Will try and keep it brief. Low back injury starting in military, off and on with a handful of tweaks over the years. Worse with prolonged sitting, etc. Had been doing exclusively single-leg work for the last several years due to a variety of reasons (local gym closed, only DB’s/KB’s at home, life priorities changing and stupidly losing lifting priority, etc). Finally bought a squat rack and barbell. Recently-ish (7 weeks ago) tweaked back doing deadlifts; foolishly wasn’t on a program and was doing deadlifts every 2nd day, was trying to grease the movement with 135 but probably exceeded my load tolerance as the most my back had handled over the last few years was only about 90lb per leg. Also haven’t really done conventional DL’s before and my cues were poor which likely didn’t help allocate load properly and in hindsight I was extending more than appropriate.
Long story short, the “tweak” feels pretty predictably like recurring pain – it became sharp and intense over the course of a few days, didn’t response to medication, seemed to “travel”, got worse with sitting, etc; pretty cookie-cutter issue for a 30+ year old. The issue that’s more concerning is a dull ache in my sacrum/lumbar area that’s been relatively predictable. It feels pretty central to my spine (and slightly to the right), and spreads out along the hips if it gets worse. It gets obviously worse with load, and seems to go away with rest. Prolonged standing and one-legged extension (on the right side) exacerbates it predictably. It doesn’t feel stabbing or random, it feels like a linear ache that doesn’t like load, especially shear (if I hold a DB out in front of me it’s immediately noticeable). Hard bracing exacerbates it as well. Got imaging before finding BBM and no visible pars fracture, but I know Xrays aren’t particularly sensitive and maybe none of that matters anyway. Only within the last 2 weeks have I been able to comfortably carry my 25lb 1.5 year old for short periods of time.
In any case: is it likely part of the same problem? Do I treat it any more carefully than the non-specific issue? The issue is that it seems to be somewhat triggered by bracing and load, so I’m not sure how much to push into it in the expectation of adaptation or to take it slow. Only doing squats and DL’s with a bare bar now. The non-specific issue seems to be helped by a moderate amount of load and activity, but this one not so much, it scales much more like a regular “injury”.
Regarding programming: In an effort to rehab the area as well as strengthen it long term, is it wise to get onto a program where higher rep (i.e. 8) squats and DL’s happen multiple times a week, or would throwing variations in to lower low back stress be helpful (front squats, rack pulls)? I’m not sure whether to approach this from a “get the back proportionately strong” angle, or to be more conservative, since I suspect the discrepancy between leg strength and back load tolerance to be part of the issue.
In any case: is it likely part of the same problem?
We can’t really say, and our answer wouldn’t really change the path forward either way.
Do I treat it any more carefully than the non-specific issue? The issue is that it seems to be somewhat triggered by bracing and load, so I’m not sure how much to push into it in the expectation of adaptation or to take it slow. Only doing squats and DL’s with a bare bar now. The non-specific issue seems to be helped by a moderate amount of load and activity, but this one not so much, it scales much more like a regular “injury”.
It’s unclear what is meant by “more carefully” here. Our typical guidelines are that if you train and this markedly increases symptoms (during and in the subsequent 24-48 hours), it suggests that you have exceeded your tolerance for that day and modifications are in order – whether to intensity, session volume, or exercise selection. While we don’t get overly concerned about transient symptoms during a session, we don’t deliberately “push into” them too often – rather, we aim to find a tolerable entry point that will help desensitize the person in the early phase, then transition into building capacity/tolerance from there.
Regarding programming: In an effort to rehab the area as well as strengthen it long term, is it wise to get onto a program where higher rep (i.e. 8) squats and DL’s happen multiple times a week, or would throwing variations in to lower low back stress be helpful (front squats, rack pulls)? I’m not sure whether to approach this from a “get the back proportionately strong” angle, or to be more conservative, since I suspect the discrepancy between leg strength and back load tolerance to be part of the issue.
We would recommend a relatively high amount of training variety early on, including both unilateral and bilateral movements. These may include things like single-leg and regular RDLs/deadlifts, split squats/lunges/lateral lunges, good mornings, back squats, etc. – potentially with modified ranges of motion or modified tempo. You don’t need to include ALL of these things, but we tend to use more variation than less here in order to 1) manage overall loading and 2) build capacity in new/different ways. As things calm down, variation can be trimmed down and loading can increase to be more in line with longer-term goals.
If you hare having a hard time with progression here, consulting with our rehab team would be a good next step.
Since non-specific or recurring LBP is multi-faceted and often unrelated to “injury” I’m more inclined to ignore it within reason. For something that is a bit more linear in nature I’m mostly concerned about “worsening” the issue. I doubt spondylolysis is a huge concern at 31 but I don’t want to create a potential issue that can be avoided, but I assume the path forward is the same anyways and so long as tolerance is being constantly and largely exceeded it will clear up over time.
Our typical guidelines are that if you train and this markedly increases symptoms (during and in the subsequent 24-48 hours), it suggests that you have exceeded your tolerance for that day and modifications are in order – whether to intensity, session volume, or exercise selection. While we don’t get overly concerned about transient symptoms during a session, we don’t deliberately “push into” them too often – rather, we aim to find a tolerable entry point that will help desensitize the person in the early phase, then transition into building capacity/tolerance from there.
Good to know, I’ll use that as a general guide. I tend to ignore transient symptoms unless they are obviously progressing and alarming during a given session, and they seem to be somewhat hit and miss anyway.
We would recommend a relatively high amount of training variety early on, including both unilateral and bilateral movements. These may include things like single-leg and regular RDLs/deadlifts, split squats/lunges/lateral lunges, good mornings, back squats, etc. – potentially with modified ranges of motion or modified tempo. You don’t need to include ALL of these things, but we tend to use more variation than less here in order to 1) manage overall loading and 2) build capacity in new/different ways. As things calm down, variation can be trimmed down and loading can increase to be more in line with longer-term goals.
This is also good to know. I’ll probably start off doing a more varied hypertrophy-oriented program. I’d like to grease patterns and improve the skill of deadlifting but I’ll have to vary it more for the time being.
Theoretically, do you think single leg dominance can potentially hamper bilateral progress in terms of leg capacity far exceeding back capacity? I’m concerned it will be a future issue but have little experience with it.