Ongoing Training - L5-S1 Injury

Pain & Rehab Forum [Moderated]
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Good Day,

i suffered from a “bulged disc” at L5-S1 as confirmed by my doctor and an MRI in January of 2018. The injury occurred during a WOD that included a high volume of deadlifts at 225 lbs. With rest and rehab following the injury i was able to get back to my normal training levels within about 8-12 weeks except purposely avoiding dead lifting for obvious reasons. part of it for me was mental since the injury occurred about midway during my pull from the ground and part of it was that i decided that risks of continued lower back injury were not worth the reward of pulling heavy weight from the ground.

Since then i have experienced at times quick “jolts” of lower back pain primarily in scenarios where my lower back is unexpectedly hyper extended. what i mean by unexpectedly is that there was no bracing in my core to prepare for the movement that may have put my back into hyper-extension. this could be something as simple as taking a step down onto an uneven surface and not being “ready” because the step was a little lower than you were expecting and it causes your back hyper-extend. hope that makes sense its a little tricky to explain but that is just one example.

Yesterday while performing a back squat during a warm-up set i felt this same pain to a greater degree coming out of the bottom of the squat and have been severely degraded since then. throbbing back pain, when lying on my back on the floor unable to to lift both legs at same time, pain walking, etc. clearly i aggravated the initial injury. i would say the experience was bout 70-80% as bad from a pain and debilitating perspective as the initial injury. 24 hours later at this writing, the pain is improving but I am no where near ready to return to activity. i should note that i do not now, and did not upon initial injury have any pain traveling down my legs and seems to be localized to that L5-S1 region.

My question to you is, what are your thoughts on why a back squat aggravated this injury so intensely and your thoughts on continuing to load weight on my back and train following this type of injury?

when i try to analyze what happened, it seems to me the most likely case is I ended up in the hole with my back in hyper-extended shape (butt cocked out).

i’m also worried about the mental effects this will have on my training because i experienced this pain right as i was ascending out of the hole and now it will always stick in my mind during a back squat that i could injure my back again. even with absolutely perfect form, does loading significant weight on your back continue to aggravate this injury over time?

thanks for any advice.

Btw, I am 40 year old male who has been barbell training for about 6-7 years.

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Hi, thanks for the post and sorry to hear about your recent episode, but I’m glad you’re starting to feel better. Hopefully we can help guide you from here. I’ll start by answering your specific questions, but the mental component you’re mentioning will play a big part in how you proceed from here.

what are your thoughts on why a back squat aggravated this injury so intensely and your thoughts on continuing to load weight on my back and train following this type of injury?
Why these events/episodes happen can usually be attributed to multiple known and unknown factors, some we can modify, like overall training loads and volume and outside life stress, and other we can not modify, anatomy, genetics, etc. One of the bigger predictors of injury is a prior injury, but this may have to do less with the disc changes that were identified in Jan 2018 and more with changes in activities, habits, thoughts, etc, especially if the majority of your symptoms are local to your spine, rather than radiating into your lower legs. Based on your symptoms and history, the best recommendation would be to reintroduce your activity and training in a slow, graded approach within your tolerance of symptoms. I would advise against discontinuing training and loading, you may just want to start off a bit lighter than you’re used to for now and work back up over time.

i’m also worried about the mental effects this will have on my training because i experienced this pain right as i was ascending out of the hole and now it will always stick in my mind during a back squat that i could injure my back again. Even with absolutely perfect form, does loading significant weight on your back continue to aggravate this injury over time?
I think a part of the issue here is your concept of bracing before you extend and trying to achieve “perfect” form. From a load perspective, it’s safe and productive from an injury rehab standpoint to keep increasing within your tolerance, whether that’s fatigue (RPE) or symptom levels. Getting over that mental hurdle takes time and exposure to what you’re fearful of, which is the hard part, but if you start light and work your way back up, you can allow yourself time to adapt to the movement (this goes for the deadlift too) and eventually decrease some of that fear. However, you might want to reframe what is “perfect” form as technique typically is a range that correlates more to performance than to injury risk. Essentially, you want to allow yourself more “wiggle room” in terms of being vigilant about bracing or form, and focus more externally on moving the weight, rather than internally on your body.

A little more information is always helpful too: What does your current training program look like?

That all being said, injury recovery and rehab is a personal journey and not everything can be explained in a specific way in a forum setting. If you feel like self-management is going to be challenging, we offer consults or we can possibly point you to a clinician we trust in your local area.

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Thanks for the reply. I suppose my biggest concern is that each time an episode like this occurs and assuming this will happen again, I am eroding away the cushioning between the vertebrae in my spine. I have no idea if it works that way. Do you have any specific recommendations from a rehab perspective for this type of injury and any techniques to mitigate aggravating this injury?

regarding my current training, it’s funny because this injury happened on day 1 of my deload week during my warm up set. The previous week was my most intense week during the last 4 training weeks and I injure myself on the start of the easy week. go figure…

right now I’m on a “physique” template from juggernaut training systems (JTS) consisting of 3 x 5 week cycles (mesocycles) I am just finishing up mesocycle 2 this week and was feeling great until this happened. Not sure if you are familiar with JTS…

I ran the Bridge at the beginning of the year for 8 weeks (minus the deadlifts) to check it out and saw some decent gains given the short duration. It was the first time I ran a program with sets based on RPE. I have to say I find that makes much more sense from day to day. then I went back to mindless Crossfit WODs for a couple months and then got back into some structure with the template I’m on now.

The jist of the program is that your working in the 80-90% range of your 10 rep max and taking your sets to within 2-3 reps of failure across various pulling, pressing, quad and hamstrings exercises. I end up squatting 3 times per week. The volume builds over the course of the program. This one is not about increasing 1RMs :slight_smile:

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“I am eroding away the cushioning between the vertebrae in my spine. I have no idea if it works that way”
The first thing I would say, this is definitely not happening. It’s actually quite the opposite, loading and strength training has the ability to promote disc healing, increased cartilage thickness and bone density of the vertebrae. What you’re experiencing during these episodes is more of a symptom increase which is probably more related to a load or stress intolerance, more so than a tissue change, which happens more slowly over time.

Do you have any specific recommendations from a rehab perspective for this type of injury and any techniques to mitigate aggravating this injury?
Nothing beyond continuing to train. You can still train the deadlift pattern without pulling from the floor. Not sure if you’ve tried RDLs or elevated deadlifts recently, but I’d say it’s worth exposing yourself to some hinging as avoiding entire movements won’t be the best long term solution. Doing that style of programming is totally fine, you’re essentially doing higher rep work within 7-8RPE, and if you’ve had success with The Bridge in the past you can always return to that as well.

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Can you give specific citations for these? I suspected it might have been from Foster et al, but I couldn’t find it listed in the abstract…
Thanks in advance!