Low back pain is one of the most frustrating, but also most common, things that people have to deal with. In fact, most of us will experience a bout of low back pain at some point in our lives! However, this doesn’t mean that we should avoid lifting heavy things, running, or any other activity that we love in an effort to avoid experiencing low back pain. What it does mean is that we should be prepared for when this does happen, and have a plan to address the problem if/when it arises…and that’s exactly what we want this blog post to be!
Before we actually get into our 3 step system for solving low back pain, we need to briefly discuss back pain in general, because there is a lot of misinformation (and sometimes downright harmful information) out there. For the vast majority of us, when we experience back pain we want to know what the cause is, usually thinking of things such as:
- Disc bulges and disc herniations
- Muscle spasms/strains
However, low back pain is extremely multifactorial, which means that many things contribute to somebody experiencing back pain, and it’s hardly ever as simple as just one of those things in isolation. In fact, many non-physical things can contribute to back pain, such as:
- Sleep quality/quantity
- Job stress
- Big life changes such as the loss of work, divorce, a death of a loved one
- Your overall training program and exercise routine
- Your beliefs and previous experiences with back pain (or pain in general)
- What trusted people such as friends, family, and healthcare providers say
- And many other things
Because of this, it is often (but not always) not possible to determine the one singular cause of the pain, because that’s not how back pain usually works. But, here is the good thing…we do NOT need to know exactly what is causing your back pain in order to effectively help you and solve your back pain. As long as we know what bothers your back, what lessens your back pain, and what your specific goals are/the exercises and lifts you want to get back to doing, we can develop an effective, customized plan to solve your pain and get you back to the activities you love.
And that is where our 3 Step System comes into play! The three steps are:
- Put Out The Fire
- Build Back Up
- Develop Resiliency
Next, we are going to go in-depth on each of those three steps, with specific examples of how we implement these steps with our clients to get them amazing results!
1. PUT OUT THE FIRE
This is the first step in our 3 Step System to solve low back pain and sciatic and get our clients back to the activities they love. Overall, this step is about taking the activities, exercises, and lifts that aggravate back pain, and modify them so that they can still be done, but without continuing to aggravate your back.
When we are talking about modifying exercises/lifts, there are several different things that we can modify to accomplish this. The main training variables that we can modify are volume, intensity, range of motion, tempo, and exercise variation.
Volume is basically how much work is being done while training. There are many ways to calculate volume, but in the context of back pain, the best way to do so is to assess how much volume (number of sets and reps) are being done for a given lift in a single session.
Sometimes, people will notice that their back pain has a volume threshold, and if you do more volume than that threshold, their back pain will start to become aggravated. For example, you may notice that you can deadlift without back pain if you stick to 3 working sets, but if you go above that, your pain will start to flare up.
In these cases where we can identify a volume threshold, we can easily work around this by simply lowering how much volume you’re doing to below that threshold. We work with this amount of volume as the back pain starts to calm down, and then we can begin increasing volume and try to raise that threshold over time!
So if going above 3 sets of deadlifts, squats, cleans, or any other exercise flares your back pain up, you can stick to 3 working sets per training session for 3-4 weeks. Then you can try to add another set once your back is feeling better each couple of weeks until you’re at the desired number of working sets!
Intensity is basically how hard your training is. There is both external intensity (the amount of weight that you’re lifting) and internal intensity (how hard the lift feels, often assessed by RIR or RPE).
Similarly to volume, many people will find that they have an intensity threshold, which is a weight that if they go above, their back pain will flare up. In this case, we can address this the same way as with volume, by bringing the intensity below that threshold for a while as the low back pain calms down, and then gradually building back up to a desired intensity level.
Range of Motion
Range of motion (ROM) is how far you are moving the weight. Many people find that the very bottom position of deadlifts and squats is where their back pain is most aggravated. Similarly, many weightlifters and Crossfitters say that pulling cleans and snatches from the floor, or catching them in a full squat (compared to power cleans and power snatches) are the most aggravating positions.
In these cases, we can temporarily avoid those positions while still training the lifts to keep up strength, power, endurance, and muscle size as you are rehabbing from your back pain.
For deadlifts, pulling from blocks is a great option to limit the ROM, and performing box squats or pin squats are great squatting alternatives to avoid these positions.
For cleans and snatches, if initiating the lift from the floor hurts, then they can be performed from the hang, or from blocks set to a comfortable height. If catching in the full squat hurts, then they can be modified to power cleans or power snatches.
Tempo is simply the speed at which different parts of a rep are performed. You will most typically see tempo written as a 4 digit number, such as W-X-Y-Z, in which:
W = Length of the eccentric/lowering phase
X = Length of pause at the bottom of the lift
Y = Length of concentric/lifting phase
Z = Length of pause at the top
When using tempo for training around pain or an injury, we can use deliberately slow tempos, or tempos that have pauses in them, to allow a lifter to still train, but while minimizing the risk of aggravating the pain.
Examples of tempos that we like to use with our clients are:
3-0-3-0 tempo (3 seconds down, 3 seconds up, no pauses)
5-3-1-1 tempo (5 seconds down, 3 seconds pause at bottom, 1 second up, 1 second pause at top)
Alternatively, you can just use pauses during lifts (including multiple pauses during a single repetition). For example, if heavier cleans or snatches result in pain, a good option is doing reps in which pauses are done just off the floor, below knee, and then again above knee.
Both of these options will allow lifters to still train hard (ie high internal intensity), but the pauses and tempos will force there to be less weight on the bar (ie lower external intensity). Be warned though, using slow tempos and long (or multiple) pauses are great ways to limit the load on the bar, that doesn’t mean that lifting in this manner is easy! In fact, many of our clients have found these variations to be more challenging than lifting with regular tempos!
When discussing changing exercise variation, the main things we are looking at are bar position, body position, and implement. Oftentimes, we can modify one of these variables to reduce pain while still training hard.
Bar position will mainly come into play when squatting exacerbates back pain. Some people will feel better with a more upright torso position, while others will feel better with a less upright torso position. For squatting, low bar back squatting is the least upright, high bar back squatting is in the middle, and front squatting is the most upright. Knowing this, you can experiment with different bar positions and find the most comfortable way to squat.
If deadlifting causes low back pain, you can try changing your body position by pulling either conventional (much less upright) or sumo (much more upright). Again, different people will feel better with different positions, so try them both out and go with whichever one feels best!
For implements, we can lift with a barbell, trap bar, dumbbells, kettlebells, etc! So if squats are increasing your pain, you can try goblet squats or SSB squats. If deadlifts cause your pain, you can try trap bar deadlifts or kettlebell deadlifts!
Most of the time, we are going to have to modify a combination of these variables to make training comfortable enough, but we want to make sure we try to keep training as regular as possible for the greatest carryover.
For squatting, this could range anywhere from tempo goblet squats to a box all the way to regular low bar back squats with a slight pause in the bottom. For deadlifts, we may have to start with sumo deadlifts from blocks with a slow eccentric before working to more traditional deadlift variations. And for cleans and snatches, we may do something like power cleans/snatches from blocks above knee with a pause in the receiving position.
There are an endless number of ways to modify training to make it comfortable, even in the beginning stages of rehab, and our job as your physical therapist is to find the right variation for you!
2. BUILD BACK UP
The second step in solving low back pain and getting back into the gym is to slowly progress back to your normal style of training once we have gotten symptoms under control.
In this phase, we would take whatever modifications we made during the first phase, and gradually start to progress them back to the regular variation of whatever exercise(s) really caused your back pain to flare up.
For instance, let’s say deadlifts were very painful, and during the first phase we modified them to doing 3-0-3 tempo deadlifts from 12 inch blocks. A progression back to regular deadlifts that we could take would be something like:
3-0-3 tempo DL from 12” blocks → 3 second eccentric DL from 12” blocks → 3-0-3 tempo DL from 8” blocks → 3 second eccentric DL from 8” blocks → 3 second eccentric DL from 4” blocks → 3-0-3 tempo DL from floor → 3 second eccentric DL from floor → Regular DL from floor
If full snatches were really aggravating your back pain and we had modified them to power snatches from blocks above knee with a 2 second pause in the catch, we could follow a progression like this:
Power snatch from blocks above knee with a 2 second pause in catch → power snatch from blocks above knee without pause → power snatch from blocks below knee with a 2 second pause in catch → Snatch from blocks below knee without pause → Snatch with 2 second pause in catch from floor → Snatch from floor
The important thing during this phase of rehab is to realize that some level of flare up or exacerbation of the pain is pretty normal during this time. We are carefully tip-toeing the line of doing enough training to get the adaptations we’re looking for, but not doing so much that we really flare things up again. It is very easy to start to step over this line, but if/when it does happen, all we have to do is pull our foot off the gas a little, make some adjustments, and keep on progressing when the pain calms down again.
3. BUILD RESILIENCY
This is often the fun part of rehab, where your back pain has diminished, you’re feeling more confident, and you’re back to training. However, that doesn’t mean that the work is done at this point!
Most training/gym related injuries happen as a result of doing more than we are capable of handling at any given point in time. So the best way to reduce the risk of this happening is to increase our back’s ability to handle stress!
This phase is all about training our backs to resist and produce force in many different positions (yes, we’re going to be training outside of “neutral spine” *gasp*). During this phase of rehab, we will often have our clients perform things such as:
- Jefferson curls
- Explosive band lifts/chops
- Med ball throws in various planes of motion
- Weighted back extensions
Many of these exercises implement power and speed development while the spine is moving through different positions. We do this specifically because if we can train your back to handle this type of stress, then we know it is well equipped to handle most things that you will throw its way when you’re back in the gym!
This is the exact process that we at Barbell PT and Performance have used to help our clients solve their low back pain and get back to the training they love. If you are currently dealing with back pain or sciatica that is limiting you in the activities you love, click the button below to request a free call with our team to see if we can help you out!
Barbell PT and Performance is the premier sports physical therapy clinic in the greater North Haven Area. We specialize in helping lifters, athletes, and active adults solve their injuries and get back to lifting, running, and all of the other activities they love without having to skip workouts, take medication, or undergo unnecessary surgeries.