Longstanding episodic LBP. Seeking advice for ongoing Mx.

Long time reader, first time poster (at least in the forum. I’m Lenk on the FB group)

For financial and bandwidth reasons (about to be unemployed, moving house overseas) I’m not in a position to get a consult at the moment, so I’m turning to the forum to steer me right. It’s a bit of a long story that probably would benefit from a one to one, and that’s certainly my plan later on (time and money permitting) if this doesn’t work out.

29 M ~95kg

e1rm
Squat ~125kg
Bench ~90kg
Deadlift ~130kg
OHP ~60kg

Background
Lifting for about 5 years, episodes of lower back pain since almost the beginning of training. Did a range of novice programs (SL, GSLP, SS) and several resets, saw three physios. The last of which in hindsight was very closely aligned with BBM’s take on pain and injury (if you want an Australian counterpart for the team he’d be a great candidate).

In fairness to them none tried to tell me that all I needed was regular adjustment, or that I’d “blown my back out” etc.
They did some massage, gave some corrective exercises and stretches, the BBMish guy (record holding PL) even tried programming for me but I was an idiot and didn’t listen (I was drinking the SS flavoured koolaid at the time).

Ran Madcow, TM, 5/3/1 in various iterations then found BBM and ran The Bridge, had a layoff, SS, endurance template, and most recently the bridge again. Had flare ups of LBP here and there that have meant since TM my lifts have remained at roughly the same (abysmal) numbers. Since finding BBM lifts have improved but something always causes me to take time off training (shift patterns, illness, holidays [no, I couldn’t find a gym in the middle of Iceland], but most annoyingly low back pain). I’ll take full responsibility for the first three. But the back pain is why I’m here.

I’ve tried training through it, I’ve tried taking breaks, I’ve tried lowering the weight until the pain subsides and working back up, but I seem to repeatedly get these flare ups whenever I’m on the verge of actually improving. I only got to my current numbers by training through the pain on occasion.

I saw an SS coach here in London and he tidied up my form. There was nothing egregiously wrong, certainly nothing that according to the BBM paradigm would cause injury or pain.

The pain itself has moved and changed over the years. Initially it was very central, directly over the lower vertebrae close to the sacrum. Aggravated by tilting the pelvis anteriorly, and by bending forward at the hips, flexing the lower back.
About 2 years ago had some minor radicular symptoms in the right leg, these self resolved with time. No red flag symptoms.

Over the past year or so it seems to be localised to the right side of the low back, just adjacent the lower vertebrae. Bending forward seems to cause pain, but not the onset of pain. The onset is always either squatting heavy, or, most recently, pulling heavy (heavy referring to sets of 5@8 or greater).
I’ve noticed when it does flare up I do avoid bending forward and will tilt and try and move in such a way not to cause pain.
It varies in intensity but it’s never more than a 4 or 5. Usually more 2-3. Training through it makes it worse though so I’ve stopped attempting that. It’s also aggravated by sitting, standing or walking for long periods.

To clarify, it isn’t always there. I’ve had weeks of pain free training, but eventually, maybe once a month, usually when it’s looking like I’ll improve my max, I’ll squat or sometimes pull, get the pain, and then be stuck in this endless cycle of managing the pain rather than productively training.

Current situation
I’m at the point where I’m really sick of this back pain. It’s becoming more and more of an emotive issue for me. I’ve persisted for ages but every time it happens it just seems like another defeat. I try and rationalise, keep calm, not get emotional about it, and I’ve largely been successful with that, but it’s becoming more and more difficult. I don’t have any lofty goals or competitive aspirations. I just want 1/2/3/4 for reps and to look a bit jacked.

All that said, I’ve come here with a plan, and wanted some input.

Plan
My feeling is that I have become way too sensitised to low bar squatting and conventional pulling. Such that any heavy weight brings on (at least subconsciously) a lot of anxiety around injury that ends up being a self fulfilling prophecy.

So, my plan is to run a BBM program and have leg press/sumo pull as comp lifts, and then either front, high or low bar squat and conventional pulls programmed as per the rehab guidelines (2-3x10-15, 4x8, 5x5 etc.) in the accessory slots.

My thinking is that by having leg press/sumo as a novel, once a week heavy movement, I’ll at least maintain a bit strength without squatting or involving my low back too much. And use the other slots to slowly acclimatise myself to squatting/pulling heavy conventional again. Maybe progressing from front, to high, to low bar over time, slowly involving the low back more.

So, my questions are…

  1. Does this sound like a reasonable plan?
  2. If so, over what time frame should this be implemented?

ie. How long should I spend doing 15s, 10s, 8s etc.
I appreciate I’ve essentially had 5 years of negative association towards low bar squatting so it might take awhile to change my thinking.

  1. Which program would be best suited?

I have access to the bridge 1.0, endurance program and 3DHyper. I’m leaning towards 3 day hypertrophy. I’ve never run it before though.

Thanks in advance for the input. Happy to answer questions. Sorry for the essay.

Lastly, I’m open to sticking with front or high bar and sumo if this allows me to train productively. But I still feel like a period of ‘reprogramming’ is a good idea so that I’m ultimately more resilient to this kind of situation in the future.

Hey,

Sorry to hear about the persistent low back pain.

I think it pertinent to re-conceptualize pain otherwise this new plan you’ve created may not be beneficial. What are your thoughts about the meaning of the symptoms you are experiencing?

I suppose that’s changed a lot over time.
Five years ago when it started I attributed the pain to improper technique. I deloaded and adjusted my technique several times, but this never lead to any long term pain reduction.
Past that I began to fear it was something more serious like a disc injury, catastrophised about that for awhile.

The first physio I saw allayed those fears for the most part. They said a possible cause was a particularly mobile lower vertebrae which may have been causing the musculature around it to tense up in an effort to provide structure, that tense feeling in turn causing the pain. This fit with my own ‘narrative’ as I have hypermobile joints and the idea of a particularly mobile vertebra wasn’t out of the question.

Past that, the last physio I saw, (the PLer who reminds me of BBM) told me straight up that he wasn’t sure what was causing it exactly, that it was very difficult to find a cause for back pain, that imaging was usually unnecessary and wouldn’t change anything anyway. He said it might be a disc related issue but stressed that this was not a diagnosis, and even if it was, was nothing to be concerned about. He encouraged me to keep training rather than take time off, and to stop running LP and do his program he wrote up for me.

After that I just sort of persisted with the pain, being pretty unsure about it’s cause or what it meant.
After that found BBM. Relaxed a bit about the cause, I’m fairly happy it’s not causing any long term damage as I’ve been dealing with it on and off for 5 years, and I’m still walking around and such.

I currently view the pain as annoying, a barrier to my own goals I’ve set, and a complication in my life that isn’t needed. I work as a paramedic and one of the reasons I lift is to be better prepared for the physical tasks I have at work. Currently I feel like I’m having the opposite effect in that I’m making things harder by going to work with a sore back. It’s manageable, but not long-term.

I’m not concerned it’s causing any long term tissue damage. It might be load related as it occurred while doing LP, and more recently on higher intensity or higher volume days of the bridge. I think at least part of it is that I’m hyper aware of my low back. When my working sets get heavy I have a tendency to rely on my low back to move the weight, and whilst I don’t always feel the onset of the pain acutely, when I do, it’s coming out of the hole, and feeling the weight shift from being moved with my legs to my low back. I’ve tried keeping my knees forward, and I don’t think they shoot back too ridiculously, maybe just the level of low back involvement in LBBS is too much for me?

I hope that’s kinda the answer you were looking for.
Thanks for the response Michael.