*Trigger warning* "Prehab", and deadlift progression logic

Training Q&A [Moderated]
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  1. I’m aware “prehab” is a misnomer that gets thrown around far too much (it’s all just training), but looking at general rehab principles, we generally seem to apply a combination of isolated targeting, reduced load, tempo, and variety to injured areas in order to build capacity/tolerance, while gradually introducing more regularly loaded compound movements over time to “re-integrate” the area into regular lifting.

I know there’s nothing particularly special about any of the exercises typically included in rehab programs, but I have to wonder: is there any merit to including these exercises in GPP if someone has an injury or “pain” history in a particular area? In the Hip Pain Part III article, Dr. Miles states: "Implementation of the Copenhagen protocol resulted in a 41% reduction in the incidence of groin injuries in soccer players.​" The obvious difference is that a soccer field is chaotic compared to a weightroom, with generally incomparable variables at play, but I’m wondering if spending a short amount of time on some combination of back extensions, adductor/hip flexor work (for squats), and arms (already included in GPP) would potentially mitigate these areas being limitations down the road. Doing deep ROM knee work like cannonball squats and reverse nordics have dramatically improved ROM and confidence/strength in deeper positions, as an example, and I’m at least somewhat inclined to keep one or two in now and then.

  1. I want to be good at deadlifting, but conventional deadlifts are the bane of my lifting existence. Touch and go deadlifts, dorian deadlifts, RDLs, rack pulls, etc are all generally fine. I’ve added a re-flare in back pain to my ever-growing list, and it always seems to come from conventional deadlifts from the floor (every significant back tweak I’ve had outside the military has been from lower-position deadlift movements). Would it be wise to try and progress it with far more lightly loaded deficit deadlifts and gradually work into conventional deadlifts? Rack pulls seem to lend a false sense of security and result in fairly substantial weight increases over time that don’t safely carry over to conventional deadlifts. This would seem to be a logical application of the principles in the knee rehab program, but I’m not sure if it works practically.

As always, thanks for your time!

-Rohann

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  1. I typically keep a degree of these kinds of movements in people’s training programs even beyond the rehab phase, yes. These can be isolation/unilateral/“weird” exercises, performed at the end of training sessions, on “lower priority” sessions (e.g. non “SBD” days for someone focused on those lifts), or on GPP days.

  2. There are two ways to approach this:

A - Are you training to compete in powerlifting and specifically want to pull conventional? If not, and if this is a recurring problematic movement for you, there is no reason to prioritize it or put much emphasis on it. It would be completely fine to train long-term using movements like TnG deadlifts, RDLs, sumo deadlifts, or even a conventional deadlift done off of low blocks (say, an inch or two - not like a high rack pull)

B - If you just want to do this for its own sake, that’s fine too. I don’t have a preference as to the specific approach here, although rack pulls don’t need to give that false sense of security or lead to substantial weight increases over time, particularly if someone uses a conservative approach and/or explicit weight caps. It could involve lighter deficits working up to regular deadlifts, low rack pulls working down to the floor, or simply using conventional deadlifts from the floor throughout. I would probably be using weight caps regardless for someone who has such a recurring problem with a particular movement. In addition, could use supplemental movements like single-leg RDLs, SSB good mornings (standing or seated), posterior medial taps, etc.

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  1. Good to know! Not sure exactly how to integrate them into one of the templates but I imagine it’s a wise thing to do in my case. Would “weird” be something like a Jefferson squat/deadlift if you were interested in targeting the lower back? I assume generally it would be something lighter and causing less central fatigue.

  2. Great question, and that’s helpful. My lifts are abysmal, but I suppose my order of priorities are:
    1: General athleticism for overall function and capacity for strenuous life activity
    2: Remaining injury “free”/resistant (aches and pains happen, but training shouldn’t be consistently debilitating)
    3: Getting strong and hitting some lift targets eventually. I know the deadlift isn’t essential in that regard, but I’ve always wanted to be able to deadlift well and actually like the conventional deadlift, but if there’s reason to shy away from it in favour of other lifts I’d be open to that. I also don’t want it to “beat” me though, so I’m also interested in fixing limitations.
    I would say strength is the main priority in a way, but it can’t compromise #1 and 2, which it currently seems to be.

I’d ask more about weight caps, but first: do you personally offer remote programming or consults? I seem to be an odd case in some respects, so would be interested.

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Sure, that could be an example.

Given the goals you’ve described, I would probably take a medium-term time period and focus on the lifts you already know you tolerate well and/or those that I mentioned above, build up some capacity and confidence before reintroducing a conventional deadlift. That period of time may even shift your preferences if you find yourself enjoying and performing well in other movements.

We offer a range of consult options, including a one-time form check service including discussion with a coach, one-time consultations with our rehab team for these kinds of issues, or ongoing coaching with our rehab team or on the performance coaching side. I do remote consultations with folks, mostly for medical issues but occasionally for training and injury-related discussions as well. I am not currently doing ongoing remote coaching, although we have many other coaches available.

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Thanks, that sounds wise. And I don’t want to get married to the lift; the reason I haven’t ditched the idea of it is also because each significant back tweak in the past was also accompanied by probably poor load management strategies, but not so explicitly as to convince me it was purely load management. I also always used to believe I had the “wrong acromion type” and wasn’t able to overhead press, but that’s now one of my favourite lifts, so I suspect that if I address underlying shortcomings (like capacity off the floor) I may be fine. That said, have you found you’ve had any lifters who flat-out would never properly tolerate certain lifts, despite rehab and additional work? Will stick to what’s tolerable for the time being (I imagine the start point is the same – find entry points, keep lifting and gradually increase over time).

​

We offer a range of consult options, including a one-time form check service including discussion with a coach, one-time consultations with our rehab team for these kinds of issues, or ongoing coaching with our rehab team or on the performance coaching side. I do remote consultations with folks, mostly for medical issues but occasionally for training and injury-related discussions as well. I am not currently doing ongoing remote coaching, although we have many other coaches available.

Thanks; I was aware of what you guys offered, and assumed you were likely predominantly on the medical side of things, but thought I’d ask as it sounds like you still have occasional clients. Not sure if a rehab consult or coach consult would be the better option, as I’m relatively frustrated that I seem to have little headroom with RPE when I’m not precise, and also have trouble tolerating intesity+volume, but also want to sort out programming tweaks for your template, as I’m unsure where to go from here (Phase III of the knee rehab template but unable to follow prescribed RPE except with accessories).

If you have time – for weight limits, is that more or less a calculated percentage/RPE max for a particular problematic lift that you set for a period of time?

Thanks again for your time,

Rohann

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have you found you’ve had any lifters who flat-out would never properly tolerate certain lifts, despite rehab and additional work?​

I would never make such a definitive conclusion about someone, but there are certainly people who have enough accumulated experience that they conclude a particular movement just isn’t really “worth it” to them.

If you have time – for weight limits, is that more or less a calculated percentage/RPE max for a particular problematic lift that you set for a period of time?​

No, it’s mostly made up - but basically upon finding an entry point, weight caps can be limited to a very specific, conservative increment over time (weekly, biweekly, whatever), rather than using a more fluid RPE approach, where some people may be include to jump more than is wise on a particular day, just because they may be “feeling good”.

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Thanks Austin. Been stewing on this a while.

That’s fair; I wouldn’t expect total finality, am mostly trying to understand if problems (specifically non-specific low back in this case) can generally be successfully worked through long term the way I understand knees or shoulders can, or if repeated low back issues can eventually lead to worse problems or compounded likelihood of re-injury.

I suppose a better question would be: in your collective experience (this may include research), do you find individuals who poorly respond to certain lifts but want to compete in powerlifting, for example, can generally be made sufficiently resilient to tolerate all lifts well? Or at least significantly reduce setback duration/intensity? Conversely, if a certain lift turns out to be continually problematic, does a change as small as rack pulls/blocks vs deadlifts or sumo make a dramatic difference in their tolerance?

I’d like to believe there’s an overall upward answer to this, but I’m still on the path of trying to assess whether or not conventional strength training is compatible with me, and I have little evidence to suggest that it is so far, as I’ve tried a number of approaches and am growing tired of the injury/pain cycle that seems to take longer to resolve than is typical. I seem to be unable to sustain typical intensities + volume without injury/pain over time, and my core lifts are still abysmal.

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I don’t view the back/spine as fundamentally different compared with other body areas, from a musculoskeletal pain/injury standpoint.

There is no direct research on this specific question.

Additionally, there are too many variables at play to say someone can simply be “made to tolerate all lifts well”, because there’s more to it than just the movement itself. There’s the dosage (intensity, volume, frequency) in the context of the person’s tolerance at any given time (which itself is influenced by life stressors, sleep, etc.). In other words … pretty much anyone can experience pain from any activity at any time, and there aren’t always identifiable “reasons” for this.

When managing the dosage of activity as best we can, applying auto regulation intelligently, our experience has been that we can significant improve symptoms (if not resolve them, in many people), and significantly reduce the frequency / likelihood of setbacks, particularly severe ones. However, there are no guarantees, nor strategies for absolute “prevention”.

While I can understand this frustration, it is important to understand that this conception of “conventional” strength training is entirely arbitrary and made up. There is no reason to put value on any particular movement like the conventional deadlift if you do not compete in a sport that requires it (… and the only sport that absolutely requires that movement is strongman). Strength training can involve any movement with any kind of external resistance, and I encourage you to find the things that you enjoy and tolerate best, without paying as much attention to what others are doing or to what others say you “should” be doing. You can even take a break from it for a bit and try other activity, such as more conditioning-oriented work, if you need a mental break from it.

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Thanks again for the response.

Good to know!

Additionally, there are too many variables at play to say someone can simply be “made to tolerate all lifts well”, because there’s more to it than just the movement itself. There’s the dosage (intensity, volume, frequency) in the context of the person’s tolerance at any given time (which itself is influenced by life stressors, sleep, etc.). In other words … pretty much anyone can experience pain from any activity at any time, and there aren’t always identifiable “reasons” for this.

When managing the dosage of activity as best we can, applying auto regulation intelligently, our experience has been that we can significant improve symptoms (if not resolve them, in many people), and significantly reduce the frequency / likelihood of setbacks, particularly severe ones. However, there are no guarantees, nor strategies for absolute “prevention”.

Thanks, this is more or less what I was after. And of course – I don’t mean perfect “tolerance” or “prevention”, just whether or not people can often be made to tolerate previously problematic lifts at training dosages where they tolerate other lifts well, such that a particular lift is no longer a notable anomaly to be avoided.

While I can understand this frustration, it is important to understand that this conception of “conventional” strength training is entirely arbitrary and made up. There is no reason to put value on any particular movement like the conventional deadlift if you do not compete in a sport that requires it (… and the only sport that absolutely requires that movement is strongman). Strength training can involve any movement with any kind of external resistance, and I encourage you to find the things that you enjoy and tolerate best, without paying as much attention to what others are doing or to what others say you “should” be doing. You can even take a break from it for a bit and try other activity, such as more conditioning-oriented work, if you need a mental break from it.

I appreciate the encouragement. For clarification – I don’t mean “conventional” strength training to refer specifically to issues I get from deadlifting. I’m viewing conventional deadlifting more as an experiment, to see whether or not I can “figure it out” in such a way that I can hit milestones and make it work for me, contrary to frequent opinions I hear about it being inherently “problematic” or “risky” for some individuals. If it turns out to not be worth it and it’s difficult to make it work, I’d of course much rather just get better at some sort of similar pattern (sumo deadlifts, snatch pulls, whatever), provided I can still improve my back endurance/strength/endrange tolerance regardless.

What I mean by “conventional strength training” is just tolerance/response tor reasonable intensity (i.e. prescribed RPE) and volume/frequency in compound lifts. I unfortunately do quite enjoy deadlifts, even if just RDLs/touch and go DL’s, and I enjoy squatting and OHP far more than I thought I ever would. I also enjoy benching now that I have a better handle on what it should feel like and it not automatically causing pain. That said, my headroom for RPE seems to be relatively nonexistent, and my tolerance for multiple sets of RPE 8 of similar patterns is also frustratingly absent week to week (illustrated by my inability to survive the knee rehab template, although my knees are doing fine), and this goes for almost any compound lift; not talking about random tweaks during warmup sets, but lingering new pains. I’m not assuming it’ll be this way permanently, and I’d also really like to believe there’s no such thing as “not being suited” for this sort of thing, but this combo with my lift numbers have certainly added skepticism. I’m pursuing consultation and possibly some programming help with BBM, so hopefully will make some improvements there. You’ve mentioned that running lower RPE sets and experimenting with volume could be a feasible strategy and seemed to work well in your case in the “Programming 2” podcast, but Jordan has also mentioned that higher intensities + volume are important for beginners (as illustrated by the template layouts), so I’m hoping some clarification on the programming front will either help me figure out a strategy that helps me make tangible gains without a cascade of issues, or will at least help me move on to something better suited.

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Austin: I misread your post saying you do remote consultations for folks, didn’t realize you do one-time consults. I’m not sure if the latter would be necessary in my case. Would you mind PMing me details (rates/availability, etc) about your consults if you have time? Looking for programming adjustment insight for my situation. If you think a regular rehab or coaching consult would be more appropriate, or if you simply don’t have time, that’s fine too. Thanks!

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RVR,

When you get a chance, email support@barbellmedicine.com to schedule a consultation with one of our rehab coaches, as recommended by Dr. Baraki.

-Jordan

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