Low back pain is tough, and frankly not uncommon. I have injured my low back a few times, but I was still able to train despite my injury and go on to hit PRs. At the end of October I hosted a webinar to discuss training with low back pain. You can find the link to that here. Go watch it for yourself. I discussed common causes of back pain, common patterns we see with low back pain, and methods to use during training to help you stay in the gym and continue progressing despite pain and injury. Reach out with any questions! Here is what I did for myself and some ideas for you!
I identified the cause of my pain, what made it worse, and what didn't seem to bother it too much. As a physical therapist this is easier for me to do, and it might be easy for you to do as well, but if it isn't I would recommend going to be evaluated to at least get started on the right path. For me, initially, low bar squatting and deadlifting made things worse. Any time I spent sitting for long periods of time seemed to cause a lot more discomfort and getting dressed (like putting on pants) was painful. Things like standing, walking, twisting and bending backwards didn't seem to bother me though. This is what we would call a "flexion intolerant" pattern of low back pain. Any bending forward/rounding of the spine increased my pain where bending backward/arching did not.
Every day, two to three times per day I did these exercises: Prone Press-ups, Hindu Push-ups, Open Books, Cat-Cow, and Bird Dogs with exaggerated flexion (to tolerance) and extension.
The prone press-ups were strictly an extension based exercise to desensitize my pain. The others had graded amounts of flexion that I could control to start to desensitize myself to spine flexion while also allowing me to go into pain free extension right after so my symptoms didn't linger. Doing these daily allowed me to not only desensitize my pain with the extension biased components to the movements, but slowly grade myself back to tolerating some amounts of flexion that I had complete control over each and every time.
In my training, I wasn't able to tolerate deadlifting or low bar squatting because of the demands in loaded spine flexion. I was able to tolerate front squats though with minimal or no lingering symptoms during or after training. I used this as my primary mover with a cambered bar to add a stability component and also decrease the load on the bar. I also added a pause at the bottom of the movement to also help with load management but to also expose myself to some extra time in spine and hip flexion in a position where it wasn't painful. For my deadlifting, I used exercises that were relatively pain free to continue strengthening the glutes, hamstrings, and quads. Starting with a PVC pipe I started to slowly introduce myself to the hinging pattern, both in a conventional and sumo deadlift stance as well as a split stance. Once this was relatively comfortable I progressed to single leg hinging and double leg hinging with light dumbbells, and eventually the barbell. Keep in mind these progressions took weeks, and all the while I was doing paused cambered bar front squats and addressing all of my other weaknesses while I rehabbed my back.
After about six weeks I ended up hitting a paused front squat PR at 385lb but I did it with the cambered bar! After that, I did about six weeks of high bar squats. Again, I started light and slowly worked up in weight with these due to the higher demand of hip and spine flexion compared to front squats, making sure they were pain free or only had minimal discomfort. Just because high bar squats were pain free didn't mean I had to jump right to low bar squats. I was still slowly getting back to deadlifting. Once I was able to tolerate deadlifting from the floor without any symptoms during or after training, then I progressed back to low bar squats. Keep in mind, the stress from training is cumulative. I tried only changing one variable at a time to make sure I knew what my body did and did not adjust well to.
I ended up coming back and hitting a 505lb low bar back squat only three months after my injury (matching a PR) and deadlifting 675lb (also matching a PR) completely pain free and much easier than it had ever been, both on the same day. How was this possible? I trusted the process. While I rehabbed my injury I ATTACKED my weaknesses. As the pain started to dissipate and I could do more and more I slowly graded into my main movements but never stopped attacking my weaknesses.
To summarize, follow these steps:
Identify the problem and come up with a rehab plan
Change your training to keep your problem from worsening
Attack your weaknesses
Ex: If quad strength is limiting your squat, then take this time away from low bar squatting to build up your quads!
Over time, slowly grade back into your previously painful movements
Ex: paused front squats -> high bar back squats -> low bar back squats
Ex: PVC hinging -> light DB hinging -> barbell hinging to tolerance -> deadlifts with slow progressions up in weight
Other things to keep in mind for injury prevention:
Always have a good warm-up - most people are lazy with this aspect of training
Manage your variables - hydration, nutrition, sleep, and stress levels all affect risk for injury. Do your absolute best to manage these things before and after each training session to maximize your recovery.
Listen to your body - although a program might have a certain number to lift or pace to run, that's not always in the cards that day. That's okay! Do what you can that day and move on, you still did something to push yourself.
Communicate with your team - whether you are working with a coach or physical therapist, they can't help you if they don't know what is going on. Share with them what you feel so they can best help you!
On my website you can find the FREE Runner's Guide to Injury Prevention and the Powerlifter's Guide to Warming-Up. Just fill out the info and it will be sent right to you! Reach out if you have any issues. These should get you on the right track!
Please reach out if you have any questions via email, phone call, Instagram DM, or text! Stay strong and keep pushing.
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