I have some non-specific chronic (a few months) low back pain that I feel during deadlifts. FWIW, it started during lockdown when my gym was closed and was not the result of anything sudden.
I’m rehabing by, among other things, doing higher rep deadlifts. It appears that what’s holding me back is more fear/avoidance than strength, let alone anything structural.
Should I be aiming for deadlifts that are comfortable or tolerable or something else?
Hey @quark - sorry to hear about the low back situation but sounds like you are managing well overall by continuing to train and find tolerable loads. I would continue to try and train the deadlift if that movement is important to your training goals. Try to find tolerable loads to build from each week. Check out this article HERE for general advice for managing through these situations. If you want a more structured approach for low back rehab, check out our template HERE.
Hey, thanks for your response. I suppose my main question is how much pain or discomfort to allow. For example, should I limit myself to weights (or ROM) that are pain free or should I push it to the point that it’s painful but I can complete the movement or should I be somewhere in between?
It occurs to me that this applies to just about any rehab question (other than perhaps tendinopathies). In some of the BBM materials the standard is comfortable (which I interpret to mean pain free or thereabout) and in others the standard is tolerable (which I interpret to mean pain but not so much that you can’t complete the movement).
Generally speaking we want engagement with activities to be tolerable, i.e. notice symptoms but you find the symptomatic experience tolerable. The way to think about tolerance is not feeling worse during or after the activity, and really only you can make that determination. We discussed this idea in the recent tendinopathy guide as well. We do not typically advice folks to avoid activities or only engage in activities if they are “pain free”.
This quote from your article seems a good guide: “Pain symptoms will be part of the rehab process … Even though symptoms will be present in rehab, they should not exceed your individual tolerance level (see figure 1 below). One way of thinking about tolerance is the idea of not feeling debilitated during or after activity, where pain is consistently occupying your mind, or you feel limited in your ability to complete routine daily activities.”
In other words, the rehab activity may increase pain while doing it and one can push through that pain, but don’t overdo it.
“The way to think about tolerance is not feeling worse during or after the activity”. I’m probably misinterpreting something, as this seems contrary to the idea that one might temporarily feel worse during the rehab activity.
I’d say you are overthinking this a bit, but if it helps go with what the first quote discusses. When I say worse in the second quote, we can define this as not feeling debilitated during or after the activity (this also goes for day to day life activities outside of training). Debilitated can be defined as in the first quote, consistently occupying your thoughts and attention and/or unable to do usual activities you were accomplishing with minimal to no issue. Hope that helps.