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So, I went to an orthopaedic because I was experiencing lower back pain for several months and got an X-Ray done. The report says that my L5 is sacralised, L4 has spondylolisthesis, and a mild forward subluxation of L4 was noted in the neutral position. The doctor recommended me some medicines, physiotherapy, exercise, and diet for weight reduction as soon as possible. I asked him if anaerobic exercises can be done where the lower back may experience some sort of stress, like upper/lower back exercises, squats of various kind, and different combination of upper-mid-lower core-based exercises. He said he has almost no knowledge about resistance training, and so he can't emphasise upon that. He further added that I should stick to only cardio-based exercises and diet.

But my problem is that a 20-minute jog on the treadmill (for example) burns an average of 200-250 calories, and that can be gained by eating a doughnut, for instance. Sure, I can and will avoid all processed junk food but nonetheless, even if someone burns through an hour of cardio 800-900 calories, that can be easily replenished by eating complex carbohydrates or other macros. IMO, resistance training in combination with cardio would have been the best bet, but in my case, I'm not sure if I should even continue with resistance training. Or, if I do, which exercises (anaerobic) should I totally avoid till my lower back heals completely? Any advice would be really appreciated. Sorry if this question has been asked before, here.

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    I will emphasize that you should listen to your doctor and ask for a referral to a rehab/trainer type that is familiar with your condition. – JohnP Jul 30 at 17:42
  • Oh, I am sorry. Your comment clarifies everything now. I didn't see a significant weight reduction just by doing cardio for 7 days, so I think I will have to tweak my diet and follow a proper calorie deficit diet by measuring my TDEE. – Janus Boffin Jul 30 at 18:00
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    @DavidScarlett - I admit to a misconception. After further reading, I am seeing that weightlifting is considered to be an anaerobic exercise. Mea culpa. – JohnP Jul 31 at 14:56
  • Wait, so, doesn't it change the definition of all anaerobic exercises involving weight lifting/strength training? – Janus Boffin Jul 31 at 14:59
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    Apparently not, I had forgotten about the energy conversion and energy source for the activity as being part of the classification. Weightlifting doesn't rely on fat/calorie conversion, it uses muscle glycogen stores. Hence, primarly anaerobic. It still as aerobic aspects, however, esp if you are doing circuit type training. – JohnP Jul 31 at 15:08
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Firstly, imaging, such as x-rays and MRIs, to determine the cause of lower back pain is problematic because asymptomatic people tend to have all kinds of spinal degenerations which don't actually cause any problems, with a prevalence of approximately 70% of individuals younger than 50 years of age to >90% of individuals older than 50 years of age.(1) This means that you can't actually be certain that anything found through imaging is really the cause of the lower back pain, as it's quite likely that it was actually pre-existing, asymptomatic, and unrelated. A 2018 summary of various international clinical practice guidelines even explicitly recommended against routine imaging.(2)

Research strongly supports exercise as a treatment for chronic lower back pain, and in many cases specifically recommends strength training.

Exercise in the Management of Chronic Back Pain, Thomas E. Dreisinger, 2014: "The goal of therapeutic intervention is to return patients to the normal activities of daily living—sitting, rising, bending, twisting, lifting, walking, and climbing—by enhancing strength, flexibility, endurance, and balance. Only resistance (strength) training has been shown to result in increases in all 4 of these at the same time."(3)

A 2015 study specifically investigated free-weight resistance training, and found that "A free-weight-based resistance training intervention can be successfully utilised to improve pain, disability and quality of life in those with low back pain."(4)

If I were in your position, I'd probably just go ahead with resistance training, but then I already regularly practice weight training, so I'm in a slightly different starting position. If you're worried I'd strongly recommend getting a second opinion from a doctor who does have knowledge about resistance training, and who does not use imaging as a tool for diagnosing lower back pain.

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    Thanks, David. I have a question. In the first cited paper as well as in your reply, the term "asymptomatic people" was used. I am not quite sure what it means and if I fit in that criteria. Wikipedia is giving a result which can be understood for patients carrying/having an infection. Please explain a bit what it means for someone with a lower back pain. – Janus Boffin Jul 31 at 14:57
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    @JanusBoffin - asymptomatic means that the person does not display any symptoms (pain, swelling, loss of movement, etc) of the condition that is affecting them. So they may actually have a spinal defect/degeneration, but it produces no symptoms at all. – JohnP Jul 31 at 16:59
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Sorry to hear of your back issues.

Have been there with similar issues on my own back.

A solid approach might be the following.

1). Use Nutrition to Lose Weight 2). Learn what you CAN safely do and what you should do from a Rehab and Prehab stand point.

Fat Loss Nutrition is KING for losing fat. You do not need a crazy fad diet or to completely eliminate entire food groups. Start being mindful of what you eat, cut back on the bad stuff (and all of us know what the is), eat more vegetables and protein.

As long as you are at a caloric deficit you will lose weight, you have to.

Take your total bodyweight and multiply it by 10... this will be roughly how many calories you should be eating.

1 Gram per total pound of bodyweight in protein (multiply by 4 to get calories) and the balance of calories split between carbs and fat. With out a ton more info it is hard for me to give you a target on carbs and fat... roughly 20% and 30% of each respectively will be close.

Cardio and Fatloss You do NOT need cardio to lose weight. This is coming from someone that has lost 60 lbs and kept if off for over 20 years now. I have also worked with thousands as a trainer and gym owner over the last 20 years.

What? No cardio? The more you do cardio the better shape you get into. As you get in better and better shape you burn less and less calories for that activity. Again we call this getting in better shape.

Forget the calorie read out on the cardio machine, ie treadmill. Unless you are wearing a chest strap heart rate monitor it is not likely and will not account for you getting in better shape and burning less and less calories.

Exercise for Fatloss Gaining muscle mass through weight training will increase metabolism. So yes you need to weight train.

I would avoid anything that loads the spine, ie squats and deadlifts until you can see a therapist and get a professional recommendation. I do not see a reason you can not do these lifts and axially load the spine in the future but for now you have to get healthy and learn more about your injury... the Dr. seems to be able to assess injury and prescribe a solution but could not discuss the solution he prescribed...scratching my head.

Rehab and Prehab I would look up Dr. Stu McGill. Read some of his namely

1). Cat/Camel 2). Contralateral or Birddog 3). McGill Curl Up 4). Plank, Side Plank, etc.

The January/February issue of Men's Health did a story on McGill and including a workout for low back health similar to that detailed above. You can likely find it online as well as other great info by Dr. McGill.

Good luck.

  • Should I also exclude free squats, i.e., squats without weights? I will read up these things and this advice is probably one of the best I have read in years. Thanks! – Janus Boffin Jul 30 at 13:36
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    Janus with out you standing or sitting in front of me it is hard to say. On the surface I would say if it hurts do not do it. If it does not hurt it is likely fine. So try the bodyweight squat... stop short of going down to where the hips and butt shift forward and round the low back. Google butt wink or hip wink when squatting. Good luck! – Ray Jul 30 at 13:47

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