Persistent lower back pain

Pain & Rehab Forum [Moderated]
1

I’m male / 34yo / 6’3”,195lbs / lifting experience about 4 years / BBM templates for close to 2 years.

Over two months ago I hurt my lower back, I can’t remember what I was doing, probably nothing significant but the pain/limited range of motion has not gone away.

I’m currently on week 13 of the Strength III Template and I have continued the program as written with the exception of last week. My numbers have been staying about the same or slightly improving over the last month perhaps. Gradually the pain and limited ROM had been improving, the only thing that has persisted is not being able to arch my lower back/move my head down and bend down very easily. So this means that I have a difficult time picking up things that fall down while sitting in a chair, tying shoes/putting on socks, leaning/tilting forward (while standing) without needing to put my hand on something or my knee to support myself, getting into the car where need to scrunch and lower my head. Also, sneezing hurts now.

All these problems have gradually improved over the last two months, without much of any effect on lifting, but about a week ago, it got aggravated again, and the pain and limited ROM is more severe. Much harder to reach down/bend my neck down, lean forward without supporting myself on edge of table/knees. Deadlifting is much tougher. I have still been lifting but for week 12 (last week) I missed one day (three lifts). I did not do the two heavy deadlifts for days two and four, and substituted RDLs up to about 75% of expected weight. I also took a couple extra days off throughout the week.

Because of the extra days off I should have finished off week 12 last night, but instead did lighter squats for higher reps, heavy TnG bench pressing as normal, and deadlifting gradually working up to sets of 5 at about RPE 6, 7, and 8.

I’ve dealt with lower back pain 2 or 3 times before, and it’s always gone away after a couple weeks. So I have tried to remain neutral or positive about the pain and limited ROM by telling myself it’ll go away; I’ve kept moving, kept lifting, kept up normal activity (aside from two extra days off last week). When I started DLs last night, I was not very excited to do them, hurts to bend down, hurts to stand up, (I even felt slightly light-headed on the earlier/lighter sets, but that went away as I continued), but I made sure to get them done, and not try for my normally expected weight. But go up to what made sense and felt tolerable (I would have expected to do ~350lbs for 5 @ rpe8, but I did 275lbs). Deadlift felt better as I continued, Squat didn’t really. Squat was down about 20% last night.

My questions are mainly:

  1. Shouldn’t this pain/ROM issue be expected to be gone by now? It’s been months, I’ve kept up movement and lifting, it slightly improved for a while, but then just got worse a week ago. Previous back pain has dissipated after a couple weeks, this one is persisting, and seems to be spreading into more of the muscle (it originated on the right side, deep, but now it also feels more surface level, and on both sides)

  2. Could my heavy lifting have contributed to its being aggravated again? Should I have taken it more slowly?

  3. I suppose week 13 of Strength III needs to be cancelled/put on hold. Should I run through weeks 7–12 again while using RPE conscientiously? Or do something else?

  4. Is using NSAIDs or talking to my doctor to see about muscle relaxers or something else recommended? It sure would be nice to not feel 5 out of 10 level aches and pains all day.

Thank you

2
  1. Shouldn’t this pain/ROM issue be expected to be gone by now? It’s been months, I’ve kept up movement and lifting, it slightly improved for a while, but then just got worse a week ago. Previous back pain has dissipated after a couple weeks, this one is persisting, and seems to be spreading into more of the muscle (it originated on the right side, deep, but now it also feels more surface level, and on both sides)

Most back pain does indeed tend to resolve on its own within a few days/weeks - and it sounds like you were on this track with the improvement until the repeat flare-up.

  1. Could my heavy lifting have contributed to its being aggravated again? Should I have taken it more slowly?

Yes. We would probably have had you reduce the intensities further and progress things back to normal more slowly. It sounds like you exposed yourself to a dose of stimulus that was more than you were ready for.

  1. I suppose week 13 of Strength III needs to be cancelled/put on hold. Should I run through weeks 7–12 again while using RPE conscientiously? Or do something else?

I would not plan on continuing the template, but would change the programming for your squat and DL movements to pull back on external intensity, bump up the reps (eg up to the 10-15 rep range), maybe incorporating tempo, and I would train those lifts on 2-3 non-consecutive days per week.

  1. Is using NSAIDs or talking to my doctor to see about muscle relaxers or something else recommended? It sure would be nice to not feel 5 out of 10 level aches and pains all day.

We generally don’t recommend this based on the current evidence.

3

Thank you for the response.

I will temper the load for a while and slowly build back to normal working weights. Should I expect to increase intensity at a specific rate, or gauge its appropriateness based on how I feel the next day (i.e. if I’m in more pain, then I must have increased too much)?

No NSAIDs for lower back pain(that has been hanging around a while), copy that. I try to avoid them regularly anyway, but is there an article or youtube video in which you explain this recommendation? Or an outside article I can reference?

4

Colin,

Here is a link to the most recent Cochrane review. You’ll see a common theme of a small benefit but this comes with the risks of NSAID use.