Lower back, right sacroiliac joint after failed 510 lb deadlift

Pain & Rehab Forum [Moderated]
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So, for the first time in my life today I sustained a lower back injury. I had been practicing power cleans and got a few form pointers from a fellow gym-goer that may have carried over into my deadlift. Namely dropping my hips a bit lower at setup and looking up rather then looking at the ground/chin tucked. Even though I didn’t necessarily agree, I played around with this for the power clean. When I moved on the the deadlift I neglected to fully switch back to my normal form. Once I got up to my working weight and pulled a set of 5 at 455, I decided to go for a single or 2 at 510, something I successfully did last week. On the first pull, just after passing the knee, the lift got really sticky. I decided to power through and then something went wrong in my lower back. I had to put the bar down and could barely move. I think having my head up and hips lower caused my back to round out, compounded by pulling that weight beltless (will be investing in a belt). Had to enlist a coach to help unload the bar and take a taxi home rather then the walk I usually do. Yesterday I was in quite a bit of pain. Today I have decent mobility, and only a dull pain unless the muscle spasms in my right lower back, which can then be excruciating for a few seconds. The dull pain and tenderness to the touch are in the same spot I have a 3 inch diameter red mark on the surface of the skin. The area is right over my right sacroiliac joint. Going to see a sports medicine/chiropractic doctor Tuesday morning. However any pointers on rehabbing, activity I should be doing now, etc would be super helpful. I had also planned a 30 mile hike for next weekend and now trying to reassess if that is still going to be feasible.

Thanks in advance! Ended up on this forum at the reccomendation of some redditors on the starting strength Reddit.

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Hi Bryan, sorry to hear about your low back injury. The good news is that you started to see some improvement the next day, which a good sign to maintain movement and activity. My general recommendation in these scenarios is to keep moving and stay active within your tolerance. This can be anything from walking, to bodyweight exercise, to even lighter barbell movements; avoiding complete rest is best indicated when it comes to acute low back pain. The hike may very well be possible depending on you feel throughout the week, especially as you expose yourself to more activity.

As for the injury mechanism, always difficult to figure out why/how something happened (outside of the obvious contact injury, but even then there is some ambiguity) but it’s usually a number of probabilistic factors that goes into it. So while there may be nothing inherently wrong with dropping your hips and looking up, it could’ve been different from what you were accustomed to, factoring in to the overall situation but definitely not a do or die scenario.

Let us know how you’ve been feeling the last few days and how the doctor’s visit went! Again, like I said, my biggest recommendation is to stay as active (within your tolerance) as possible.

Alan also has a great video that may help: https://www.youtube.com/watch?v=riq-DfDDimc

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Hey Mike, thank you. Well, I am feeling better. Still some stiffness and tightness. The doctor I went to see is 90% sure it is a compressed/herniated disc or whatever the correct terminology is. So I have been told to take advil and engage in non axial movement, being aware of pain. He seems to think that I lost core tension, rounded my back and acutely compressed the disc. He could not be conclusive with an xray as it was l4-l5 and behind the hip bone, so I am going in for an MRI later this evening. The tissue is still tender to the touch. Some part of me still hopes it is an acute muscle injury, but that is likely denial. He didn’t see an issue with hiking this weekend as long as pain does not increase.

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Well, I do have a herniation on L5 and L5 S1. The doctor said likely I had pre-existing trauma on those vertebrae - and thinking back I did. He said the MRI was indicative of this because of ligament hypertrophy around this injury. He said that I like lost flexion and rounded my back applying pressure to these previously damaged/weak discs. He did clear me to hike, bring my 3 inch powerlifting belt with me for support if I experience discomfort. I was told to expect healing to occur, but full healing to take 3-6 months due to the low vascularity around the spine. He wants me in for chiropractic/pt once a week for 12 weeks and says I can start lifting lightly next week. I’d like to get an idea of a barbell rehab program. What would be a good path to take? Pain has subsided 95%

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Since I am pretty much 100 percent pain free except some sciatica if I sit too long… I have decided to do the lower back rehab template. I’ll keep this thread updated on how that goes.

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Hey Bryan, thanks for the responses. Glad to hear you’re feeling better! How’d the hike end up going?

Have you started looking for a PT or chiropractor yet? And where do you live? Maybe we can help guide you to see someone who is knowledgeable about training/lifting.

As for the barbell rehab program, generally it comes down to finding the variations and loads (probably using an RPE based approach) that are tolerable, and working up intensity progressively over time. I would have to know more about your prior training and goals going forward for more specifics. This is why working with a provider who is knowledgeable about training will definitely help. That being said, if pain has subsided 95%, it’s hard for me to say that you will need much. Just comes down to how comfortable you are with returning to modified training and what your access to providers is. We also provide consults for those who need a more structured plan and guidance.

As for the diagnosis, it’s not too surprising that you have findings of disc changes in your low back as the incidence is prevalent even in people without low back pain. Most of these changes happen over time, as the MD mentioned, but can be normal adaptations to life and training. I won’t deny that it can have some contribution to your current episode, but if you’ve been training without low back pain for some time now, there can be more modifiable factors to focus on, i.e. training, activity levels.

As for the mechanism, rounding of the spine is pretty much unavoidable, especially during heavier attempts and we don’t seem to have strong evidence in research on humans that suggests that rounding can cause injury/pain. We even have some research that shows in individuals that deadlift with what appears to be a “neutral” spine, end actually flexing their lumbar spines up to 23 degrees under live x-ray. Similar to the disc changes, it doesn’t mean rounding can’t contribute at all to injury mechanisms, but I like to think more in terms of what’s modifiable. So if disc changes and rounding are within normal limits of spine anatomy and movement, we can acknowledge them, but also look to other areas where we can make changes and/or move forward.

Fortunately, most episodes of acute low back pain episodes resolve within 6 weeks, which you are already experiencing, and we know that if we want to reduce re-occurrence, we want people to resume normal activities as soon as tolerably possible. I understand if this is new to you, it can be confusing in light of what the MD had told you about your MRI, but I said all of this because I hope you can see the positive in your rapid improvement of symptoms and how some of these findings can be within normal limits, as we know that avoiding movement and activity out of fear of further injury can actually predict persistence of pain and I would hope to help you avoid that.

Thanks again for replying and let me know what further questions you have!

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Hi Mike,

The hike wasn’t meant to be. My brother had a mechanical issue on the vehicle we were going to use. I spent the time thinking on how to rehab this instead, and catching up on my todos!

So… yeah I am working with local sports medicine doctor/chiropractor. The self same one who requested the MRI. However he is advising I lay off of barbell lifting “forever” if I don’t want this to get worse and I am sure I don’t agree with his approach 100%. He is also doing some manual manipulation of the spine, on which the science (of doing that when an acute injury is present) seems dubious at a cursory glance to me. I am definitely wanting a second opinion.

I purchased the low back rehab template bundle from you guys and I will share the MRI during the included consult and get your impressions. I’d probably like that consult to be at the outset, then maybe purchase 2 more at the middle and end. I personally feel fine and the more I move the better I feel. I am in New York City and local recommendations are welcome, but totally comfortable working with somebody online as well. I have 100% body weight range of motion and everything back pain free. My goals are to get my squat up to 500, deadlift 600, bench press 315, bf under 20% (or to lose about 20 lbs from where I am now) and ability to run under an 8 minute mile in the long term. My shorter term goals are to rehab this injury and make any habit changes to prevent recurrence. I also see it as a time to work on my cardio a bit with the energy I will have from not lifting at more maximal intensity. My previous training is about 2.5 years of barbell lifting, starting with a novice linear progression and then the Texas method. I am relatively active, walking 2-3 miles a day and going on longer hikes occasionally but not doing significant cardio conditioning. I sit all day at work and at home quite a bit as well. I invested in sit-to stand desks as part of the outcome of this incident.

Thanks for your thorough reply.

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@Michael_Ray Just tagging you to let you know Bryan will be doing your low back template.