Question from a Reader: Back Pain & Reps – How Do You Decide?

I received a question from a reader and, as with nearly all questions that I get via email, I answer them on the site. Reason? I just assume someone, at least one other person on the planet, will benefit from reading both the question and my thoughts and may have additional thoughts of their own. SO, here we go……

Hi Doug, I’ve been reading your blog for years and really appreciate all your solid knowledge. I am a 53 y/o F, PT working in an outpatient clinic in a hospital treating ortho patients. Former bodybuilder, still working out and trying to manage injuries past and present myself. Question: In reviewing your new Fusion program which looks awesome, I wonder how you decide between reps over sustained holds for some of the exercises. I’m thinking specifically of something McGill says in his book Low Back Disorders about keeping the hold to 6-8 sec. because of some apparent evidence about trunk muscles requiring O2. Any thoughts?? Mary

Thanks for your question Mary and here are my thoughts on it. Not in any particular order.

I know the book by Dr. McGill, and by the way, it’s an excellent resource for anyone who deals with people who have lower back pain. The information you’re referring to is in the section on developing rehab programs for people with back pain; not for people who are asymptomatic. And he states that when first starting, to keep the contractions of holding postures to about 8 seconds and that is based on some research using near infrared spectroscopy that showed decreasing blood flow to the muscles.

Later in the book, he has some normative data on, for example, a side bridge, which is in the 90 second range and he shows a number of exercises that take well over 8 seconds so I don’t think he meant that you should limit all exercise that involves the trunk to 5-8 second holds. Otherwise, you would have a very hard time reaching a 90 second side bridge.

The issue he’s trying to address is one of tolerance and capacity. Tolerance is your ability to produce force for a short period of time – you could think of it as strength. So, for example, you might be able to lift 100 lbs three or four times. That would be your tolerance. Now, if you need to haul something around the yard, that is, say, 60-or 70 lbs, like a bag of sand, you’re not going to be able to do that for very long. Your capacity will be low because the load is so close to your tolerance. So, to increase your capacity, you can lower the load (get smaller bags of sand) or work in short intervals and take breaks (which most people don’t do and end up hurting themselves). It’s when you’re working too close to your tolerance, repeatedly, that you get in trouble and hurt your self (or it’s also true that if you work well beyond your capacity, you can get hurt too – like sitting too long).

When starting out on a program for back pain, many of my clients will perform 3-5 reps of a movement and at that point can no longer hold the form so we stop. We’re really close to their tolerance. Gradually, they increase their capacity – the ability to produce work or more reps – by just bumping the rep count a little.

You asked how do I decide between rep counts and sustained holds in some of the drills in Fusion. First, Fusion is primarily for people who do not need rehab. They may have some aches and pains but not bad enough to go through rehab – but maybe not quite sturdy enough to train on their own. That being said,  sometimes there’s no choice, for example, a plank, a side plank, a Warrior I or II – all of those are sustained holds by virtue of the drill itself. As far as the hold durations go, usually those are tucked into a rep count. For example, in TIN, a core Element, one of the drills is a Plank Transfer. You perform a plank and then move a weight from one side of the body to the other. The duration of the plank hold is a function of how many reps you do. Usually 10-12 so the duration is relatively short. Now, I have some drills in the STAMINA series that use durations instead of rep counts and that’s because one way to increase your capacity is to produce more work per unit of time. In other words, you try to produce more reps in the same amount of time, for example, 45 seconds of squats.

I hope that answers your questions and if anyone else has some ideas, feel free to enter a comment below.