So I’m on board with BBM’s general concepts about injuries, working around them, avoiding catastrophizing, etc.
What I’m somewhat uncertain of right now is conceptualizing a relatively lengthy recovery period for an injury/pain.
As I mentioned in another thread, I seem to tick the boxes for pars stress or some sort of facet irritation. Standing single leg extension test produced pain on the right side. I’ve had “non-specific pain” from tweaks which seems to move around and I understand the strange nature of it, but this particular pain scales reliably with load (as well as hard bracing), is reproducible, responds to NSAIDs/Tylenol and seems to go away with inactivity. Happened June 14th and still dealing with it. Xrays (including obliques) showed no spondylolysis, unsurprisingly. Never been above about a 4 at worst (the other “stabby” back pain I’ve had was probably about a 7).
I know the procedure is generally the same – work around it, find alternative exercises, etc, and don’t exceed capacity, judged by marked increases in the subsequent 24-48h. I seem to have a hard time scaling up load without any discomfort, however. Currently front squatting a 25lb kettlebell and doing 1 set of 5-8 with an empty barbell doesn’t seem to change discomfort/pain, but anything beyond that (even barbell rack pulls) does seem to. What’s tricky about this is that the “load exceeded” ache often isn’t felt until about 6-12h post workout. Sometimes it’s immediate, other times not at all.
Long story short – is exceeding load via playing with load to find new tolerances setting back healing? Should I be aiming for being completely pain free in the following 24-48h? I want to be sure I’m not impeding recovery but still progressing.
My current hypothesis is that the reason it happened in the first place is due to a disproportionate amount of leg vs back strength. I hadn’t done barbell or bilateral leg work in well over 5 years (probably more like 7); having only ketllebells at home and falling off the gainz wagon meant exclusively doing single leg stuff. I seem to have overdone bilateral work without noticing it as an issue.
Should I continue to do things like Nordics and variations, single leg work, etc? Or should I be trying to scale leg work with back capacity? I’d really like to build a more resilient back and focus on bilateral work in the future.
Long story short – is exceeding load via playing with load to find new tolerances setting back healing? Should I be aiming for being completely pain free in the following 24-48h? I want to be sure I’m not impeding recovery but still progressing.
Probably not, and we would not aim for being completely pain free in the rehab process.
Should I continue to do things like Nordics and variations, single leg work, etc? Or should I be trying to scale leg work with back capacity? I’d really like to build a more resilient back and focus on bilateral work in the future.
There isn’t anything magic/special about Nordics in particular compared to other hamstring exercises, but we would encourage using a variety of both bilateral and unilateral movements (as opposed to narrow, highly specific exercise selection) to build a broad base of capacity during the rehab process. I wouldn’t be concerned with keeping things “proportionate”, as there really isn’t a “normal” amount of back vs. leg strength, for example. People simply adapt in proportion to how they are trained.
Thanks for the response, probably should have just made it a continuation of the other thread in hindsight.
Probably not, and we would not aim for being completely pain free in the rehab process.
Good to know, and glad to hear. The approach does seem to be working incrementally, even if frustratingly slow at times. Lifting usually alleviates discomfort for a while at this point.
There isn’t anything magic/special about Nordics in particular compared to other hamstring exercises, but we would encourage using a variety of both bilateral and unilateral movements (as opposed to narrow, highly specific exercise selection) to build a broad base of capacity during the rehab process. I wouldn’t be concerned with keeping things “proportionate”, as there really isn’t a “normal” amount of back vs. leg strength, for example. People simply adapt in proportion to how they are trained.
Right, and I didn’t mean to imply there was, they’re just simple to do with little equipment. And good to know re: exercise selection, I’ve been trying to incorporate very light good mornings, pause RDL’s with a bar/Dorian deadlifts, reverse hypers (when possible) and Nordic variations for capacity building. Unilateral RDL’s seem to be fine if unloaded or very lightly loaded but split squats are still bothering me for some reason.
Why is building capacity across a broad range of exercises the preferred way to rehab, instead of just using a few exercises? Can’t progress in one exercise carry over to other exercises as well?
The question is more of “how much carry over” and the answer is typically “not much.” It is also not necessarily the “preferred way” to rehab as there are instances where specificity absolutely matters. But often when someone has an exacerbation of symptoms it tends to take away some exercises and therefore makes it beneficial to use others. There is also the rather common phenomenon where athletes overweight 1) the importance 2) how much carryover there is in certain exercises. Most (re: not all) athletes could greatly benefit from doing a few more different exercises in the vein of being an athlete over being a specific type of athlete.
Follow up:
Recently had a significant flare up, first time since June of 2021. My lifts have progressed quite slowly as I’ve been busy but also trying to be conservative with progress as any faster usually meets the above criteria for exceeding capacity (only squatting about 80lb and RDLing the same about 8 months later). Some questions re: diagnoses.
I know they’re usually not all that useful for herniations/bulges or the like as rehab tends to be the same as for non-specific pain. Is there any other consideration for something like a pars defect (if it is something like that) that has reliable pain correlates with specific movements or loads? I’d rather ask here as most clinics/spine health sites/etc have typical useless information (stretching) or typical FUD (avoid lifting weights and become fragile at the age of 35).
Sorry to hear about your flare up of your symptoms, but overall it sounds like you have been moving in a positive trajectory with your rehab process.
To answer your question, the presence of a pars defect would not necessarily alter our treatment management. Rather, we would advocate for progressive loading and slow exposure to symptomatic positions while considering the context of the movements and activities are important to the individual. Set-backs unfortunately do happen and are a normative aspect of being human.
I’m glad to hear that; it can be difficult to tell. On the positive side, this is the first flare up I’ve had and my “re-entry” weights were considerably higher than before. Haven’t scaled weight up significantly but lifting seems to be improving things overall.
Glad to hear that re: pars stress. I’m frankly not sure if I have one. I wasn’t sure if it was worth doing the necessary fighting within the Canadian medical system to wait six months for one. Xrays didn’t show anything in any case. That said, my pain does seem to travel a lot and ranges from sharper/tighter pains higher in the lumbar area to achey, persistent pain in the sacrum and hip areas, so it may well be “conventional” LBP.
A few random questions if you have time:
-Is it generally well-accepted that individuals can still well-exceed their previous capacity over time?
-In the little I’ve been perusing it seems the Chinese Olympic team spends a lot of time doing low-back specific work, via loaded good mornings, etc. Is there any evidence, anecdotal/observational or in the literature that indicates this would be a good strategy in the future to improve resilience in heavy lifts? Wondering if unloaded work or body-weight higher-rep work would be beneficial as a supplement.
-Does recovery (specifically sleep length, quality and stress level) correlate well with recovery and resilience overall? I’m aware of the study indicating collegiate injuries are higher during exam periods but I’m not sure what the primary factor is there.
Just want to say again how much I appreciate what you guys do, you mark an important change in the trajectory of rehab and though pain science is fascinatingly complex, it’s encouraging that it’s leading to a far simpler/“teleological” solution overall.
Without operational definitions of resilience and recovery, this really isn’t answerable. Sleep does seem to correlate with injury risk independently, but mechanistically we don’t know why.
What’s the point of this then? Simply addressing weak parts in the chain to maximize lifts? I imagine there isn’t going to be a whole lot that’s dramatically effective in the presence of competition (constantly pushing limits) and PEDs.
The two definitions are probably not dissimilar. Something in the ballpark of:
Resilience – The ability to remain injury/pain free while performing relatively demanding tasks (obviously includes recovering quickly)
Recovery – The rate and efficiency of one’s ability to return to demanding work loads.
Higher tolerance of relative load/volume presumably factors into the above.
I’ve mentioned in other threads that at least for me, I suspect some degree of inflammation relative to diet is a consideration here, if not for “injury” then for pain. Still need to re-test as it has been a long time, and it hasn’t been a scientifically rigorous test but I had a much more difficult time with consistency around the time my hs-CRP levels came back around 8.2 mg/dl. The subjective difference in lingering pain is noticeable if diet isn’t in order.
Mechanism is interesting but “why” doesn’t matter as much to me at this point. “That” sleep correlates with injury risk is sufficient.
Apologies, forgot to add:
-Belts are frequently mentioned and I’m aware of what they actually do, but I’m not sure on your recommendations re: implementing them. I know they don’t “prevent injury” or do a whole lot more than increase IAP, but many people subjectively seem to feel more secure and less issue-prone while wearing them. Is there a threshold they’re recommended for in the longterm rehab process when you’re under “damn this is heavy” weights?