Gauging effort in rehab

Pain & Rehab Forum [Moderated]
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Hello,

To summarize my situation (M/36 years old), I have some persistent lower back pain for some 8 weeks now. It started with just some tenderness in my lower back sometimes but it was mostly fine, so I kept training without modification to my schedule. This pain kept growing and increasing, but for about 5 weeks did no modification to my program, because, most of the time I was fine performing the movements (even improved on some), sometimes it went away with activity or rolling and stretching and there was no predictable pattern as sometimes I performing, for example deadlifts actually made the pain go away will other times it worsened. This kept worsening and it started to interfere a lot with sleep, which I presume then started to make everything worse as I assume my recovery started to worsen even more and I kept not changing the program.

For some context, while I do my deadlifts and back squats I am by no means passionate about barbell work, I just do them for strength and conditioning (and am quite weak at them, as I’ve only started training them regularly less than a year ago). What is more important to me is handbalancing (which is just a hobby, but one that I love), which requires me to be somewhat suppler than most people in things like pike flexibility. Which is precisely what went to shit with this, because while in general you don’t want all your flexibility to come from the lower back and more from the hamstrings, I do have to flex your lower back, which is now very stiff, just feels like the last joints wanna be locked in extension forever. The pain levels are not by any means awful, they are honestly just more annoying than anything, it’s just that this does affect my performance and in general I am not feeling very athletic as any sudden jolt or move in the back when I am not being careful or warmed up is very uncomfortable.

So I stopped being stubborn and had my program changed to be able to manage load more appropriately to the current situation (also reading a lot of Barbell Medicine stuff, because the message of moving resonates with me)… Two weeks now and I feel the situation is improving (sleeping much better), albeit more on a week by week basis. Basically weekly load on the main lifts is less and more in line of “do what you can without issues” for gauging intensity. Also some easier exercises to try and work more range of motion in the back.

My question though is this: doing squats or deadlifts, on the workout itself, it never feels painful, having a neutral back on anything, even loaded (obviously to a degree that I can maintain) is absolutely fine, the issue though is that one the next days, I will feel this problem worsening, so the question is should I judge the RPE relative to the current workout, i.e. if the movement feels ok, gauge the intensity based on your actual perfomance, or should I be erring in the side of caution because I am still exceeding my recovery capacity ? Is it realistic to expect that this type of injuries keeps improving always, so a regression in pain or performance is always a sign that the intensity and load was gauged incorrectly ?

In advance, big thanks, also for the amazing content you put out dealing with the topic of back pain.

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Hi, thanks for the post and questions! I’m glad you’ve been able to see some progress with the program modifications and education. Those are excellent questions, so hopefully I can provide some further guidance for you.

“The question is should I judge the RPE relative to the current workout, i.e. if the movement feels ok, gauge the intensity based on your actual performance, or should I be erring in the side of caution because I am still exceeding my recovery capacity?”

Yes, I would gauge the RPE based on the intensity of the performance within your symptom tolerance. If the movement/load exceeds your tolerance, then you can shave off some weight. There’s some evidence to suggest that exercising with tolerable symptoms can be beneficial for short and long term outcomes.

“Is it realistic to expect that this type of injuries keeps improving always, so a regression in pain or performance is always a sign that the intensity and load was gauged incorrectly?”

A regression in either pain or performance is typically part of the process, it’s rarely linear. It could have some correlation to your activity (intensity and volume), but there may be other factors involved. Obviously these factors of load and volume can be modified easier, which is why we recommend altering them. So if you experience regression, you can try to repeat the previous session or decrease load/volume slightly to see if that allows you to progress, but it doesn’t have to be a smooth road to get the desired long term outcome.

Hope that helps, let me know if you have any other questions or updates.

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So to update a bit on my situation. Things have been improving, but following a very non-linear model. I have tried applying the same ideas of BBM to flexibility and have gotten much more comfortable with flexibility.

The other day though, after a two weeks vacation, getting back to squatting a weight, just for one set, I probably overestimated the load I did and again, while doing the set was no problem (so no decrease in performance), the next 2 days after there was a sort of regression in back pain. I feel this is completely natural and I am not worried about this part.

What concerns me though is this, one thing that I feel consistently has an impact is actually not moving or sedentary activity, in a way, I am not afraid of exercising and moving in general, but in I consistently feel this nagging pain getting worse after let’s say long periods of sitting or after a night’s sleep. Unfortunately I cannot change the sedentary aspect much, because I am a software engineer by trade. In a way it’s like the opposite of kinesiophobia (lol) and it concerns me because ideally I shouldn’t have to warm up and move all time to not have pains in my lower back.

This is the difficulty I am having with the process, I have been improving my performance in training with reduction of issues performing movements, but it’s still hard for this transfer fully to “non-training” life.