Thanks so much for the useful content that you put out - I’ve listened to many of your podcasts (particularly episodes 19 and 20) and read through your blog.
Context:
Around eight weeks back I started getting consistent lower back pain after deadlifting heavy twice a week in preparation for a meet and training through the pain. My lower back would get sore, but the pain would die down after 1-2 days, just one specific spot would still be painful. This spot is on the left side of my SI joint, at the top of my glute - it doens’t hurt when I press on it, but the pain radiates into my glute, and occasionally I even get pains shooting down my left leg, on the outside of my knee and calf and on top of my thigh. After the meet (six weeks ago) I stopped deadlifting and then also stopped squatting a week later, as any deadlifting and squatting would give me radiating back pain.
Steps taken:
I went to a physio who specifically works with powerlifters and he said that I’d likely annoyed one of my disks. He told me to take Iboprofen and to focus on back strengthening work two weeks (McGill big 3, bodyweight back extensions). He also said my hips were sightly uneven, and my legs weren’t the same length (tiny difference), so he had me do press ups onto a towel on my left side and made some manual adjustments. I now understand that there’s hardly any motion possible in the SI joint, so that part of the diagnosis he gave me kind of feels like bogus, based among other articles on this one: Navigating Potholes: My Back Pain Experience | Barbell Medicine. Not 100% sure though. I went back two weeks later and he did a few more tests, checked my form on squats and DL, and cleared me to start lifting again, light for two weeks, followed by heavier, partial ROM (box squats, DLs off blocks). This was four weeks ago.
When I tried squatting light again (~90 lbs for multiple sets of 5-8 reps) it was completely pain free in the gym, but my pain would flare up again afterwards (after 1-2 hours) to quite intense levels. I tried front squats as well and had the same results - pain free in the gym, painful 1-2 hours later. Since then I’ve been trying to train modified, focusing on lunges and split squats for lower body, doing more core work, etc. This is always pain free while in the gym. Sometimes I’m fine after training, and sometimes the pain flares up again later that day - still in that one spot, radiating out. Benching sometimes makes my lower back feel painful after training as well. Since last Friday was the first week I decided to take fully off lifting (doing low impact cardio and swimming instead), and I went to yoga yesterday, and I had as much pain last night as I had after I tried to squat again. I try to walk a lot during the day and I have a standing desk at work, which helps me control the pain.
My main two questions are these:
- How can I determine what range of motion and load I can train if I don’t have immediate feedback? Is this just a matter of trial and error?
- I’m not sure if the fact that my pain comes so delayed, means it’s mainly in my head/that I mainly just got super sensitive to any lower back pain, as you often talk about - or if there actually might be something wrong with me. I asked my physio what would happen if the pain in that one spot wouldn’t disappear, and he said there were a few timelines - either I’d go back to training, and it’d go away over time, or it wouldn’t, and he’d send me for an MRI. But given your thoughts on MRIs, I’m not sure it’d be useful for me to get one.
All in all I’ve been dealing with this for around 8 weeks now, the first two of which I was still squatting heavy. I’ve been training “modified lower body” (lunges etc and the occasional light squats/front squats) for the last 5 weeks, with pain not really getting much better. I’d be super grateful for your thoughts!