We are in to our third month of myth-busting all the things female fitness!!! I am pretty sure we’ll comfortable roll over in to April too! If you have a question, or if you’ve “heard” something from your brother’s, best-friend’s, mother-in-law that doesn’t quite sound right – send it through and we’ll get to the bottom of it!
For now, let’s get started on what we looked at in March in Female Fitness Myths Part 3…
Deadlifts are bad for your back/Squatting will hurt my back
Studies show that lifting weights in the gym (defined as squats and deadlifts) can help prevent back pain! Learning to lift properly, synchronisation of the deep core and pelvic floor, and strong technique all go a long way towards a healthy back. It should be noted that “good” technique will vary from person to person, as outlined in the article referenced1.
Furthermore, lifting and moving stuff is a fact of life, and ultimately, we are training our clients to live life better, or at least more easily. Resistance training has been shown to
- dramatically improve the quality of life for people living with chronic disease2.
- keep your bones strong and healthy, and can slow the onset of osteoporosis3
- prevent cardiovascular disease4
- prevent and slow the onset of diabetes5
- regulate insulin and reduce inflammation6
- help you survive cancer7
- boost your metabolism and assist you in losing body fat8
- improve your mood and help combat depression9
- improve confidence, sleep quality10, and posture!
- improves balance and reduces risk of falls11
**Little disclaimer – not all of the studies I’ve quoted above include women. The benefits are for the general population, with the usual story that there isn’t enough information specifically for women for me to make a female-only benefits list!**
All of the studies quoted are looking at lifting, either as a part of or as the whole of a strength training program.
Now, if a client reports back pain with squatting or deadlifting, I’m not telling you to ignore them or otherwise dismiss their concerns. A lot of clients DO get injured performing these moves! However, We can also understand that back pain can sometimes be:
- stress related
- posture related
- hyper mobility related
- stiffness related
- caused by their foot/pelvis/shoulder
- a pelvic floor dysfunction
Ideally, we’d love all our female clients to be cleared by a pelvic physio before lifting.
However, just because the client believes that squatting or deadlifting hurts their back, doesn’t mean we shouldn’t do it! Conversely, it also doesn’t mean we SHOULD. Before blowing them off all together, vary the variables and see if there’s a version of a squat or a deadlift that they can do without pain or repercussions in their back:
- reduce load
- reduce where they hold the load (eg. On the shoulders vs dumbells by their sides)
- reduce range of motion
- change foot position
- cue pelvic floor
- mobilise the thoracic and pelvis first
- activate the glutes first
- practise technique with banded loads
- check pelvic positions
- stabilise by using a smith machine or leg press instead of free weights
… to name a few ideas!
So, the take-home message being that lifting can help your client’s back pain – however you should only move through pain-and-consequence-free movements in your sessions – whilst advocating for your client to explore WHY their back hurts.
In the meantime, here are some exercise Considerations for someone with back pain:12
- Take pressure off the affected area by mobilising the structures above and below it. For example, if the L4L5 is the affected area, mobilise the client’s thoracic spine and pelvis (glutes and hips).
- MOVE: unloaded movement like stretching and mobilising is fantastic for reducing recovery times. Furthermore, there is some evidence that suggests resting will make it worse.
- Avoid loaded strength training whilst the area is inflamed (painful).
- Consultation with the client’s physio or doctor is important, which means the client has to go and see someone when they’re inflamed
- Commence deep core training (even for men, pelvic floor exercise can have an analgesic effect)13. Get qualified in deep core training here.
Let’s take a closer look at the strategy of mobilising above and below…
In response to an enquiry asking me to go deeper in to mobilising to reduce “pull” on back pain when squatting or deadlifting – here is a deeper explanation. Before I start – this is not a referenced and researched session like most of my Lives, this is just my process that I have developed over the past 20+ years as a S&C.
When a client reports back pain in a squat or a deadlift, that is an opportunity to find more information. Every time you make a “tweak”, whether its changing the foot position, load position, pelvis position, cued pelvic floor, or range of motion, you need to make a note of it then ASK the client what changed for them – is the pain the same? Better? Worse? Where is it? Then note that down too.
Mobilising above and below the pain is another strategy to tweak the impact of the movement:
- Do the squat/deadlift – get feedback about pain/pressure
- Mobilise above – pick a driver and move 3 ways
- Do the squat/deadlift – get feedback about pain/pressure and what has changed (if anything)
- Mobilise below
- Do the squat/deadlift – get feedback about pain/pressure and what has changed (if anything)
If it’s gone – then always mobilise beforehand. If it’s worse try something else (including a visit to the physio).
For me, front loading squats hurts my back. I do have a L4/L5 bulging disc, but more often than not it flares up when I am stressed, not as a result of squats – and if I back load it doesn’t hurt at all. I STILL SQUAT!
This is the most common kind of back pain I’ve seen (the old L4/L5/S1 region). It’s important to note that even if a bulging disc is present, only 50% of people with a bulging/herniated disc report pain, and it’s unlikely the squat/deadlift CAUSED it (but don’t push through the pain anyway).
To mobilise above and below an L4/L5/S1 – I’d be going thoracic and pelvis, then choosing 3 directions to move them… Forward and back, left to right, and some kind of circle, for example:
- Slump and flex
- Step left and right
- Hands and feet, forward and back
- Step over a fence
And all the unlimited variations in between….
If the pain is in the shoulder blades, try mobilising the neck (forward and backward, left to right, circles) and lower back (forward and backward, left to right, circles) .
To Modify an Exercise for Women Means to “Make Easier”
“Modifying” an exercise for a pregnant woman, someone with an injury, or just women generally often means “make it easier” when applied to women. I’m thinking about push ups – toes for the boys, knees for the girls – or burpees – jumping for the men, stepping for the pregnant women – but there are hundreds of other exercises, and ironically, the modifications aren’t always appropriate!
Let’s take burpees, for example. The traditional burpee is the lie down, jump to your feet, then jump in the air. Many women are given a “modified” version of this, which involves stepping out. This is definitely easier, but if she has a diastasis, it’s just as inappropriate for her abdominal wall. And what if she wants the intensity?
Burpees can be better modified by thinking about the body in front of you. If she has stress incontinence, for example, can we keep the intensity without bouncing on her pelvic floor? Can we avoid the prone position that exacerbates a diastasis without dropping intensity?
So let’s talk push ups now. For most women, their trainers aren’t checking for diastasis and linea alba integrity in a prone position. I’ve personally had many instructors who don’t believe women are strong enough in their arms to do push ups, conveniently forgetting we’re lighter to begin with. The upshot of a trainers belief that they can’t is that they won’t ever ask them to try.
My perspective is that women are absolutely strong enough to do push ups on their toes, if taught properly and patiently. However, there are issues with diastasis if they’re mums. However, dropping them to their knees makes it easier on their arms, lowers the intensity, and can still be a problem for their abdominal wall too!
True modifications keep the load and intensity, but alter the position for the individual. For mums, this will overwhelmingly be their abdominal wall, lower back, or pelvic floor – and if you know nothing about the deep core then get qualified now2. So for a push up, you could keep the load on the arms but take it off the abdominal wall by
- Sticking their butt in the air,
- Pressing your fingers in to her shoulder blades with her knees up close
- Doing a bench press instead
If you’re “modifying” a box jump with step ups, or skipping with a walk, think again. Is there a way that you can take the pressure off the pelvic floor but keep the intensity?? Some of my favourites include:
- Knee repeaters
- Squat to toes
- MB slam
But don’t take my word for it – think about the individual in front of you. What are their goals? Their vulnerabilities? Their injuries? Their expectations? Is there are way to tick all those boxes in your “modifications” without automatically going easier…
The Pill Doesn’t Affect Your Training Capacity
Um. It’s does. However we aren’t exactly sure how it affects you or your clients. The research is scarce, conflicting, and sometimes like comparing apples with oranges (because of the different make-up of each contraceptive), but here’s my best shot at untangling it.
Anywhere between 44-68%1 of your clients will be on some kind of hormonal contraception, and this will impact their training, but that is where my certainty ends. For some women there are annoying side effects to taking a hormonal contraceptive, like migraines2, or mental health dysfunctions3, that have nothing to do with their training but can affect it nonetheless.
The affects are not always negative, for example, women on the pill do not have the increase in soft tissue injury risk around ovulation that menstruating women do, although even then, they’re still 8x more likely to have a soft tissue injury than men4. The pill helps close the gap in joint laxity but doesn’t eradicate it.
Your training will also be more consistent than your menstruating counterparts5. This means that cycling the training can be linear rather than cyclical (although you still need off weeks), but you you miss out on the super-hormone benefits of the hormone peaks of a menstruating woman’s cycle too! Generally, women on the pill have slightly inferior exercise performance overall6.
From a confidence perspective, taking a hormonal contraceptive gives women some measure of control, as illustrated by the female tennis players at Wimbledon last year, where players spoke out about having to wear an all-white uniform while possibly being on their period7. Having said that, with 95% of performance research using men, woman haven’t yet got the tools to hack their physiology, except to make it more like a man’s – thereby hopping on the pill and skipping menstruation when it’s not convenient (myself included)8.
Some hormonal contraceptives will negatively affect your ability to gain lean muscle mass, and increase cortisol levels post exercise (your stress hormone, when chronically high can contribute to weight gain and mental health problems)9. However, these results are specific to the kind of contraceptive the woman is taking, with women in another study gaining more muscle mass than their menstruating counterparts on an ethinyl estradiol pill versus a progestin10. There are so many variations of dose, hormone make up, and how the contraceptive is administered that more research is needed to understand it properly.
There is also a possible reduced ability to recover for women on oral contraceptives11. As we know, the luteal phase of a woman’s cycle is pumped with added circulation, antioxidents, and brain calming hormones, women who are on the contraceptive pill have a high-recovery window during their withdrawal bleed and in the early days of resuming their pill, but otherwise recover differently through the bulk of each month.
Probably the biggest issue with people who exercise a lot, or diet, is RED-S; Relative energy deficit syndrome where a women loses her cycle due to relative calorie deficit or over training. Taking the Pill means you can’t track your cycle, potentially missing RED-S, which can have an impact on performance, health, bone density, heart health, and more – well in to the future. Furthermore, if you’re on a contraceptive that contains synthetic oestrogen, it can have a negative impact on bone health anyway, which is compounded if someone is in low energy availability12.
So the answer is yes, the Pill will affect your training. However more research is needed to tell us exactly how.
You Have to Cycle a Woman’s Training Around Her Cycle
I know I bang on about cyclical training a lot, and I do prefer it. But no, you don’t have to do it to get results with your female clients.
What you DO have to do? Track her cycle!
The cycle is a magnificent way to gain an understanding in her overall health. It is as vital as her resting heart rate and rate of perceived exertion. It will be the first sign that something is wrong with your female clients; whether it’s emotionally, mentally, physically.
However, your training plan itself can remain the same throughout the cycle as long as she’s healthy and happy to perform it. Any training plan, whether it’s cyclical or linear should always include an off week, even for high performance athletes, and if she feels like taking it in her mid-luteal phase, that’s totally up to her.
While performance is not impaired by her menstrual cycle13, the symptoms of menstruation may impair her thoughts and feelings about her training, which will impact her performance14. 89% of women in one particular study reported that menstruation or PMS will affect whether or not they’ll show up at all, the main constraints to participation being the proximity of a toilet and sanitary waste disposal. If you’re an outdoor trainer, these are possibly more important that cycling her training.
Got any more myths for me?? Send them through!
13Bi X, Zhao J, Zhao L, Liu Z, Zhang J, Sun D, Song L, Xia Y. Pelvic floor muscle exercise for chronic low back pain. J Int Med Res. 2013 Feb;41(1):146-52. doi: 10.1177/0300060513475383. Epub 2013 Jan 23. PMID: 23569140.
2Restore Your Core Series: https://intoyou.teachable.com/p/13cec-core-masterclass