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Training Out of Low Back Pain 101


Today's post was inspired by recent events in my training. You could unfortunately say I am a low back pain connoisseur. Fortunately, I've narrowed down the causes of my issues so I can avoid them moving forward. However, even if you do everything PERFECT from a technique, programming, nutrition and recovery perspective, some sort of injury during training is unavoidable if you are competitive or pushing yourself. In the statistically likely scenario I can't avoid another pain generating event in my low back, I am documenting the culmination of knowledge I have acquired so far in conquering personal fears and training OUT of pain in hopes that it will provide you (and my future self) comfort the next time you find yourself in a similar situation.


I'll start by reviewing the contexts in which I encountered pain before addressing some misconceptions about low back pain. Then I'll dive into how I trained out of pain before providing some movement tools you can use should you encounter this setback in your training. These recommendations assume you do not have any of the red flag symptoms noted below. If you have any of these symptoms, stop reading and seek guidance from a medical professional before reading further.

  1. Sharp, shooting, or radiating pain

  2. Loss of feeling or numbness

  3. Incontinence

  4. Sudden back pain with previous fracture or history of osteoporosis

  5. Inability to walk or stand

  6. Intolerable pain

Disclaimer: I am not a medical professional or physical therapist, and I am likely not YOUR coach and I do not know YOUR specific circumstances. The following information is provided to give you broad concepts that you can hopefully apply to your specific situation.


CONTEXT

For the purpose of this post, low back pain is defined as pain near the lumbar region of the spine. The recent episodes of low back pain and injury I encountered were after periods of pause deadlifting. The first episode occurred in November 2021 when I worked up to my top set, paused for a 2-count, and once I initiated the 2nd pull out of the pause... "POP!" The weight dropped, my back became hyper sensitive to movement, and putting the plates back was difficult. I tried to power through the rest of my training session, taking note of what my body was and was not sensitive to. Trying to bench press with a moderate arch was not possible, so I proceeded to complete my bench training without an arch before calling it a night. The next day, I could not get out of bed without 9 out of 10 pain unless I used momentum from my legs to kip me up or I rolled to my side off the bed. I could not walk or move around without bracing my core as any tiny movement of my low back would cause pain.


The second episode occurred in April 2022. Again, I was 2-count pause deadlifting, but pausing right off of the floor. This time, there was no discernable sensation or other Rice Krispies sound effect that indicated something happened. In fact, I was able to complete the entire deadlift portion of training but was quickly sore and sensitive after. I proceeded to start my bench press portion of the session and as soon as I set up my arch for benching, I knew... HERE WE GO AGAIN :)


MISCONCEPTIONS

There is a TON of misinformation out there causing people to be fearful of back pain, and understandably so. I would be lying if I said I wasn't scared when I couldn't' get out of bed the day after my first episode without 9 out of 10 pain. If you do not have any of the red flag symptoms previously noted, it is likely the issue will resolve without any medical intervention. Below are some misconceptions about back pain that are important to debunk in order to manage your own fears and expectations should you encounter pain in the lumbar.


"Lifting Is Bad for Your Back"

We live in a society where employers put posters up telling you to lift with your legs and not to use your back, the implication being that your back is frail and using it will herniate a disc! In a biomechanical study (4), it was found that "squat lifting" versus "stoop" lifting (i.e. with your back) did not prevent lower back pain. I'm not saying you should lift everything with your back, but lifting with your back in and of itself is not inherently dangerous if you are acclimated to the loads and body positions of the task.

Systematic reviews and meta-analyses have shown that spinal degeneration including herniated discs are common among populations who have no back pain symptoms at all and go about living normal healthy lives. It was found that likelihood of degeneration increased with age. More interesting is that even things that sound as terrifying as a herniated disc can resolve on their own (1,2,3).


These studies were conducted on the general population, not specifically strength athletes. So I'd love to see a study comparing the likelihood of spinal degeneration between trained and untrained populations as well as their self-efficacy after a pain generating event.


"Your Back Must be Perfectly Straight At All Times"

Studies have shown that even when people maintain a neutral or lordotic spine, the lumbar spine is still flexed (4,5,6). I'm not saying that you should be cat back deadlifting at every training session, but a little lumbar flexion won't break you if you are acclimated for the task. In fact, there are freakishly strong people out there who deadlift with very rounded backs, although the majority of the rounding is likely in the thoracic spine which is safer than extreme rounding of the lumbar spine. However, lumbar flexion is likely unavoidable in your day-to-day life (7), so you can choose to stay bed ridden to avoid lumbar flexion, or you can choose to make your back more resilient through training and acclimating your body appropriately.


MOTION IS LOTION


After I got over my own fears and stopped feeling sorry for myself, with the help of the information provided above, I was ready to begin my recovery process, which was basically just modified training with appropriate movements and progressions. After my November 2021 episode, I did the following in order to progress back to and exceed my pre-injury levels of strength. My April 2022 episode was nowhere near as bad, so I am currently executing an abridged version of below. Depending on how severe your pain experience is, you may need to lengthen or shorten your recovery process accordingly.


Weeks 1 & 2

  • DO NOT STOP MOVING

  • Increase tolerance to movement

  • Bodyweight Squats 8-10 Reps, 2-3 Sets, 2-3 xPer Day

  • Bodyweight Good Mornings 8-10 Reps, 2-3 Sets, 2-3 xPer Day

  • Dissipate low back fatigue

Week 3

  • High Bar Squats in lieu of Competition Low Bar Squats

    • 50 to 60% of E1RM

    • 5 to 8 reps up to 4 sets

  • Competition Sumo Deadlifts

    • 50 to 60% of E1RM

    • 5 to 8 reps up to 4 sets

  • Feet Up Bench Press Variations

  • Single Leg Movements

  • Ab Work

Week 4

  • Return to Competition Squat Bench Deadlift Day

    • Worked up to Top Sets of 3-4 Reps @ RPE 5-6

  • Normal Training Throughout Week Progressed Conservatively

Week 5

  • Competition Squat Bench Deadlift Day

    • Worked up to Top Sets of 3-4 Reps @ RPE 6-7

  • Normal Training Throughout Week Progressed Conservatively

Week 6

  • Competition Squat Bench Deadlift Day

    • Worked up to Top Sets 2-3 Reps @ RPE 7-8

  • Normal Training Throughout Week Progressed Conservatively

MOVEMENT TOOLS

Movement is a tool that can be used to help you achieve your goals, whether they be for obtaining competitive strength or for training out of pain. The following movements are possible tools and substitutions you can incorporate if your low back is sensitive to pain. The goal with incorporating these movements is to maintain a level of fitness and continue the habit of training, with the hope that we can return to normal training after a period of time. These should be regressed based on your tolerance for movement and/or sensitivity to low back pain as noted under implementation below.


Squat Variations

  • High Bar Squats

  • Safety Bar Squats

  • Front Squats

  • Goblet Squats

  • Belt Squats

  • Split Squats

  • Hack Squats

  • Landmine Squats

  • Single Leg Squats/Lunges

  • Leg Presses

Deadlift Variations

  • Romanian Deadlifts - Moderate to High Reps

  • Stiff Leg Deadlifts - Moderate to High Reps

  • Trap Bar Deadlifts

  • Hip Thrusts

  • Kettlebell Swings

  • Glute Bridges

  • Single Leg Deadlifts

IMPLEMENTATION

Below are a few methods for regressing your squat and deadlift variations after a low back pain incident. These regressions can be performed in isolation or in combination. I have not provided progressions, since the main goal is to progress back to the original movements when your body is ready.


Regression 1 - Bodyweight Only

  • If you cannot tolerate any of the movement variations with an empty bar or weight, then starting with bodyweight could be one entry point of recovery.

Regression 2 - Reduced Range of Motion

  • If you can tolerate the variation for only a partial range of motion (ROM), execute partial ROM movements and gradually increase ROM as your symptoms allow.

Regression 3 - Band Assisted

  • Similar to using a band to assist a pullup, bands can be used to increase range of motion by reducing the amount of weight at the hardest portion of the movement.

  • Gradually reduce band tension as your symptoms allow.

THANK YOU!

Low back pain can be a scary thing! The majority of back issues encountered in training can be resolved without medical intervention if managed with the right mindset and appropriate progression of movement back into your life. If you found this post helpful, be sure to like, share or comment below!


REFERENCES

  1. Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. PMID: 25430861; PMCID: PMC4464797.

  2. Zhong M, Liu JT, Jiang H, Mo W, Yu PF, Li XC, Xue RR. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis. Pain Physician. 2017 Jan-Feb;20(1):E45-E52. PMID: 28072796.

  3. Chiu CC, Chuang TY, Chang KH, Wu CH, Lin PW, Hsu WY. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015 Feb;29(2):184-95. doi: 10.1177/0269215514540919. Epub 2014 Jul 9. PMID: 25009200.

  4. van Dieën JH, Hoozemans MJ, Toussaint HM. Stoop or squat: a review of biomechanical studies on lifting technique. Clin Biomech (Bristol, Avon). 1999 Dec;14(10):685-96. doi: 10.1016/s0268-0033(99)00031-5. PMID: 10545622.

  5. McGill SM, Marshall LW. Kettlebell swing, snatch, and bottoms-up carry: back and hip muscle activation, motion, and low back loads. J Strength Cond Res. 2012 Jan;26(1):16-27. doi: 10.1519/JSC.0b013e31823a4063. PMID: 21997449.

  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304869/

  7. Levine D, Colston MA, Whittle MW, Pharo EC, Marcellin-Little DJ. Sagittal lumbar spine position during standing, walking, and running at various gradients. J Athl Train. 2007 Jan-Mar;42(1):29-34. PMID: 17597940; PMCID: PMC1896074.

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