Re-aggravation of Low Back Pain

[Dylan Priest]

My first incident with back pain occurred in December 2020. I missed out on serious training for all of 2021 due to low back pain (sometimes half-assing rehab, other times trying to do normal training and re-hurting myself.) Around March of this year I began proper training again. I followed the guidelines of the pain in training article using high rep sets of squats and deadlifts to progress from the empty bar up to doing 70kg on each for sets of 15. From there I progressed to doing sets of 10, and then 5 and then to "regular training" with top sets and back off sets. I was able to complete both a 140kg single on squat and 150kg single on deadlift without any significant pain. The problem was that my pain, or injury or however you want to describe it never really went away. It was never so severe that it caused me to stop exercising, or really any activity during that time, but there was always a small, dull pain in my back that often got worse as I was sedentary for long periods. This was accompanied with some mild sciatic which again wasn't so bad that it stopped me from doing anything but was basically constant. So even though I was progressing fine in training it still felt like I wasn't really "fixed." Ultimately this came up in training once more today. I was doing triples on deadlifts with only 100kg, and on my final set I re-aggregated my low back (left side, above the tail bone as it always is).

I guess my question here is: What am I supposed to do differently this time?

The pain in training article talks about finding an entry point; an exercise you can do without pain, and that's what I did. I didn't have pain with normal squats or deadlifts so I just progressed those normally. I never experienced any sort of "extra" pain with them compared to any variations so I never felt a need to replace them. I never felt any sort of building up to this incident, and it was with a weight far below what I've done without pain. It feels like I progressed exactly as I should have, but the problem never really went away and now it feels worse than it ever has before. The only thing I can really say for what happened is that on the particular rep that I hurt myself I definitely recall getting a bit lazy with my form and setting my back; it felt quite rounded just before I bailed on the rep but I don't really know if that contributed anything to the incident.

[Austin Baraki]

Hi Dylan,

Sorry to hear about this frustrating issue. If I were in this situation I would be leaning more heavily into the exercise variation side of thing, even if the goal is for this to be temporary. A bit more of a break from "SBD"-focused training and using tons of movement variation, bilateral/unilateral work, dumbbell/machine work, etc. in ways you have never done before, while applying the same principles to load progression. I think the most recent podcast on "spondy" with Dr. Miles lays out some of these general principles in a useful way, even outside the context of that particular diagnosis. If you continue having trouble with this issue, I think a consult with our rehab team would be the next best step to get you moving towards your goals again.

[Dylan Priest]

Hi Dylan,

A bit more of a break from "SBD"-focused training and using tons of movement variation, bilateral/unilateral work, dumbbell/machine work, etc. in ways you have never done before

Thanks for the response. I believe that I can do this, though my gym is somewhat of a "hardcore" gym with not a lack of machines. I believe I can replace free squats with leg press, hack squats, split squats and leg extensions, but I'm not sure about to go about replacing deadlifts. Would something like high handle trap bar deadlifts, hip thrusts and hamstring curls work for a regime?

[Austin Baraki]

I'd also incorporate some some lateral lunges/lateral goblet squat-type movements for the squat subs.

For deadlifts I'd consider an alternate-stance (e.g. sumo if you're typically a conventional puller), starting with something that forces conservative loading like 3-1-0 tempo (pause mid-shin, 3-count eccentric), trap bar is fine, 3-0-0 (or slower) single-leg Romanian deadlifts, good mornings, back extensions, and the other things you mention are all options. In addition to direct back work with lat pulldowns, cable/machine rows, etc.

[Dylan Priest]

I'd also incorporate some some lateral lunges/lateral goblet squat-type movements for the squat subs.

For deadlifts I'd consider an alternate-stance (e.g. sumo if you're typically a conventional puller), starting with something that forces conservative loading like 3-1-0 tempo (pause mid-shin, 3-count eccentric), trap bar is fine, 3-0-0 (or slower) single-leg Romanian deadlifts, good mornings, back extensions, and the other things you mention are all options. In addition to direct back work with lat pulldowns, cable/machine rows, etc.

One last question: Is there anything else I should be doing to help with rehab outside of the barbell training? As I said before I was progressing on squats and deadlifts for a while. I was getting stronger without strong incidents of pain, but it never really felt like the issue went away. I kind of worried that the same thing might just end up happening again; getting stronger but not feeling better

[Austin Baraki]

One last question: Is there anything else I should be doing to help with rehab outside of the barbell training? As I said before I was progressing on squats and deadlifts for a while. I was getting stronger without strong incidents of pain, but it never really felt like the issue went away. I kind of worried that the same thing might just end up happening again; getting stronger but not feeling better

Hard to say much for your specific situation outside of our general health-promoting guidelines, sleep, etc. These kinds of individualized questions are the kinds of things best addressed via a consultation.