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Making Adjustments During Low Back Rehab

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  • Making Adjustments During Low Back Rehab

    Age: 33

    Weight: 175 (165)

    Height: 5'6

    General barbell training history: 10 years

    Competitive powerlifting history: 1 year

    Current programming: https://docs.google.com/spreadsheets...it?usp=sharing

    Low back pain history (long term): Pain off and on since age 16-17. BBM and their educational materials have helped me to re-frame this experience completely and to train around it and sometimes through it.

    Low back pain history (short term): A feeling of "tightness" and of a "pulsing discomfort." Pain began in the middle of week 4 of the linked program, but there was no sudden training cause or moment of injury. Pain duration: 12-14 days. I've noticed that I have a habit of bracing my stomach/core and holding my breath when I bend over and feel (or expect to feel) this pain. I do have some LBP during daily tasks, but that's not always an indication that it will hurt during training. I was able to mostly train through it last Tuesday with only slightly lower than normal intensity based on RPE and %. On Thursday and Friday, I made a judgement call and substituted my programmed (sets of 6) deadlifts for higher rep sets of 8-12, 303 tempo and block pulls, conventional and sumo.

    General observations: Throughout my training blocks (3-4x per week, 9-12 exercises per week), I've noticed that I experience LBP after 4-12 (ish) weeks of belt overuse use on all exercises, including variations like RDLs and rows. When this has happened, the LBP typically subsides after a brief time away from the belt and some intensity adjustments (as guided by RPE). This time it has lingered a bit longer. The pain is affecting my performance on squat (I feel it at the bottom position especially) and on deadlift. Bench is mostly alright. I've purchased Low Back Rehab template, but given this history of LBP subsiding quickly after brief and minor training modifications, I've decided to plug in week 4's SBD programming into my current push-pull meet prep (3 weeks out) and see how things respond. Today I'm doing conv. deadlift, feet up bench, and SSB paused squats, 5 sets of 10 @ RPE 4, 5, 6, 7x2.

    My e1rm on squat is 350. On Tuesday, I did 135x10 (RPE 4), 150x10 (5), 170x10 (6), and 185x10 (7). This felt like I was pushing right into a slightly uncomfortable but not unmanageable intensity. On my second set of 185, I racked it after the second rep based on the pain I was perceiving. I deloaded to 135 and performed that for 2 sets of 10, and that felt alright.

    Questions:

    1) Is what I've described here a reasonable adjustment during the rehab process?

    2) What role do pause and tempo work have in the rehab process? For example, there's some fear that if I "bounce" into the bottom of my squat, I could get a shooting pain or spasm and lose control of my body or the bar. Are pause squats a good way to address this? To really sink into that low position? Or is it preferable to practice the bounce at a weight I can manage? Or some combination?

    3) Not a question. I'm just looking for some reassurance. I have a history of getting better. I need to remember that.

    Thanks,

    Brandon






    Last edited by WonderCat4Life; 07-25-2019, 09:02 PM.

  • #2
    Hey, thanks for posting, sorry about the delay in getting back to you!

    1) I would say everything you posted about the adjustments to training are very reasonable, you can definitely progress through a combination of the LBP template and the training program you attached using symptoms as your guide.

    2) As for tempo and pause work and their role in rehab, I see it as more of an intensity limiting factor. So by slowing down the reps and adding in pauses, you keep internal effort high while dialing down the absolute weight on the bar, which can allow for a more flexible path during rehab, while still driving progress. There's nothing inherently wrong about the "bounce", it just comes down to the goal of the movement. If a bounce allows you to move the most weight possible for a competition, then it's totally fine. Pause squats can still be useful as a training variation for the sake of variation itself, but it's not better or worse than a more dynamic movement out of the hole.

    3) You got this. You have the attitude, support and plans in place that you need and as long as you keep moving, you'll get through this and crush that meet.

    Let us know if you have any other questions or updates!

    Comment


    • #3
      Originally posted by MikeAmato View Post
      Hey, thanks for posting, sorry about the delay in getting back to you!

      1) I would say everything you posted about the adjustments to training are very reasonable, you can definitely progress through a combination of the LBP template and the training program you attached using symptoms as your guide.

      2) As for tempo and pause work and their role in rehab, I see it as more of an intensity limiting factor. So by slowing down the reps and adding in pauses, you keep internal effort high while dialing down the absolute weight on the bar, which can allow for a more flexible path during rehab, while still driving progress. There's nothing inherently wrong about the "bounce", it just comes down to the goal of the movement. If a bounce allows you to move the most weight possible for a competition, then it's totally fine. Pause squats can still be useful as a training variation for the sake of variation itself, but it's not better or worse than a more dynamic movement out of the hole.

      3) You got this. You have the attitude, support and plans in place that you need and as long as you keep moving, you'll get through this and crush that meet.

      Let us know if you have any other questions or updates!

      Thank you very much!

      The symptoms are improving on squat and deadlift and the weight on the bar is increasing gradually. I'm still training beltless.

      Sumo is much less painful than conventional, which is not a surprise since that's why I started pulling sumo in the first place -- about 6-8 months ago. Once the pain crept into the sumo variation, I knew it was time for a rehab of some sort and that's when I made my original post and purchased the low back rehab template.

      Right now I'm working with less than 50% intensity on deadlift. 185x8 on conventional is an RPE 7 (pain being the limiting factor), on sumo it's closer to a 3-4 (some pain, not nearly as sharp).

      I can report that this recent bout with LBP really set in after a back to back blocks of (relatively) serious pulling volume (primarily sets of 6s, 8s, and 12s). 14 weeks of training M/T/Th/F with deadlift/row/RDL programmed in 4/12 weekly exercise slots, nearly always with a belt. Maybe the stress/fatigue just caught up with me? I'm not sure. I could probably push it and starting training normally on sumo, but for now I think I'm going to view this as an opportunity to work out whatever it is that's giving me back pain on conventional (and now sumo, though not as sharply). I don't want to rush it and suddenly find myself back in this spot 3 weeks from now. In the future, I'll probably back off the pulling volume and replace it with squat/press.

      I appreciate the response and whatever additional help you can offer.

      Brandon

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