Hello BBM, firstly thank you for all the amazing content you guys make. Me and many of the people I care about have benefited tremendously from you guys :). As a warning, perhaps not everything I write in this post is going to be pertinent to your answer, but I rather provide as much context as I can just in case.
I want to preface that I’ve already posted here in 2022, when I tweaked my lower back (sciatic-type symptoms) for the first time. I ran the LBP template at the time successfully and went on to PR both my deadlift and squat by a good margin in the following years, following mostly self-programmed upper-lower templates (which is a split I enjoy a lot). Admittedly, sometimes some symptoms would creep up, but for a good while, ignoring them was sufficient and the pain would go away quite quickly (even at very high relative loads/RPE)
However, in the last year I’ve lost a significant amount of weight (on purpose) and fell into the trap of consistently overshooting my RPE/adding load too quickly session to session. For upper body, this seemed fine, as I haven’t really experienced any symptoms whatsoever. However, my lower back pain has reared its ugly head in the last few months, and I have been unsuccessful in rehabbing it with “minimal” program changes. My approach was to lighten the load for squats and hinges, then linearly increase the weight by 5lb every week until I was hitting my old numbers/RPE. This worked for a while, until I reached close to my old numbers and my back would start hurting again. In addition, my right knee started to experience some discomfort at the bottom of the squat (but seems to be symptom-free at parallel or above and also feels fine with isolations/single leg movements).
All this to say, I am a little frustrated that this hasn’t resolved in the time that I would want, which tells me I should probably take a step back and run the LBP template again.
So, here are a few questions on how to move forward:
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I still want to do an upper-lower program 4x a week, while keeping the same upper-body programming I have been doing. If you were to “transform” the LBP template into a 2x/week program (specifically the lower body/rehab movements), how would you do it? FYI, I don’t know if the LBP template has been updated since 2022, in any case that is the version I have now, which I assume is sufficient.
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What would be your advice, if any, in dealing with my knee discomfort at the bottom of the squat?
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Going forward, what can I do to give myself the best chances of not experiencing more pain in training, especially in my lower back.
Thank you, and again, sorry for the long-winded post 
Hi there! Thanks for the kind words. We definitely appreciate it.
We are currently updating the low back pain template, but the one you have is current. There are 6 lower body training slots and 6 trunk exercises. You could distribute these over 2 days (upper lower) instead of 3 (full body). If it were me in this context however, I’d modify slightly by recommending:
Day 1
unilateral squat pattern (bulgarian split squat, tempo, db’s)
Squat pattern (paused HBBS)
hinge pattern (hip thrust)
Trunk (isometric)
Day 2
Unilateral hinge pattern (e.g. 1 leg hip thrust)
Hinge pattern (rdl)
Squat pattern (leg press)
Trunk (rotation)
I think the knee pain during your squat is caused by a similar mechanism as the low back pain flares you’re experiencing: too much training load for what you can currently tolerate. To me, it sounds like your rate of progression may be a bit quick. I also have some concerns with how close you may be training to failure (RPE). I think moving away from a linear progression target (e.g. add 5lbs each week) and a higher RPE (e.g. 8 and above) could be useful. You may also want to take a look at one of our programs, as I think that may be a good strategy to build some momentum after the low back pain rehab template.
Should you need it in the future, our pain and rehab team is available for consultation.
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Hey Jordan, thanks for the reply. Just a few additional questions:
- Any problem in substituting the isometric trunk exercise with a dynamic one? Ex. Weighted crunches or leg raises? I’ve never been a fan of isometric trunk work, but willing to do it if you insist .
- I’ve never really done any trunk rotation exercises in my life. I was curious as to why they would be smart here (should they be something I keep in my program long term to help with back resiliency?), and also a few suggestions on exercises I can perform here.
- I assume this template addresses Phase 1 of the LBP template. Any guidance for the rest of the program? I can probably figure out what to do based on the template you gave me, but I’m willing to hear any advice if you have it.
Thanks again!
I would definitely start with at least some isometric work in this setting. You get a lot of non-rotational trunk work in your program, yet are often required to do loaded rotation work in life. Might as well get some exposure. Plus, when people predominantly have back pain with extension or flexion, sometimes they tolerate rotation stuff better.
Yes, this is phase 1 to start. I’d want some feedback from that to address specifics of phases 2 and 3, but we’re kind of creeping into consult territory, you know? I do think you could reasonably make the same types of substitutions in training frequency for those phases and do great!
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