Nov 30, 2018
Trent and Coach D return for round 4 of the series on lower back
pain, wrapping up the topic with a meaty discussion about exercise
for treating chronic low back pain as well as acute pain from
As mentioned in previous episodes, it's very important to first
get an accurate diagnosis to understand what you're dealing with
before getting back to training. Hard neuro symptoms such as loss
of motor function, drop foot, etc. are more serious and may require
a different approach to treatment than chronic sciatica, for
instance. The diagnosis helps identify the source of the pain, and
provides some idea of the likely healing time of the tissues
affected (muscle, tendons, bone).
Once an accurate diagnosis has been made, treatment should -- in
most cases -- begin immediately. Rarely is rest the right answer,
unless the athlete is dealing with a severe injury. At this point,
the coach or medical provider should begin educating the athlete
about the nature of their injury and some of the things they may
experience during the rehab process, being careful not to
catastrophize the injury. Sometimes they are going to experience
pain during their workouts, but using the exposure without danger
principle discussed in Part 3 will help rewire their pain response
while giving the tissue the best environment to heal.
From here, Coach D likes to break down the exercise progression
into several steps, with pain and knowledge of the injury and the
typical healing times for different types of tissue serving as the
The Exercise Prescription
- Bodyweight movements while laying on the back.
At this point there should be little or no loading of the spine,
just introducing light movement.
- Knees to chest
- Trunk rotation
- Bodyweight movement, progressing to sitting.
The athlete should focus on keeping the spine neutral and using the
back as a rigid lever during these movements. At this point we have
still not introduced loading beyond bodyweight.
- Sit to stands, from a high box to progressively lower box if
- Hip hinges, using the back as a rigid lever
- Compound movements, with light loading. This
is a good time to break out the training bars, broomsticks, and PVC
pipe. Adjust the grip, implement, or movement pattern as necessary
to accommodate for pain tolerance. For instance, if the lifter is
having a hard time holding a regular barbell, try a safety squat
bar or buffalo bar. Loading should be conservative at this point;
there will be plenty of time to progress to heavy later.
- Squats using a light bar, kettlebell, or even bodyweight squats
to a box, but using full range of motion.
- Planks and side planks in short intervals, increasing duration
over time, for athletes who still have trouble loading their spine
in a horizontal position.
- Sled pulls and drags
- Weighted carries with dumbbells or kettlebells
- Compound movements with progressive loading.
At this point it's time to reintroduce the compound lifts -- the
squat, press, and deadlift -- with some load.
- The lifter needs to pay special attention to executing the
lifts with perfect or nearly perfect form. At this point the
athlete's pain should be low to moderate on the pain scale, and
they can load the lifts using pain as the guide.
- Use common sense with the progression: a 400lb squatter coming
back from a minor adductor strain need not make 5lbs jumps every
workout, but he probably should not make 50lbs jumps either.
Likewise even a strong lifter coming back from a more severe injury
such as a hamstring tear may need to make more conservative jumps
while the tissue heals. In both cases the progression model will
look the same, but the timelines will be different: the lifter with
adductor strain may only need 2-3 weeks before he is back to
squatting 90-95% of his previous loads, while the hamstring injury
may require months, depending on the severity.
At first the athlete should be doing these movements every day.
Once compound loading begins, as the loads climb they can start
tapering their workouts from every day to every other day,
eventually back to their original workout schedule, such as 3 times
The key thing when dealing with pain is motion is
lotion, and movement as soon as possible after an injury is
the best way to promote healing in the damage tissues. For those
suffering from chronic pain and not necessarily an injury, movement
is still the answer! Progressing to compound movements
- increases blood flow to the tissue, which
brings nutrients, facilities cellular waste removal, and brings
growth hormones to the tissue
- reduces scar tissue, as the muscle is
encouraged to heal in the direction that it is used, as opposed to
randomly scarring, which can increase the chance of injury in the
- reduces muscle atrophy
- improves motor sequence firing
and increases muscle stamina, which help make
movement and everyday tasks easier
Further Reading on Back Pain, Pain Science, and Exercise
Intervention for Pain
- In the
Spine or In the Brain: Recent Advances in Pain Neuroscience
by Nijs J, Clark J, Malfliet A, Ickmans K, Voogt L, Don S, den
Bandt H, Goubert D, Kregel J, Coppieters I, Dankaerts W
Effects of Functional Resistance Training on Fitness and Quality of
Life in Females by Cortell-Tormo, Juan & Tercedor, Pablo
& Chulvi-Medrano, Iván & Tortosa-Martínez, Juan &
Manchado, Carmen & Belloch, Salvador & Perez-Soriano,
- Exercise in
the Management of Chronic Back Pain by Dreisinger T
Effects of Strength Exercise and Walking on Lumbar Function, Pain
Level, and Body Composition in Chronic Back Pain Patients
by Lee JS, Kang SJ
- Individualized Low
Load Motor Control Exercise and Education versus High-Load Lifting
Exercises by Aasa B, Berglund L, Michaelson P, Aasa U
- Core Strength Training for Patients with Chronic Low Back
Patients With Low Back Pain Benefit From Deadlift Training?
by Berglund L, Aasa B, Hellqvist J, Michaelson P, Aasa
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