Lower back pain is an incredibly common thing even among the normie population who don’t lift weights. Lower back pain is thought to affect about 10% of the population and was cited as being the leading cause of disability by the NHS.
As you can probably guess lower back pain is also a very common ailment with people who train and compete in strength sports with it coming up amongst the most commonly injured areas in crossfit, powerlifting, weightlifting and strongman in studies that look at the epidemiology of injuries in the 4 major strength sports.
It is a problem or issue I deal with on a very regular basis having suffered from some kind of training related back pain for pretty much my entire training career. Lower back pain was something I experienced as a teenager playing rugby and it has naturally followed me into my powerlifting.
Lowerback pain is also something that I help others to deal with as a coach. What follows are the practical and pragmatic steps you can take to manage and to train with lower back pain.
1 – There probably isn’t a specific mechanism for your lower back pain. But there is almost certainly triggers for it.
It is current thinking that a lot of back pain is psychological in nature. Some experts most prominently of whom Stuart McGill do not agree with this train of thought and insist on there being specific and identifiable triggers and mechanism behind those pain triggers.
From my own experience, there are 100% certain movements and exercises that cause me to experience back pain when my back has been flared up. Some of which can be warmed up and train through and others that need to be left alone.
2 – Remain as active as is feasible.
You should remain as active as you can. We will discuss in the upcoming steps more specifically how you can manage and progress your back pain. However it is important to keep up to your normal daily routine as much as possible.
If you let the back pain take over your life and disable your ability to perform normal daily activities and tasks your prognosis and recovery outcomes will not be as good. This might be doing 3x per week upper body weights instead of your normal 5x per week weightlifting or CrossFit routine. Modify where needed and try and persevere where you can.
Total bed rest and inactivity is a terrible idea!
3 – Identify and isolate movements that cause your back to seize or to give you pain.
For the first period of dealing or training around lower back pain, you will want to identify what movements cause you to regress in function. For instance, when I hurt my Back in August of last year it was deep squatting that was causing my back to feel worse. So for a period, I had to avoid deep squatting both in training and in real life.
You might not want to provoke the pain yourself (if you are working for a professional they will likely try to do this in their assessment). However you should be keeping keen attention on day to day life and 100% in training for any movements or exercises that cause a reaction of either acute pain over say a 3/10 on the pain scale or that causes your back to stiffen up or to regress.
4 – Desensitise the pain response by staying out your trigger positions by practicing “good movement hygiene”.
Once you know what kinds of movements cause you pain you need to be mindful of what they are and to avoid them in day to day life. If rotation of the torso causes your back to spasm then you need to turn using your hips. This is specific to the pain you are experiencing so I won’t write out every possible example of what this might be.
You also need to practice what Stuart McGill calls “good movement hygiene”. This basically means performing everyday tasks while maintaining good spinal mechanics i.e. producing movement from the hips, knees, ankles, and shoulders and trying to not flex and rotate the spine in a nonthinking manner.
Basically, the goal is to give the spine and affected area it needs to recover and desensitize from pain. Once your back isn’t reactive anymore than you can move to the next stage of getting back into training and movement.
5 – Develop a daily basic conditioning and core endurance routine.
Once you have figured out what causes your back to flare and how to avoid it in day to day life you will begin to experience little of no pain day to day. At this stage you should begin to progress into a fuller training routine. Before we get to this stage we should start to develop some targeted mobility and core endurance work to help you to become better able to move in a way that won’t flare your back but also to develop the more basic core endurance needed to make you more robust.
The mobility routine should be specific to your pain trigger, limitations and the task you are wanting to get back to. An example of a routine like this for hip related stiffness/pain would be.
- Couch Stretch – 2 minutes each side.
- 90/90 Stretch elevated – 1 minute each side x 2
- Psoas Release with the ball – 1 minute each side x 2
- Frog rock stretch – 1 minute.
Something like this performed around training or first thing in the morning will help to loosen and mobilize the hips.
Core endurance training should focus on holding and maintaining good spinal mechanics and advancing the length and difficulty of holding and stabilizing positions. The best place to start is the McGill Big 3.
These three exercises are
- Modified curl up
- The Bird Dog
- Side Plank
These three exercises produced the greatest amount of abdominal activation whilst also producing the least amount of stress on the back. These should be performed on a daily basis as part of your rehab routine or they can be performed as a useful warm-up routine before any heavy training.
6 – Return to your meaningful task or training routine in a structured and purposeful manner.
When you return to training you should look for exercises that are related to what you want to do but don’t provoke much pain or cause too much stiffness form performing them.
We should be looking to work through a certain amount of pain as we are looking to strengthen specifically the area of the back we have affected however we don’t want to cause too much stiffness or pain.
Here is a pretty solid process for thinking about progressing your training.
- Find and exercise or modified exercise you can move through a full range without intolerable amounts of pain of discomfort.
- Load this exercise or range 2-3x per week.
- Start off with high reps 15-20 reps and low sets 2-3 reps.
- Raise the weight as you can set to set, session to session.
- When the RPE for the rep range begins to become too much to maintain your technique and stay focused on what you are doing drop the rep range. I.e. if you are performing 3×15 reps and your RPE climbs to 8-10 then you should drop to 10-12 reps.
- After a while when you are beginning to perform more meaningful loads (i.e. you would need to program and overload to get stronger at the movement) then you should progress your exercise and movement.
This is an ongoing process that requires constant feedback and assessment. You should seriously consider engaging with a professional during this process.
7 – When you are back to full fitness make sure you are on top of your processes.
Once you are back to a full training program you should make sure you are on top of what you are doing on a day to day basis to help ensure you are robust enough to train fully without getting injured needlessly.
- Keep up your mobility and core conditioning work! Just because you are fit doesn’t mean you should stop doing the things that helped to get you here in the first place.
- Keep your movement quality high. The sloppy technique is no longer an option you have to pay attention to what you are doing on every rep and every set. Especially when it gets heavy. It’s okay this will make you a better lifter anyway in the long run.
- Know your ability to recover. Some people will be able to lift heavy 3-5x per week whilst others will only be able to lift heavy 1-2x per month. This is an individual and is something you need to understand for yourself.
- Build in your recovery to your training and be a hard line on it. Deloads and active recovery sessions need to be programmed into your training and kept in your training. When you go too far you will go back to stage one of this process so you should tread on the side of caution when you are not sure.
- Walking on a daily basis is very important and is therapeutic for your back. Try to get in your 10,000 steps.
- Don’t sit for too long where you can help it. Try not to sit in a fixed position for more than 25 minutes without standing up or going for a quick walk.
- If you train in the morning try and wait till at least 1 hour of being awake before you lift heavy.
- During deloads try and deload your spine completely it’s a good idea to move away from heavy compressive exercises during your downtime. Try alternatives like belt squat machines or even just go and swim/do yoga for the week. You aren’t going to get weak in one week.
- When you are going for it fucking go for it. When you are going heavy or going into a hard set then get into the right mindset if you are in two minds during a heavy lift you are much more likely to reinjure yourself from hesitation then from lifting in a compromised position.
- Likewise, when it’s not on it’s not on. You develop a sense for what is an acceptable amount of pain or stiffness to push through and when it’s too much. When it’s too much just pull back or find an alternative.
- There is always tomorrow or next week, just because you had to modify your session it doesn’t matter in the long term you have plenty more time to progress.
I hope this article has given you some frameworks for your thinking and some ideas on how to train around and to progress your back pain.