Hi! Happy new year, Dr. Baraki and Dr. Feigenbaum!
I’ve been a long-time lurker, and this is my first time registering to post a question.
As background, your content, along with your peer Alan Thrall’s, was invaluable to me when I first tweaked my back in June 2021. Tweaked on the 4th DL rep of 160kgs @ 77kgs BW. Was excrutiating at the time, but got over it quickly, basing myself on your content. It was the end of my NLP, but I easily transitioned into intermediate training.
I’ve gotten a new injury. My natural approach is that these things go away quite quickly on their own, but this one has taken a turn that I’m not familiar with.
Without further ado…
Basic vitals: 5’9 175lbs 37M, about 16 months of actual barbell training/early intermediate lifter, long torso, normal femurs, short tibia. (Okay at squats, bench, press; bad at DLs; beginner at Olys).
The injury event: December 26th,first pull of a snatch at 67.5kgs. Was attempting to match my power snatch PR, having beaten my power clean PR a couple of days prior.
Immediate post injury: recognized as a back tweak. Tried to recover mobility ASAP, Managed air squats/DLs and using just the bar. Some pain, but nearly full mobility the rest of the day. Took a train and a long haul flight that night.
Injury manifests in two different kinds of pain: shortly after my arrival, I noticed the injury “splitting” in two. One, the original classic low back tweak. Tight, some initial pain at movement, but improving quickly. The other, a new and more worrisome development, felt like tendon pain / dull-ish nerve pain (oxymoronic but that’s my best description) along my left glute and hamstring. This is the more worrisome symptom, as at the time of writing this, the low back pain is gone (as we would have expected). At the time of writing, the nerve-y pain flares up almost exclusively in the upper left glute (from a birds’ eye view, around 7 o’clock).
Observations: the pain can be largely avoided by bracing my core and maintaining a neutral spine. Certain movements (getting up from a sitting/lying position, stepping into trousers/shorts etc) necessarily require a moment’s relaxation and the pain flares up. It is a 4-5 / 10 in scale, so it’s not excrutiating like classic nerve pain, but still flares up and subsides. If classic nerve pain also feels like a bright light, this feels like a maroon flare. (Pardon the literary description). NSAIDs help, but I’ve tried to limit their use. When lying on the affected side, the flare-up is much more minor, but is instead felt in the lower glute.
Prior buildup: I’ve injured my left posterior chain a few times. In November I tore the lower left hamstring during a DL work set (hypothesis: it was my first day doing isometric split squats, my hammies were fried, and weren’t ready for heavy pulls in the same session). I followed Starr rehab protocol with B+ success; on one of the last days, after some volume DLs and squats at moderate weight, I noticed some tendon-y pain on the left side. This tendon-y discomfort was steadily subsiding, so I initially assumed my current pain was a re-aggravation of this injury. The pain was similar, but with the benefit of a few days, I suspect I was wrong.
Lifting post injury: I’ve done two HIIT-type circuits with a 12kgs kettlebell and some light bands. As stated, I’ve travelled, and no barbells here. Suits me fine as light load reactivation was the goal anyway. The only movement that lightly reproduces the discomfort is the bottom of the kettlebell swing. Goblet squats, RDLs, snatches, OH squat etc were fine. My plan is to attempt a light barbell day tomorrow: roughly 65% of 2x5 or 3x3 etc of several movements.
Core questions:
1) have you encountered this before? Is something putting pressure on my nerve? If so, is it because something shifted in my spine, or is instead something so inflamed that a week later, it’s still pressing on the nerve? I realize you can’t examine me, but if you’ve encountered something similar, you might have a hypothesis.
2) I intend on lifting (load-managed) so long as it doesn’t flare up or aggravate the injury. However, if the hypothesis is that something in my spine is out of place, should I alter this course?
3) When I see a specialist here, how do I separate the diagnosis from the predictable “stop lifting” prescription? There is no lifting culture where I live. I trust the doctors as medical professionals, but am weary of misguided prescriptions to step away from lifting. I’m weak compared to what you’re used to, but gymgoers here stare at you like an alien for squatting 3 plates for a working set. Doctors have told my parents (suspected inguinal hernia for my mother) that “young folks deadlifting 160kgs” basically have a deathwish. Imagine if they met you.
Thanks a mil Doc.