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  • How often is too often?

    I've been following your programming for about a year now with generally very good success. However, I have a recurring issue with my lower back "popping" about once every 3 months or so. I experience extreme stiffness and pain in my lower back when this happens that lasts for 4 or 5 days. I have seen Allan Thrall's video about this situation and read your article "Pain in training: What do?," so I am generally not too freaked out when it happens. I reduce load substantially, then build back up, and am generally back to training at 100% within 2-3 weeks.

    However, I am concerned that this is happening much too frequently. I am a bit worried that this chronic abuse may lead to long term problems, and I am hugely frustrated to continually be set back like this in my training. Is this type of frequency of "light injury" common in your other lifters? What should I be doing differently? I suspect that I may need coaching here to appropriately manage my fatigue, as I probably try to push too hard in an effort to get strong as quickly as I can.

  • #2
    Yea I think this is probably a load management issue, particularly in the months after a injury. I'd probably be more conservative during the 6-12 weeks after the injury, gradually working back towards "normal" training, I.e. non-modified RPE, rep, or ROM.

    How are you currently planning your "comebacks"?
    Barbell Medicine "With you from bench to bedside"
    ///Website /// Instagram /// Peri™ Rx /// Whey Rx /// Barbell Medicine Podcast/// Newsletter /// Seminars ///

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    • #3
      In the past I suppose I have been pretty ambitious with the rate of my "comebacks." I do not modify RPE down for 6-12 weeks. Rather I do that for more like 2-3 weeks with use of "work around" exercises. For examples, I would use heavy "cowboy" belt squats on my days where squat is the first exercise, so that I can still train my legs heavy. For the other supplemental work I would do light tempo squats and RDLs with full ROM. Usually I find that light tempo squats with full ROM (which usually takes 4-5 runs at achieving depth before I'm actually loose enough to do it) temporarily relieve the pain and stiffness quite a bit. Keeping a heating pad on the area also provides me some temporary pain relief and helps me to sleep at night.

      This strategy has generally worked pretty well, as I feel good to start lifting heavy within 2-3 weeks. At that point I would just go back to my normal loading on the normal exercises with full ROM. I have been assuming that I was fully healed, as I have been able to tolerate hard training and PR in the months between these incidents. For example, this happened around week 4 of a run through the legacy HLM template about 3 months back, and I still ran out the program after a two week "comeback." I ran a mini peak at the end of the program and did a mock meet where I squatted 530, benched 415, and deadlifted 625, all of which were lifetime PRs despite this being the third "comeback" this year.

      Given the PRs, I've been assuming that everything is healed-up just fine. However, the recurrence of these incidents now makes me wonder if that's really the case. My most recent bought started about two weeks ago, and my usual strategy has not been fruitful. In fact, I have "popped" my lower back again while attempting to rehab at the end of the second week of the comeback while attempting 315 lbs tempo squats. This resulted in me feeling utterly despondent and defeated, as I was feeling really good all week. I had high hopes of finishing the program out, if I just kept working hard through this setback like previous times. As that was obviously not the case, I decided to reach out to you to ask for any advice you'd be willing to share.

      Do you think that my back has never actually healed through all these "comebacks" even though I have productive training between events? Alternatively, I am starting to question whether I am habitually overshooting the RPE during the programs. I find it difficult, honestly, to be objective at times, as I question myself on hard days as to whether lowering the weight on the bar is indeed the smart thing to do or whether I am just wussing out. As I result, I often do not lower the weight, and, well, here I am hurt yet again.

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      • #4
        CRJ,

        I prefer to to think about whether you're back to full capacity with respect to performance and training tolerance rather than whether not the injury is healed so to speak. One thing that may be useful conceptually here is the a deeper dive into why you have pain during movement with these incidents. In general, we think this is due to being sensitized to the movement and it's normal loading, tempo, ROM, etc. You become less and less sensitized week after week, but you probably don't get back to normal until many weeks later -though how long this takes is individualized. I think you're likely ramping back too quickly, too soon and then never fully regaining your training tolerance, thus repeating the cycle here.

        Let me know what you think.

        -Jordan
        Barbell Medicine "With you from bench to bedside"
        ///Website /// Instagram /// Peri™ Rx /// Whey Rx /// Barbell Medicine Podcast/// Newsletter /// Seminars ///

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        • #5
          Jordan,

          I suppose that explanation of never regaining full tolerance seems reasonable. However, how should I know when and whether I am fully desensitized? After each of these comebacks, I am using full ROM with lifetime high loadings for several months before it happens again. I mean, if I can do that, how can I not be desensitized?

          The truly frustrating bit in all of this is that it keeps happening to me with no warning signs that I can recognize. For instance, up to a few weeks ago I was feeling great that my back was holding up really well with regard to fatigue during the last 8 weeks of the program. Then it popped during some relatively low weight beltless squats after deadlifts, on a low stress week no less. I had been pushing pretty hard up until the low stress weak (probably too hard), but my back didn't pop then. It popped during the low stress week. It actually popped at the END of a low stress week when fatigue was feeling lower than in previous weeks. I mean, wtf, right? Why then of all times? How was I supposed to see that coming, apart from the fact that this always happens to me?

          Should I just do one light set of ten squats a week for a year or two? I suppose I've recently seen that work well for a pretty good lifter on Instagram.

          -Chris

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          • #6
            I think that we should view performance and vulnerability to an injury as separate entities. If your training-induced fatigue has been reduced substantially via your comeback training, you may manifest your previously developed fitness adaptations. Conversely, the acute detraining coupled with the recent sensitization likely makes you more vulnerable here.

            I'm not sure there are hard signs in this case, though I do think exercising caution with return to sport is a good idea in general.

            Also to be clear, I'm not concerned at all by your back popping. That doesn't necessarily mean anything happened, though the sensation and perception of what that means to you likely influences your experience.

            Barbell Medicine "With you from bench to bedside"
            ///Website /// Instagram /// Peri™ Rx /// Whey Rx /// Barbell Medicine Podcast/// Newsletter /// Seminars ///

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            • #7
              I think we're getting messages crossed here a bit. When I said my back popped at the end of a low stress week, I was referring to the to the original incident from a few weeks ago, not the second pop during the comeback training. I suppose I am not THAT surprised that my back popped again during the aggressive comeback after only 2 weeks. The part that is confusing to me is that it popped during a low stress week after many months of normal, hard, pain-free training, in the same place it always seems to pop. Are saying that the acute detraining during a low stress week carries a heightened risk of injury in general?

              I suppose your statement that "performance and vulnerability to injury" are separate makes sense. When you say "there are no hard signs in this case," are you saying there is no objective way for me to recognize when I have returned to a normal state of low vulnerability? If that's the case, then I suppose you're saying that being desensitized for a long period of time (say 3months) does not mean I have reduced vulnerability to injury. Does that then imply that I may never again have reduced vulnerability to this injury? Or can rehab provide "reduced vulnerability to injury" AND desensitization through separate mechanisms?

              I am glad to hear that my back is probably ok. My perception of the sensation of the pain means to me that I probably wasted all the effort on the last few strength training blocks and will need to start all over again later. I suppose these things happen though. It's still better than a stick in the eye or, like, doing Crossfit.


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              • #8
                I understood the timeline, CRJ. I'm just not worried about the popping, as that doesn't mean that anything has happened requiring special management or care. That said, the pain experience is very real and I would manage things based on that. I do think it's good advice to plan on taking a slightly more conservative approach when coming back from pain.
                Barbell Medicine "With you from bench to bedside"
                ///Website /// Instagram /// Peri™ Rx /// Whey Rx /// Barbell Medicine Podcast/// Newsletter /// Seminars ///

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                • #9
                  I understood your position that this is not a medical problem and pain experience is real, Jordan.

                  I guess your guidance to avoid reinjury is essentially to just be more careful to some unspecified extent for an unknown, variable amount of time into the future at which point my risk for reinjury may or may not fall without any way of meaningfully measuring it since it is not tied to performance, lack of pain, or indeed any physically measurable parameter. That sucks for me, huh?

                  Well, I suppose I've taken enough of your time. I'll just leave it at saying thank you very much for taking the time to answer, and I appreciate you guys, your programming, and your outstanding educational content on youtube. I've learned a lot from you guys, and I do try to spread the good word to anyone who will listen. I even finally got my lifelong sedentary 38 year old brother following your beginner prescription, and he loves it.

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                  • #10
                    No, my specific advice is to plan for a longer period of retraining after these tweaks to build up your tolerance. This is reflected in our low back pain template. While we can't predict how long or what specific elements are needed to ensure success, a few general rules of thumb:

                    1) Plan on doubling your time to return to normal training, e.g. ~4 weeks in your case
                    2) I would plan on starting with sets of 10 @ RPE 5,6,and 7 and working towards 6 @ RPE 6,7,and 8
                    3) I think I may start with an altered tempo and/or ROM pull for the first two weeks, then go back to normal pulls

                    Hopefully that helps.


                    I'm pumped your brother is training btw!

                    Barbell Medicine "With you from bench to bedside"
                    ///Website /// Instagram /// Peri™ Rx /// Whey Rx /// Barbell Medicine Podcast/// Newsletter /// Seminars ///

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                    • #11
                      CRJ
                      Junior Member
                      CRJ i experience very similar issues with my lower back, either facet joint or SI joint inflammation that occurs sporadically throughout the year and is very discouraging. it does seem to occur more frequently when im more fatigued than usual, and in my case also recently happened on a low stress week after i had been hitting it pretty hard. also, stress seems to intensify the perception of the pain or "injury". All in all, this is an issue that happens to me 3-4 times a year and always derails my programming, but i always get back to normal training. i guess what i need to work on is not allowing this to derail my current progress, and view it more as a hiccup than a catastrophe. hope you get back to normal soon, and thank you Dr F for all your responses as this thread happened to be perfect timing for one of my questions as well.

                      cole g

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                      • #12
                        Thanks very much!

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