Hello Barbell Medicine,
I first experienced debilitating nerve pain in my lower back (right above my butt, right side) when I was around 15, after a soccer game. I could not go to school for a week so had an MRI scan. The doctor said it was a bulging disc and that it was genetic. I have also been lifting since early teens, and I kept lifting after the pain went away in several weeks. Since then, I occasionally feel discomfort but it always goes away and never becomes a problem. Now I’m 22 and last week, for the first time in a few years, I experienced incredible pain in that exact same spot. I spent the weekend in bed and have not been to the gym since (although the pain decreased very rapidly; I am fine now with slight discomfort while sitting). I know that you guys do not recommend long breaks in such circumstances and I am not keen to take one, but I am slightly wiser than I was at 15 and don’t want to get crippled. So I would very much appreciate your advice on how to continue training in the safest way possible. I know that this issue has been discussed on the forums before and that mine is not a singular case, but I am also assuming that severe back pain at such an early age is not very common.
Hi, thanks for the question and post, glad to hear you are starting to feel better. I would say off the bat, it’s definitely common to have a significant episode of back pain at an early age. The data suggests that over 80% of people will have a significant episode of low back pain, enough to cause changes in day to day function, in their lifetime and it’s not linearly correlated with age. Furthermore, we don’t have good evidence to support that lumbar disc bulges are genetically predisposed to certain individuals. On the other hand, there seems to be some plausible evidence to suggest that spinal loading increases disc healing and thickening.
My advice to you would not be much different than most people: to resume activity and training in a graded fashion. I may have some more specific advice but I would need more information about your activity. What does your training program currently look like?
Hi, thank you very much for your answer. Currently I am training five days a week, squatting, benching and pressing twice and deadlifting once. Personally, my workouts are more focused and enjoyable when I do one or two big lifts a day rather than three. The set-rep-RPE scheme of the General Intermediate Template worked well for me, but I bastardised the rest. Specifically:
Monday
Belted squat: 3-5x5@RPE 7-8 (RPE increases as fatigue accumulates but my squats most often do not reach RPE 9 and do not go below 7)
Belted high bar squat: 3x8@RPE 8
Ring pull ups: 3-5 sets of 6-10 reps
Tuesday
Paused bench: 4-6x5@RPE 8-9
Belted press: 4-6x5@RPE 8
Cable flies: 3x10-12
Lateral raises: 3x15-20
Curls: 50-75 total reps
Wednesday
Deadlift: 3-5x5@ low RPEs, hard to gauge (the heaviest single I’ve done was 185 KG@RPE 7-8, this week I did 5x5@120 KG. This was the first time I deadlifted since I posted). I’m building back up.
Seated rows: 3-4x15-20
Curls: 50-75 total reps
Friday
Paused squat: 5-6x4@RPE 8-9
Ring pull ups: 4-5x6-10
Lunge: 3x10-12 (I’ll see how that works, haven’t done it since my back hurt)
Saturday
Bench: 5-6x4@RPE 8-9
Belted press: 4-5x8@RPE 8
Incline bench: 4x6@RPE 8
Curls: 50-75 total reps