’s one of our things we always say, “You know what you should do? You should put a timer, you should put a three minute timer, do what you can within it. Let the timer go when you have to rest, don’t be like, “Oh, I’ll pause.”
Rose: Right, just let it run.
Jarlo: Let it run. Do your things move because some days you’ll be able to do more. Some days you won’t be able to do more, you’ll be doing less, but that doesn’t change how you’re doing. That’s to me is really freeing. And what it’s really meant by when Ryan says, “Don’t worry about sets and reps.” It’s not that you don’t do sets and reps. It’s not that you don’t do repetitions of things, is that you be really mindful of what’s happening while you do it and don’t be restrained with, “Oh, I got to do three sets of 10 today. I got to do it. I got to do it.”
Rose: No matter what, even if-
Jarlo: No matter what. Well, what if you’re feeling great? Why don’t you do more? So, let’s think about that way. Let’s think about it as if it could be limiting, but also why force yourself to do three steps of 10. If that day is not good, why do you want to make yourself worse? It actually does make yourself worse. It’s the method of our programs and the GMB Method that makes this most likely safe for you to do, not just the exercises.
Rose: Because you’re talking about what we call autoregulation, which is paying attention to how you feel and making adjustments off of how you feel. And this is what you talked about earlier in that, if you feel pain, you don’t want to reinforce that pain pattern. And why stopping, changing what you’re doing, taking a break, doing less will reinforce that good information coming in, which will hopefully move you forward and out of that pain.
Jarlo: Correct. This is another thing too. We’re not saying don’t work hard or as soon as you break a sweat or feel fatigued, stop. No, we’re talking about pain. There’s a difference and you know, there’s a difference. We all know there’s a difference. We’re not saying don’t work hard. That’s another thing too. We’re not pushing it where you’re not improving. Because another reason with exercise building tolerance is that you do push yourself when you can, you should push yourself when you can, you should. But say it again, you should push yourself when you can. This is why it’s really important to understand what pain is. Pain isn’t like discomfort, burning muscles, breathing hard. That’s not pain. Oh, man. I’m on the new, I told you the other day, I’m on a rowing program. If I would stop whenever discomfort I wouldn’t even last five minutes.
Rose: That’s the same with most people in running.
Rose: Just so uncomfortable in the beginning.
Jarlo: Running there’s a big difference within your running and then you have this sharp pain in your foot and you just keep going or you’re running and it’s freaking hard to breathe and you’re like, “Crap.” And you’re on the six mile and you got another two to go and you just want to stop. That’s not pain. Come on now. Let’s just get that out of the way. And I think let’s give the benefit of the doubt to people that do say things like no pain, no gain. That’s what they’re really talking about. If you’re talking about does this person really trying to help you. They’re saying that. Hopefully they’re not saying, “Oh yeah, I don’t care if you hurt your shoulder, keep going.”
Rose: Right. Exactly. It’s exercise at some level when you’re pushing yourself is going to be uncomfortable.
Jarlo: Yes and it should be. That’s how you grow. That’s how you grow more tolerant. But pain is something different. Pain is something different.
Rose: Okay. With thinking about locomotion exercises, we have to talk about the squat and there’s a lot of, talk in the fitness industry and even within our client base about what is a good squat? When I squat my back is really round. Is that okay? If I’m squatting with a load on my back, like I’m back squatting with a barbell, how low should I be going? What if there’s a butt wink? There’s just so much around the squat. Can we talk a little bit about what is good for the low back with squatting and what’s not.
Jarlo: I’m going to repeat this again and again, it’s tolerance. And we’ve talked about this a little bit before with the back wink and as your back is rounded out, if you are on the bodyweight, squat and your back rounds out. You’re probably fine. The problem is if you’re just getting used to squatting and squatting that low and your back rounds out and you keep going too much, that’s the problem. That’s the tolerance thing. And that’s why we always talk about auto regulation and being really mindful. For me, how many years or for you. That’s the thing too. I’m flexible enough and my back very rarely rounds out at the bottom of a squat, but that’s not-
Rose: I was going to say.
Jarlo: That doesn’t mean that’s why I can do it and do it for a long time. It’s because I’m used to it. Even if my back did round that more and it does. What is that thing where this is squat, where your butt is fully on the ground, but your feet are still fully on the ground?
Rose: Mm-hmm (affirmative).
Jarlo: Right. It’s hard to do. Not a lot of people can do that. My back has to round at that. It fucking has to.
Rose: But if you all looked at our squats, Jarlo and I next to each other, we have completely different squats. Jarlo is able to get really low with his back flat. I’m able to get pretty low. My back probably never going to be flat and I’m okay with that, but I can do 20 minutes of locomotion without stopping and my back does not bother me.
Jarlo: Because you’re used to it. You’re tolerant. And so that’s another thing with like, people say, there’s just starting our programs. And they say, “I like it. It’s great.” But then I do these squats or do these locomotion and I feel it. It’s not a lot of pain.
Rose: It’s sore or tight.
Jarlo: It’s sore. That’s perfectly normal, man. It’s the whole thing of I’m using muscle I didn’t know I have type of thing its cause it’s new for you. It’s straight up new for you. Let’s go back to this whole butt wink thing with loaded squats. It can be bad if you’re not used to it also too uou’re probably going to lose a little bit of power because you don’t have that kind of good alignment. But let’s look at Olympic weightlifters and it doesn’t even matter if they’re like amateur or world class, straight up Olympic Games. And they are putting themselves with there at the bottom of the snatch and bottom of a clean, they are fully rounded out with hundred pounds over their head. I’m not saying that they are a hundred percent perfect, but they can do that and they’re not dead. That’s going to tell you something right there. It’s tolerance. It’s tolerance. What can your body do? It’s why we build calluses. It’s why bones heal. Exercise builds tolerance, movements build tolerance. That’s all it is.
Rose: Okay. Another question about tolerance for our lifters out there because we do have quite a few people who come to us who they lift weights in some way, whether it’s Olympic lifting or just lifting at the gym for their workouts. What about things like weight belts? I see a lot of fellow trainers and people at the gym who use belts when they’re either dead lifting or squatting. What do you think about that?
Jarlo: Well, I use a belt. I use a belt, when I’m really lifting heavy. Because it does help you lift heavier weights. You can’t deny it. Does it help back pain or does it help you not get injured?
Rose: Does it protect you? Yeah.
Jarlo: Right. Probably not. Unless, and this is the whole thing you really feel it does. If you have it in your head, that I have to wear this belt or I’m going to get hurt, well yeah.
Rose: You should probably wear it then.
Jarlo:You should probably wear it. I’m not making fun of people because I was one of those. I was religious. I’m like, “I need my belt.” I have a lever belt. A lever belt is a power lifting belt, has a thick lever and has a lever. You just put the hooks in and then you lever it shut. If you don’t know it, it’s the best thing in the world. Because I don’t have to put the prongs in. I had that for … When did I buy it? I was in PT school in 1996. I’ve had this belt probably older than some of the people listening. I love that thing. I love it. If I went to the gym, I didn’t have it. I drove back home. And it’s probably not as helpful as you think.
Rose: Got it. Okay. Why does stretching or doing flexibility work on your hips often help with low back pain?
Jarlo: That’s a good one. And as part of that whole, what type of sensations and news is going towards your back. Now, if your hips are tight, that means you’re going to have to move. That’s the whole thing. It’s the chain, the chain link thing. If you’re stiff and all of these links of the chain, the rusted and the rusted here then the one that can move, get overworked, overuse there and then they become less tolerant or they aren’t as tolerant as all of that, those inputs. If you can have flexible hips, strong hips, you’re taking away the stresses to your back. That’s just as simple as that.
Rose: So, a great tool for a lot of our clients who have low back pain is our hip mobility sequence.
Jarlo: Yeah because-
Rose: A lot of people feel a difference from that.
Jarlo: That will help until your back can get all these inputs and gradually improve its tolerance. That’s why right away it helps because you’re taking away some of that stress. It’s sort of like this magic thing was like, “Oh, why is that helping my back so much. I only did a few times.” It’s cause one you’re moving, movement is great, but two is yeah, you’re decreasing all of those kind of bad inputs or not bad, but you know what I’m saying?
Jarlo: And then you’re allowing yourself now that it feels better, you’re probably walking more, you’re probably doing more and you’re doing more with less pain and that’s a positive feedback loop. Or as before you do something and it hurts, then you got this negative feedback loop. It’s not something where like, “Oh, I figured out the magic thing.” Just do this exercise and you’re going to feel better. There’s a lot to it.
Rose: Last question because we have a lot of desk jockey, we have a lot of people who sit for a majority of the day. I mean, at this point, you and I sit a lot for a lot of the day, we’re on the computer a lot. We hear a lot about like, “Oh, I need to set up my desk ergonomically.” And we kind of talked about that with the standing versus sitting desk. How important are ergonomics really relative to just getting up and moving more and not being sitting somehow.
Jarlo: If it’s relative to getting up and moving more, then there’s no question. Don’t even worry about it. If you can get up and move more, that’s it. That’s the thing. The trouble is a lot of people can’t, so that’s the trouble and even though people are well meaning like, “Yeah, get up and move, man. Just move, set the timer,” of course. But there’s some people in jobs, they can’t, they literally can’t either you’re a truck driver. You’re long haul. How are you going to do that? It’s easy for someone to say only drive a few miles and then get out. This person has to get their work done. Even the same thing in like offices. You’re working, you can’t disrupt it. You can’t disrupt it every five minutes of every hour, you can’t. That’s where ergonomics is super important.
Jarlo:So, ergonomics is sort of this external way of improving your tolerance because you’re all set up. That’s why posture, when we say posture is important because posture good, bad, whatever doesn’t create pain. It doesn’t. But can you remain in these postures that you need to have happen for your work, for your activities? Then yes posture is important. Does that make sense?
Rose: Yeah. We’ll touch on that more with the upper back and neck.
Jarlo: Yeah. We’re going to do, that’s why we have to … There’s so much, that could be like three hours, but that’s where ergonomics is super important. And I have a few friends, therapists that, that’s a big part of their work and I’m sure they’ll say the same thing. It’s like, “Yeah we could tell this people, oh, don’t worry about it. Just move around go up and down. But you can’t.” To just say that is just being disingenuous. And then just trying to project your own things to people, that’s like saying get a different job. Thanks for saying that.
Rose: Right. Not helpful.
Jarlo: Not helpful, not helpful at all. Was that good? That was a lot.
Rose: Yeah. The low back is a lot.
Jarlo: And that’s why I kind of wanted to separate this out. Have this pain conversation again. We have an article on GMB that I wrote a few years ago on pain and it’s really good. I’m probably going to update it and actually because of a little bit more research, but it helps. We have our spine article, lower back. We have all these things, the hip one that you mentioned, we’ll put this in the show notes. But I think this was really good to trying to help people understand where it’s coming from and what they can do about it. That’s the thing. What can you do about it? I don’t want to just give an anatomy lecture for an hour. That’s not helpful at all. These questions we did and I think we’re really good.
Rose: Yeah. And if people still have more questions or they’re working with our programs and they need help, they’ve got pain, they’re trying to work with it and you can always email us at firstname.lastname@example.org and we can see if we can help you.
Jarlo: Awesome. Well, thanks so much, everybody. Hope that was useful. Yeah, like Rose said, if you have any questions or comments or even praise for us, please write us and drop us an email. Facebook comment, Instagram, all that stuff. Well, thanks a lot. Thank you, Rose.
Rose: Thank you.
Be sure to catch the next episode by subscribing to the GMB Show: