Managing Lower Back Pain in Training: A Programming Perspective
In powerlifting, lower back pain is probably the single most-commonly reported ailment among competitors and casual lifters alike. Whether mild or debilitating, lower back pain is no joyride to have to train around. While resting the area and using other recovery modalities such manual therapy or stretching may help ease the pain, eventually you will have to adapt your training to be able to come back from your injury. Below are a few things from a program standpoint that you can monitor and control to help you recover from lower back pain in training. What follows is not medical advice, only my personal recommendations based on my own training experience and my coaching of other lifters. It is my hope that you find some of these suggestions useful, and that they help expedite your recovery.
1. Exercise Selection
The big takeaway here is the necessity of identifying for yourself which exercises trigger your back pain and which ones don’t. That list can and should change as time goes on, but it is an essential starting point. In the days following an acute injury, the list of pain-free exercises might be limited to walking, upper body exercises, and some lower body machines. That is a completely fine place to start. In fact, walking daily has been demonstrated to be one of the most effective methods for handling back pain, and can be a helpful tool to keep in your program for the duration of your recovery and beyond.
When some of the initial pain and tightness has subsided, your list of pain-free exercises might expand to include single-leg, free-weight movements like lunges, step-ups, or single leg RDL’s. You are only limited by your creativity here, but the goal is to be able to target the same musculature as the competition movements (in order to fill in the gaps from taking them out of your program) while simultaneously being able to drive intensity and build strength in those muscles (more on intensity in the next section).
In general, exercises with a more vertical torso position and more external stability will typically be easier on the lower back when you are first getting back into training. As such, it is usually easiest to progress from more vertically oriented torso positions to more horizontal ones, and from more stabilized to less stabilized exercises. An example here might be starting with a hand-supported safety bar squat, which provides lots of external stability and gives the lifter the ability to stay in a more upright position, and progressing from there to an unsupported safety bar squat, and from there back to their competition squat. The exercises that cause pain for an individual can vary greatly, but in general it is a safe bet to begin with more anteriorly loaded squat variations such as goblet squats and front squats, and progress to more posteriorly loaded variations like high bar and low bar back squats.
In hinge movements, it is also often easiest to start unilaterally, such as with a hand supported single leg RDL. From there, you may try progressing to kettlebell deadlifts, hex bar deadlifts, or any other lighter variation which keeps the center of gravity for the exercise closer to your base of support. Partial ranges of motion are also viable options on both squat and deadlift movements, such as pulling off of blocks if only the bottom few inches of a deadlift cause you pain.
2. Load Management
This could easily be number one on the list, but it seemed easiest to address it second. When we talk about intensity we are talking about two things:
Absolute Intensity: The actual amount of load on the bar or implement
Relative Intensity: Your proximity to failure on a given set
As with many training injuries, it is highly likely that we were simply not regulating load and intensity in our program appropriately, and causing too much stress to be able to recover from on a weekly and block basis. This should be reexamined afterwards, but in the mean time, both absolute and relative intensity should be dropped in the days and weeks following an injury. How far should they come down? That depends.
If you identified your lists of both painful and pain-free exercises from part one, you will likely find that some exercises fall in both categories depending on how heavily they are loaded. For example, you might find that your competition squat is fine when it is done lightly, but begins to agitate the injury sight when you get above 50% of your one rep max. I would call this your “pain-threshold” or the point at which the exercise becomes inadvisable to continue performing. This the point at which the exercise stops being of benefit to you, and begins to be to your detriment. You don’t need to know precisely where this is either, a ballpark estimate will work just fine.
In your training following an injury, when we reintroduce exercises that initially caused pain, it is important to start them well below the pain threshold and on the low end of both absolute and relative intensity. We can make up that lost training stimulus with other, pain-free exercises in the mean time, but we should treat the newly reintroduced exercise as a poison we are trying to build up an immunity to, only adding in what we can recover from and never crossing the threshold into painful territory.
In practical terms, if you are reintroducing your competition deadlift into your program after a week or two away from it post-injury, I would recommend starting with a low-volume rep scheme that does not change from week to week—lets say for the sake of example 4 ascending sets of 3 reps. We would want to choose a starting point that is well below the pain threshold in terms of both absolute and relative intensity, which in this example might mean that anything over 405 pound causes pain, as does anything over and RPE of 7. We could start with as low at 225 for 3 on our first set, and work our way up slowly over the course of the session, staying well below an RPE of 7. The following session we can progress a little further in terms of both absolute load and relative intensity on those same sets, and eventually the pain-threshold will be increased until we no longer have to factor it into our programming.
3. Volume & Frequency
“Volume” has many varying interpretations and definitions depending on who you ask, but in this instance we are referring to volume as meaning the total number of sets x reps for a given exercise. Frequency here refers to how often we are training a particular movement or exercise during the training week. Much like there was a theoretical pain threshold for intensity, there very likely exists a volume and a frequency threshold for your recovery as well. The pain threshold for volume would be the point where a certain number of sets or total reps during a single session or during the week as a whole can cause your symptoms to flare up. For example, let’s say you were accustomed to doing 4 working sets of deadlifts in one session or 8 total sets during the week before your injury. You might find that afterward you reintroduce deadlifts post-injury, that 2 sets per session and 4 total sets during the week is all you can reasonably manage at first without causing pain.
For frequency, the pain threshold would mean how often during the week you can train a particular movement without it becoming painful. For example, if you are accustomed to squatting 3 times a week but find that upon returning from an injury this is too much for your back to handle, switching to 2 sessions a week for a while may be appropriate. Again, for both of these markers, we don’t need exact numbers, just approximations.
While it’s generally best to start on the low end with volume when coming back from an injury, you may be able to build up frequency more quickly if you use smarter exercise selection. For example, instead of doing low bar squats three times a week, you might substitute one of those days with a front squat day and the other with a goblet squat day. Not only will this help you build up your volume with pain-free movements, but also these self-limiting exercises can help regulate your absolute intensity while keeping your relative intensity high.
Back pain can be extremely frustrating to deal with, but as long as you keep this information in mind, there is no reason you can’t keep training around it as you recover. Appropriately managing your intensity, volume, frequency, exercise selection, and movement quality is the only long term solution to recovery, and is as close as we can come to injury prevention in training.
While you are in the recovery process, the help of a clinician, such as a chiropractor, physical therapist, or other specialist is a great way to help relieve your symptoms and expedite your recovery process. To speak exactly on what they can offer you would be out of my scope of practice, so be sure to check out the accompanying article to this one, which is written by a chiropractor:
“Managing Back Pain in Training: A Clinical Perspective”
By Dakota Boellstorff, D.C.
