Here’s What You Need To Know…
1. For many lifters and strength athletes, lower back pain and dysfunction is the price of doing business making gains in the iron game. Eventually, you’ll be bitten by the lower back pain bug. Better get prepared.
2. Instead of complaining to anyone who will listen about your lower back pain and being “forced” to take a month off of training to focus on getting fat on Cheetos, how about you do something to train through the pain.
3. The worst thing you can do to get back to uninhibited pain-free training is to push through your normal workouts on a blind stupor. Intelligently modified movements and tactics are your best bet.
4. Here’s how to get the most out of your lower body training while dealing with lower back pain, allowing yourself to heal and regenerate while making some gainz in the process.
So You Hurt Your Lower Back, Now What?
True veterans of the iron game that have clocked enough hours under some heavy ass loads know that lower back pain and injuries are a frustrating and derailing part of the game. If you think this doesn’t apply to you, think again; back injuries are the price of doing business if you’re training at the right intensity. So get off your high horse and listen up! It’s just a matter of time until the iron takes you as its next victim.
This isn’t your physical therapist’s handcuffing list full of dainty recommendations to lay off the weights and try a new brand of tampons. These tips will have you maintaining your hard-earned muscle armor and dominating your stat sheet while letting your lower back recover, thus reducing the risk of another debilitating injury.
#1 Assess The Severity of Your Lower Back Pain
Dominating sets can wait a day; we have to first figure out if you’re able to get back in the saddle, or whether you’re going to wet your saddle. With every case of lower back pain presenting in a unique fashion, it is necessary to determine whether you are dealing with just another muscle tweak, or a excruciating painful amount of structural and functional damage.
Before you pick up the phone to throw your name on the weeklong waiting list to see your primary physician, who is probably a triathlete, if he trains at all, go through this checklist. If you are having any of the following red flag symptoms, your best bet is to make that call:
- Tingling or numbness
- Loss of sensation
- Loss of motor control (inability to coordinate voluntary movements)
- Loss of bowel or bladder function
- Severe immobility- unable to walk
This can not be reiterated enough; if you are presenting with any of the above red flag signs and symptoms, contact your preferred medical provider (more on that in #2) and be evaluated in person. These red flags represent medical issues, and are no longer just orthopedic based problems. When in doubt, get diagnosed.
#2 Skip the Trip to Your Ortho
If you made it through the checklist above with a clean slate, chances are you are dealing with a purely musculoskeletal issue. Without neurological involvement you will be able to independently manage your painful episode, lucky you.
The ability to successfully self-treat will save you time, money, aggravation and your general sanity. Through my years of treating lower back pain as a sports performance physical therapist, I can confidently say that 95% of expensive diagnostic imaging procedures are downright worthless.
Sure today’s imaging techniques can show structural damages in high definition, but have we forgotten about functionality? There are guys playing on Sundays in peak physical condition with train wreck imaging, cashing big checks and doing it pain free. There are also desk jockeys out there hindered by gut wrenching pain with clean scans. As Tyler Durden would most likely say, “You are NOT your fucking MRI!”
If this is a chronic or recurring issue, the current symptomology should present in a consistent manor as previous injuries. And guess what, if you’re not willing to do things you have never done to rid yourself of this literal pain in your ass, your orthopedic surgeon will be more than happy to grab the knife and open you up, cashing another absurdly large paycheck from the fat cat insurance company in the process. The choice is yours. So choose to be your own best advocate.
#3 Classify Your Painful Pattern
Individuals with active and painful lower back pain symptoms will all be uniquely shitty in their own dysfunctional ways. Just because your recumbent bike-riding spine doc has classified your condition as “special”, it can still be categorized into one of two distinct groups; flexion or extension-based pain and dysfunction. In a matter of seconds, you will be able to identify your painful pattern and move towards recovery all while continuing to crush weight in an intelligent manor.
Flexion based pain and dysfunction is most prevalent within our Americanized culture full of sitting, slouching, and overall piss-poor posturing. On the opposite end of the spinal spectrum, extension-based dysfunction presents more in active populations, especially those stuck in an anteriorly tilted pelvic position for extended periods of time. If you don’t know what I’m talking about, turn on ESPN. CrossFit has produced some of the fittest men and women on the planet, but also some of the most poorly positioned backsides for elite athletes in recent memory. And we wonder why CrossFitters continue to get injured.
Using two clearing tests popularized by the Functional Movement Systems, you will be able to determine your prominent movement dysfunction by the presence of pain while completing the motions below. If either of these tests illicit pain, that is considered a positive test. The most painful test classifies you as either flexion or extension intolerant. Check out the two positions below:
Flexion Based Intolerance Clearning Test Position
Extension Based Intolerance Clearning Test Position
The results of these clearing tests will differentiate the daily movements and positions that will aid your path to recovery and those that will leave you flat on your back for the next three weeks, wishing you would have taken this classification system seriously.
For flexion-based dysfunction, avoiding sitting and slouching is imperative. As for extension, hanging out in an extended spinal position for long durations can exacerbate your current symptoms, delaying your recovery for a few more painful weeks.
For both painful patterns, keep moving and change positions as often as possible. Keeping your body mobile while routinely giving your spinal structures a break will speed up the recovery process and having you pushing new PR’s in no time.
#4 Avoid Heavy Front Loaded Hip Hinges
You should inherently realize that the position you were in when you exacerbated your lower back pain symptomology should be avoided. Don’t try to reinvent the wheel. Don’t think you’re, smarter than a 5th grader! Stay off these movements until you earn the right to program them back into your routine:
- Barbell Row
- Good Mornings
- Full Range Crunches/Sit ups
- Back Extensions
- Low Bar Back Squat
- Leg Press
#5 Enhance the Kinetic Chain
A majority of lower back pain is earned over time, and is not just an anomaly as many fool themselves into believing. That means that your mobility and movement patterns have probably been dysfunctional for a long time, and have been getting progressively worse with every single faulty rep. Get your foot off the damn break before you hit the gas!
The jaw dropping bioengineering of the human body provides many answers to why we get injured. This is most apparent in the Joint By Joint Theory, popularized by Grey Cook and Michael Boyle. This theory states that joints alternate between mobility and stability as their primary function. The lumbar spine is no exception. It primarily serves as a set of stability joints, and is surrounded by the thoracic spine and hips, which are primary mobile joints.
To get our bodies back to equilibrium, a strong prehab-rehab emphasis must be placed on stabilization of the lumbar spine, which we will cover later, and mobility work for the thoracic spine and hips.
Putting a focused effort on increasing hip mobility and range of motion can be manipulated by the positioning of the spine in movement. While your primary goal of training is protecting the spine, keeping it in a vertical position decreases the likelihood of buckling and reinjuring yourself.
As your spine stays vertical, as it was designed to do in foundational single leg movements, more range of motion of the hips into flexion and extension will be needed to get the job done. Shakira says it best, the hips don’t lie; they are the true intermediate joints of the body, so improve their function first.
#6 Range of Motion is Dictated by Spinal Position
To successfully train through lower back pain, you must accept the fact that pain changes everything. From an activation, mechanics and motor control perspective, your body is compensating to stay out of pain. Even without direct stresses placed on your “Achilles Heel,” your neurological system is on overdrive.
The way we train through pain is to simplify and perfect foundational movement patterns while stabilizing the shit out of the core, hips and shoulders. Core activation, thoracic spine stiffness, and efficient dynamic hip stability will protect your spine allowing continued recruitment of large amounts of lower body motor units necessary for growth and strength gains.
Protect your back by keeping your ribs down and in a neutral position. Owning your rib posture will position the core muscles for optimal activation, thus further stabilizing the spine.
Another technique to stabilize the lumbar spine is to tap into Mother Nature’s weightlifting belt. By tensioning the broadest fascial layer in the body; the thoracolumbar fascia (TLF), the spine is placed in a more neutral alignment. Fire off prime movers that connect to the TLF, including the glutes and the lats, to generate more tension around your mid section. With enough tension, you will live to lift another day.
Don’t forget about your breathing and core activation techniques to create a maximal amount of tension surrounding the spine. It’s not about the technique that you utilize to achieve super-stiffness, as Stu McGill would say, it’s about actually achieving it.
Perfecting your lumbo-pelvic rhythm, or quality of motion as you get into and come out of triple extension of the lower body, will also improve gross spinal biomechanics and deload the lower segments of the lumbar spine, limiting unwanted shear forces. Keeping the spine in neutral and avoiding any unwanted deviations from a centralized position will decrease risk of injury, especially at the most vulnerable ranges of each movement.
Spinal position needs to dictate range of motion of each movement of your program. An assessment with body weight and under load needs to be administered to determine your ability to maintain a neutral spine throughout all phases of the movement. The bottom of lower body movements, such as coming out of the hole in the squat, and the initial pull of the deadlift are notoriously dangerous for the lower back. Limiting these movements will keep you moving towards your goals without falling off the train and re-injuring yourself due to shear stupidity.
If you are able to generate the prerequisite amounts of spinal stability to start working back into deadlift variations, your best choice is the trap bar deadlift and rack pulls. Both these movements will decrease range of motion, and allow you to maintain a neutral spine.
#7 Ditch Direct Spinal Compression
Avoiding direct spinal compression will allow you to train pain free while also going heavy and keeping the intensity sky high. Direct spinal compression refers to loads placed on top of the spine, for example a high or lower bar position. Without diving too deep into mundane movement science and anatomy that you don’t care about, compressive loading increases shear forces in the lumbar spine, and increases core instability due to the high center of gravity, making it one of the riskiest loaded positions for those recovering from spinal insult.
Keeping the load under the level of your current pain or site of injury will decrease the risk of a lower back exacerbation or re-injury. Unless you have freaky short arms, the easiest way to keep the center of gravity low is through placing loads in the hands. In this hang position; your shoulder joints act as a dynamic fulcrum allowing accommodating changes in the center of mass. This will decrease shear forces, which by this point you realize is kind of a big deal.
#8 Incorporate Accommodating Loads
The bottom position of most foundational lower body movements, including squat and deadlift variations, places the lumbar spine at its most vulnerable position for injury. Since the goal is not only to maintain strength while healing from an injury, but also to enhance performance, the use of accommodating resistances such as chains and bands can be a very advantageous way to overload your system.
Accommodating resistances provide a slight deload at the bottom of the motion, reducing shear forces, poor biomechanics and loss of core stability encountered during the amortization phase. Chains and bands also allow some heavy load to be placed on the movement when a lockout into pelvic neutral is achieved. Anytime you can minimize your risk of injury while still yielding a high ROI, use it!
#9 Embrace Single Leg Strength Work
If you earn the right to train through bouts of lower back pain, don’t be the guy who ignorantly refuses to modify his existing leg day. As I mentioned before, pain changes everything, and in order to get a leg up on your lower back pain, you must evolve along with your programming.
Single leg work not only has to be a component of your program, it has to be the focus and foundation for strength and hypertrophy gains. You heard that right, get ready to embrace unilateral work into your primary movements, while focusing your assistance lifts, finishers and conditioning on bilateral movements.
General ordering and emphasis of movements needs to be altered in order to yield the training effects that will prevent your legs from shriveling up like an osteoporotic 80 year old.
Your single leg work needs to be programmed first, and programmed heavy. Next, movements out of the split stance should be completed within strength and hypertrophy parameters. Finally, bilateral work can be programmed as extended sets, finishers and conditioning work.
The key is to get as much work out of these single leg movements as possible in order to pre-exhaust your legs and move into the next phases of the training session. To get the most out your legs, choose one hip dominant and one knee dominant movement for each of the three subcategories of your workout (single leg, split stance, bilateral). Remember to refer back to the contraindication exercise list above when choosing movements to make sure you aren’t continuing to shake that powder keg of a back you are walking around with!
#10 Increase Work Volume
In order to overload your lower body while staying within the parameters of the programming techniques above, the overall work volume of a training session needs to increase. Volume can be most effectively manipulated by adding both sets and reps to the programming for each movement.
For single leg primary strength movements, it is imperative to not only push as hard as possible, but program with primary strength loads that keep you within 4-8 reps. Overall volume of your workout will be increased in these primary movements because they replace the traditional power work, between 1-4 repetitions, that is commonplace for many strength athletes. As long as you can maintain spinal positioning and stability, work towards 50 total reps per leg for single leg work.
During split stance work, strength and hypertrophy parameters are most advantageous to continue the pre-exhaustion of the lower body, while also putting an emphasis on increasing the total volume of the session. Stick to sets of 8-15 reps per leg, while working your way to 60 total reps per leg.
For any single leg movement, make sure to complete all your reps on one leg before moving on to the opposite leg. This will allow you to maintain maximal tension and stability through the pillar while not having to reset your spinal position over and over. For example, for step-ups, complete 6 reps on the left, followed directly by 6 reps on the right for your primary single leg strength movement.
You’ll know its time for bilateral work when you start shaking, are walking a little butt-hurt, and contemplating going to the bathroom to release your demons. This is called pre-exhaustion, and the work that is put in after this level of trashing is what will keep you progressing, even with a painful lower back.
Bilateral work is saved up for extended sets, finishers and conditioning. Pick two movements that meet the criteria for safe lower back programming (my favorite is the trap bar deadlift off platforms and isometric bodyweight squat holds), and crush it! Bilateral work is maximal effort, so go hard. Don’t worry about stressing the core; your legs will be so fried that they will be the limiting factor to every set. Keep loads relatively light, and reps to the max. Shoot for 3 sets of 20+ reps for two bilateral movements to put the final nail in this workout’s coffin.
About The Author
Dr. John Rusin is a sports performance specialist and injury prevention expert that has coached some of the world’s most elite athletes including multiple Olympic gold medalists, NFL and MLB All-Star performers, and professionals from 11 different sports. He has also managed some of the most successful barbell sport athletes in the world including world record holding powerlifters, CrossFit Games athletes, and IFBB professional physique athletes.
His innovative pain-free performance programs have been successfully implemented by over 25,000 athletes worldwide including his best selling training system Functional Power Training, which has revolutionized the way coaches and athletes develop strength, muscle and performance pain-free. Dr. Rusin’s work has gained him the reputation as the go-to industry expert for rebuilding after pain, injuries or plateaus.