Categories
Flexibility & Injuries

How I fixed my Chronic Back Pain

Contents:

  • Overview: Basic Truths
  • My background
  • Main approaches to back pain
  • Myths
  • The pain cycle: What makes pain linger
  • Recommendations

Video version of this article:

“Back spasming up? You’d better ice it ASAP” – Chiropractors

“If you EVER round your spine, I’m afraid you’ll die.” – Osteopaths

“You’ve just got weak abs, do more planks” – Rehab specialists

“We could operate, but it might make it worse” – Neurosurgeons

“There’s nothing wrong with you, it’s all in your head” – Physiotherapists

“Your back pain is simply because your root chakra is misaligned, which is overactivating your left inferior oblique causing a slight anterolateral shift of your pelvis when you walk. You just need to wear more of the colour brown and take this expensive herbal liver tonic”. – Kinesiologists

Thanks for the advice, bro-therapists, you bunch of knobs.

A bunch of knobs

If you’ve been struggling with back pain, you’ll likely also have been told a similar bullshit-cocktail. It’s likely got you nowhere with your pain, but done wonders for lightening that heavy wallet.

If you’ve had recurrent back pain with no success, read on. Clearly your current approach isn’t working.

And you’re not alone.

1) Basic truths:

  1. Back pain is poorly understood by health sciences. Each field has a little piece of the puzzle at best.
  2. There is an entire industry founded on selling devices and miracle cures for back pain based on extremely fishy evidence. Such cures are no better than placebo, but will cost you a lot more.
  3. While underlying diagnoses may differ, there are several common features in typical back pain. This is good news: These features provide a trail into resolving your pain.
  4. You must take ownership over your recovery. No therapist can ‘fix’ you with a triumphant crack.
  5. The road to recovery requires a multifaceted approach and consistency.

Eric Cressey identified the 5 common problems people like us face with back pain:

  1. Many got sub-par, outdated physical therapy.
  2. They were just as concerned about maintaining a training effect while injured as they were about actually fixing the injury.
  3. They lived and died by their diagnostic imaging (MRI, x-ray, etc.), but paid little attention to the relationship of those scans to their symptoms and functional deficits.
  4. Most sought to learn more about their injuries so that they could be informed consumers in dealing with doctors and therapists, but they wound up more confused because of the varying opinions in the field today.
  5. They were looking for direction in how to progress back into a “regular” training regimen, but all that most of them could seem to get from their clinicians was contraindications (“don’t do this”).

While I can’t diagnose your specific issue, I have been round the houses with my own back pain. Several of my own clients, in person and offline have been able to fix their back pain. This article will save you the journey of dead-ends and help you to claim your life back.

2) My Background

You may be thinking that if the experts haven’t nailed back pain, then who is this presumptuous swine with fine rhymes opining on the spine?

I am speaking foremost as a patient, (who happens to be trained as both a doctor and sports massage therapist), sharing my experience of chronic, radicular back pain.

Professionally, I’ve also treated several clients with back pain as a sports therapist with the approach below.

Ultimately, this article was borne out of a tearfully obsessed personal need to get out of pain, which became an intractable curiosity to get to the bottom of such a common yet poorly managed epidemic.

I truly understand what you’re going through. The physical pain, the existential frustration, the endless chase for an answer amidst murky evidence and conflicting recommendations. Being fobbed off by health professionals. Feeling like you’ll be in pain forever.

And the pain… it’s so AXIAL, so inescapable, so up in your grill. It’s like Satan the Prince of Darkness himself has skewered you with his fiery poker into the very axis of your being.

Not so sure about those nipples, Satan

I had chronic, severe flexion-intolerant back pain for 8 years following a gymnastics injury when I was 19. I thought I would carry it to my deathbed. (Flexion-intolerant = pain when rounding the lower spine).
The deeper down the rabbit hole I went, the more I saw that often the mainstream approach has it totally backwards.

I received a wacky range of diagnoses:

  • Quadratus lumborum tear
  • Weak abs and glutes
  • Facet joint syndrome
  • Psychosomatic: ‘you just need a positive attitude.’
  • Poor activation of the left internal oblique(??)

As my understanding grew and my medical training progressed, I started to see through the fanciful language of these diagnoses:

  • A torn quadratus lumborum is an extremely unusual injury to sustain from a gymnastics injury. That’s more likely to happen being hit by a car. And wouldn’t produce this pattern of flexion-intolerant back pain, NOR would a soft tissue injury explain years of persistent pain. A broken femur takes 2-4 months to heal.

Verdict: Poor diagnosis

  • “Weak abs and glutes”: If that’s true, then send me to the labs right away, I’m a human marvel. The miracle man who deadlifted 250kg with weak abs and glutes.

Verdict: Poor diagnosis

  • “Facet joint syndrome” is typically associated with extension-intolerance (pain when arching the back)

Verdict: Poor diagnosis

  • “Psychosomatic”: For a 19 year old competitive weightlifter/gymnast presenting with sudden onset back pain following a clear mechanism of injury? Wouldn’t exactly be on the top of your list would it?

Verdict: Poor diagnosis


Every clinician I saw seemed to have their ‘pet diagnoses’ that they try to thumb everybody into. The key to being a good clinician is looking at what’s in FRONT of you, not what you simply EXPECT to see.

The physio who works with the elderly thinks you have weak abs.

The physio who’s watched a couple of Pete O’Sullivan videos now thinks that all back pain is psychosomatic (’tissue deniers’).

The new age therapist thinks your energy is out of alignment.

The biomechanics expert thinks its all about your glute activation.

The chiropractor thinks everything down to asthma and bacterial infections are due to spinal subluxations.

The GP checks to rule out red flags. If not, he prescribes you some paracetamol and sends you on your merry way.

Do you see the pattern here? Every clinician means well, but they have a certain set of tools in their box. This is why you need to take ownership over your pain. Don’t get sucked in by any of the ‘explain-all’ theories, as tempting as they may be. It’s a lazy thinker’s trap.

Meanwhile, I couldn’t train. I couldn’t even put on my socks. I was in disabling pain, and was desperately looking for relief. I particularly did not appreciate being dismissed as an attention-seeking hypochondriac.

Late diagnosis:By 2015 I had no answers, and no relief. I accepted that I’d be in pain forever. Stupidly, I trained through it. When possible, I would compete through the pain, but the episodes were now becoming more frequent, and more disabling. The pain was starting to spread to my hips and leg. By this point I was floored for a few days every couple of months, unable to stand and having to crawl to the bathroom. 

I was running out of ideas:

  • Back brace
  • Actipatch
  • Kinesiotaping
  • Stretching
  • Lifting without a belt
  • Lifting with a belt
  • Bedrest
  • Hot baths
  • Muscle relaxants
  • The full rainbow of painkillers
  • Chiropractors
  • ART
  • Icing
  • Massage
  • Osteopathy
  • Acupuncture
  • Death by foam rolling

One morning after an allergic reaction to some Chinese food (we’ll revisit that in a moment), I was awoken at 5am in agony with my legs on fire. I was crying like a little girl, and crawled to the walk-in-centre (I didn’t see the irony) for an emergency appointment. The GP gave me more painkillers, but looked back through my history and said ‘something’s not quite right here. You shouldn’t be experiencing this at your age’.

He ran a blood test for HLA-B27 (ankylosing spondylitis, an inflammatory spinal condition), and referred me for an MRI.
The blood test came back negative, but the imaging revealed a posterolateral disc bulge at L5-S1 (a ‘slipped disc’). It was at the nerve root level to match my symptoms. 

When your disc is so slippery it also slips through the proverbial net 👀.


To save on health resources, back pain is assumed innocent until proven guilty. This is the double edged sword of the UK healthcare system compared to the overinvestigative style of the US system. (We discuss the pros and cons of each in this podcast with Kamal Patel from Examine.com).

“The evidence clearly shows that most low back pain often has nothing to do with tissue damage.

Paul Ingraham

As with clothing or political trends, we tend vacillate between the prevailing viewpoints. On one side, there’s the overly mechanistic approach to back pain (‘all back pain is due to tissue damage‘). When they find that doesn’t explain every case, the reactionary perspective inevitably overshoots (‘tissue? What’s that?’).

The former view produces false positives, the latter, false negatives. The reality, of course, lies in the middle. But you need to assess the patient in front of you, and not treat a rule of thumb as concrete truth.

I was a false negative (heavily pregnant, but told I was just fat).

This should really have flagged up earlier:

  • Young, fit male
  • No other musculoskeletal or psychiatric history
  • Clear mechanical risk factors (competitive powerlifter, gymnast)
  • Sudden onset pain with clear mechanism of injury
  • Pain lasting >6 months
  • Clear radicular (focal nerve root) symptoms

When imaging was eventually done, it revealed nerve root compression that precisely matched the distribution of my pain and symptoms.

Neurological symptoms:

Things then worsened over the following few months: I was admitted to hospital for 8 days with an infection:

👋️

During my stay, I experienced the worst episode of pain ever. They stuffed some diclofenac up my bum (magic stuff, btw), and things settled. When I tried to stand later that night, I slumped on to the floor. My left leg wasn’t working properly, and I’d lost sensation down the leg across the S1 dermatomal distribution. I was sent for another MRI, which showed the disc bulge had worsened. I don’t have the second image to hand unfortunately, but it was reported as follows:

Most likely cause of this exacerbation: existing narrowing of nerve root space precipitated by prolonged bedrest and systemic inflammation from infection (just look at my face).

For the next 6 months I had lost plantarflexion in the left calf, and developed a pimp-limp. I couldn’t walk properly, let alone return to gymnastics or lifting. I stewed for days on my vipassana retreat over my new life as a disabled person, the prospect of adapting my car to put the brakes on the steering wheel.

The good news The data actually shows larger disc bulges have a much higher recovery rate than small ones. The sensorimotor symptoms have 90% reversed and pain is a thing of the past.

So after putting off writing this post for a long time, and many requests to just publish it, I feel it’s my duty to cover the lessons learned and the strategies to fix your back pain.

3) Causes of back pain

Rest assured, I was not the typical case of back pain. If you’re suffering from back pain now, statistically the future is bright for you. Typical mechanical back pain resolves on its own within 6 weeks.

There are a few schools of thought that come into and out of fashion. They all carry a sliver of truth, but not the whole picture. It is the combination of factors plus a pinch of bad luck that turns a back-tweak into a chronic-pain-in-the-ass. Understanding what’s going on will help you unravel your own pain and get back on the road to recovery. But first, we need to get clear:

‘There is no such thing as nonspecific back pain, the cause just hasn’t been discovered yet’

Stuart Mcgill PhD

A clinicians blindly shotgunning treatments in the hope that something sticks suggests they don’t really know what’s causing the pain. Once we have a clear pathophysiological mechanism, we can orient and target the treatment around a verifiable model.

“Therapeutic eclecticism is a sign of diagnostic incompetence.”

John Sarno, MD

Back pain most often has:

  1. Predisposing factors
  2. A trigger, a precipitant,
  3. Something that keeps it in existence: a perpetuating factor.

Predisposing factors include anatomy, posture and activity.

Often the precipitant is mechanical: “I tweaked my back picking up the kids/deadlifting/gardening”.

The perpetuant is usually a combination of mechanical and psychosocial factors – hence the ugly termed ‘biopsychosocial model’ of back pain: Poor movement patterns irritating the initial injury, and avoidant behaviour creating a ‘fear avoidance cycle’. We’ll cover this in a moment.


Saw this in the news today. A sign from the gods that it had to be included in the article. Do not attempt at home.

The “Mechanical” model


Dr Stu McGill is the BNOC when it comes to practical management of mechanical back pain in athletes. It’s worth checking out any of his books. While there are medical and genetic causes of back pain: inflammatory arthritides, malignancy, infection, cysts, kundalini syndrome, trauma, here we’re just discussing the run-of-the-mill form.

See our interview with him here:

Predisposing factors:
A risk factor that puts you at higher risk of back pain:

  • Family history,
  • Risky activities (e.g. weightlifting, manual labour)
  • Training or movement habits creating abnormal length-tension relationships in the muscles, e.g. imbalance between anterior and posterior core → muscle tension → pain.

Are you at risk?

Lifting weights is a predisposing factor. Flexion-intolerant back pain is more common in lifters who spend a lot of time in loaded anterior pelvic tilt (squats, deadlifts and their variations). Lordosis (monkey-butt posture) arises from hypertonic lumbar extensors, tight hip flexors producing abnormal length-tension relationships from front to back.

Or, someone with tight hamstrings will form a compensatory lumbar ‘kink’ under load when the hamstrings are not flexible enough to accommodate a deadlift start position.

So why don’t all lifters herniate a disc? It’s a game of risk. Just because you cross the road doesn’t mean you’ll get hit by a car.

Precipitating factors:
McGill is known for his ‘life cycle theory’ of vertebrae: the idea that a spine can only undergo a certain number of flexion cycles in its lifetime before it gives out. Moving in a way that puts a disproportionate amount of flexion load through the spine is wasting valuable spinal capacity. This includes daily movements and lifting technique. If you’re injury-free, it’s accelerating the ageing process. If you have an injury, it’s stopping you healing.

According to Mcgill, ‘bad spinal habits’ – i.e. moving your spine in an uneconomical fashion is a precipitant. This effect is cumulative: so both minor and major leaks can add up to tilt the balance to a cycle of pain.

The Lead Domino
A lot of the time, that time you tweaked your back isn’t really the ‘injury’. Perhaps you’ve spent years lining up the dominoes and this was just the little flick. And we have a tendency to ascribe all kinds of meaning and overanalysis to the trigger.

To add insult to injury (pardon the pun), it’s often doing the most innocuous task. I recall doing 200kg deadlifts for 5×5 a few years ago, only to ‘sleep funny’ and ‘put my back out’. It’s like surviving the Twin Tower attacks, only to get hit by a bus as you leave the building. It makes you feel like a plonker.

Funnily enough, I just got this text from Chris:

Bad spinal habits

Chronic back pain tends to cause hip extension using the hamstrings and subsequent back extension using the spine extensors creating unnecessary crushing loads. Gluteal muscle reintegration helps to unload the back.

Stu Mcgill

Mcgills data shows that flexion-rotation movements were the worst offenders for disc damage (twisty situps anyone?).

His treatment and exercise plans revolve around:

  1. Removing offending exercise triggers
  2. Identifying and eliminating ‘leaks’ to spinal capacity
  3. Corrective exercise: Rebuild spinal endurance, ‘stiffness’ and stability
  4. Ingraining new movement patterns
  5. Safely loading those new correct patterns
  6. Returning to the sport with the improved pattern

I love this. Finally, a method.

Perpetuating factors:
So what are these ‘improved patterns’? The goal is to develop and adopt the muscular activation patterns of somebody who is pain-free. Kind of like fake it ’til you make it. Back pain sufferers (even those with a history of back pain) have observably distinct muscle activation patterns to those without back pain. Ironically, if you have back pain, you likely use your spinal erectors more in daily tasks than non-sufferers. The hips go lazy, in a phenomenon beautifully named ‘gluteal amnesia’.

The corollary is true for non-sufferers: more hip activation, less backtivation (yep.. I went there).

So:

Those with back pain: Lumbar dominant.

Those without back pain: Hip dominant.

While not everybody agrees with McGill, there’s a process informed by a mindboggling amount of his complex lab and cohort studies with athletes to arrive at his conclusions, which include some eyebrow raisers:

  • Flexibility is actually correlated with back pain
  • Maximum strength is NOT protective of back pain
  • Spinal endurance is protective of back pain
  • The ability to rapidly generate core stiffness is protective of back pain
  • ‘Gluteal amnesia’ 🍑️ and overactive spinal erectors is present in those with back pain, and the reverse for non-sufferers

Hold up. Strength is NOT protective?
Well rustle my jimmies, you mean the T-nation hype was wrong? I thought I was ‘bulletproofing’ myself by squatting and deadlifting. But it’s not as simple.

There probably is some protective effect from lifting, but it is likely offset by:

  • Lifting heavy 4x/week, only to spend the rest of your time with poor spinal habits, slouched in that office chair
  • Imbalanced training programmes (see precipitating factors above)
  • If your technique or leverages are unfavourable, deadlifting may be worsening the problem
  • Max-strength style lifting has been shown to ‘functionally repurpose’ muscles in the spine from oxidative, endurance-style fibres to glycolytic, fast-twitch fibres. Great for letting you snatch more, not great for minimising back injury.
  • Weekend warrior syndrome is a particularly big risk factor: Someone who is sedentary for most of the week, with spaced out intense exercise.

When you account for the above, you can see why posture is often unfairly blamed. Posture can often be the effect, rather than the cause, and there are distinct benefits to improving it. See my guide: Posture 101 for more on this.

Psychosocial Causes of Back Pain

The next piece is the psychosocial model, the woowoo, easy-to-dismiss side of back pain. This becomes less easy to dismiss when we see that the mechanical approach does NOT fully explain the pain. Two people with similar movement patterns could sustain the same precipitating injury, and yet have different outcomes, because of the way they process their pain.

Many pain-free individuals will show some level of disc bulge or spinal abnormalities when scanned. So if you have chronic back pain and get a scan, it’s easy to misattribute your pain to any incidental quirks of your anatomy.

We must be careful not to spot a disc bulge and immediately assume that’s the cause of the pain. “Look! Tissue damage. It’s right there – case closed”. Not so fast bozo.* If patient is experiencing pain at a different nerve root distribution to the level of the bulge, then the bulge alone cannot possibly explain their pain symptoms!

*I’ve been wanting to use the phrase ‘not so fast, bozo’ for a long time. I’ve now had my moment, thank you.

The data often finds no correlation between number of abnormalities on X-ray and clinical patient symptoms for radiculopathy degenerative osteoarthritis, transitional vertebra, spina bifida occulta and spondylolysis, and often makes patients feel worse about their injury.

We must be aware of this. I see this constantly with my patients. If you have an anxious or catastrophising personality, and are shown imaging abnormalities or given a label to validate your pain, it can be detrimental. Pete O’Sullivan (inb4 SideShow Bob) works with patients to overcome the label:

Key point: By over-imaging and trying to find the 1-5% of people with structural back pain, we create a pain cycle in people who would otherwise have been fine. [Type 1 error].

“I have never seen a patient with pain in the neck, shoulders, back or buttocks who didn’t believe that the pain was due to an injury, a hurt brought on by some physical activity.

The idea that pain means injury or damage is deeply ingrained in the American consciousness. Of course, if the pain starts while one is engaged in a physical activity its difficult not to attribute the pain to the activity. (As we shall see later, that is often deceiving.) But this pervasive concept of the vulnerability of the back, of ease of injury, is nothing less than a medical catastrophe for the American public, which now has an army of semidisabled men and women whose lives are significantly restricted by the fear of doing further damage or bringing on the dreaded pain again. One often hears, Im afraid of hurting myself again so Im going to be very careful of what I do.

In good faith, this idea has been fostered by the medical profession and other healers for years. It has been assumed that neck, shoulder, back and buttock pain is due to injury or disease of the spine and associated structures or incompetence of muscles and ligaments surrounding these structures without scientific validation of these diagnostic concepts.

Ideas about the vulnerability of the back are, to a large extent, based on the diagnoses practitioners make. Such words as herniation, degeneration, deterioration and disintegration, constantly used to describe the lower end of the spine, provoke fear and provide a ready explanation for the injury and the attack of excruciating pain. If the structural diagnoses are correct, something happened to the spine during the last evolutionary eyeblink and it has begun to fall apart.

This idea is one of the great impediments in the way of recovery. It must be resolved in the patients mind or the pain will persist.

^ John Sarno, MD

So there’s the first big psychological precipitant: I’m broken’: The readily-accepted identity change that comes with receiving a diagnosis.

And the perpetuant: The altered movement habits that arise as a RESULT of this change in identity. You’ve seen that people with back pain tend to overuse their spinal erectors relative to their hips. Another observed feature in back pain sufferers is antalgic behaviour: got to reach into the top cupboard to get a tin of beans? A pain free person wouldn’t give it a second thought. They’re loose, their breathing remains normal, they move smoothly.

But when you’re in pain, you probably move more like this guy:

https://www.instagram.com/p/BmSu7ZPhiws/

Combine this antalgic behaviour with pain, anxiety and feelings of catastrophe: not a good recipe. This mixture is enough to prolong back pain which could have self-resolved into a chronic problem: Oversensitisation of tissues and increased threat perception. This even happens at a pain-receptor level: increased density of alpha and gamma receptors in the spine so that normal stimuli to spinal positional receptors are interpreted by the CNS as pain, even in the absence of tissue damage.

Fortunately, the cycle can be interrupted and the perpetuants reversed. Many people have had success with this approach alone.

You’ve now taken the red and the blue pill….

Before we go on – now that we’ve discussed the mechanical and the psychosocial causes, do NOT fall into the trap of thinking that your back pain is simply ‘one or the other’.

Our minds want certainty. Maybe you’ve decided already. The existence of ‘normal abnormalities’ has led some experts to jump to the conclusion that there is NO SUCH THING as tissue damage causing pain. Do we even have tissue? Is the spine a myth? Are we all just imagined creatures in a test tube?

Think holistically. This is EXACTLY how experts have jumped into fiercely defended ‘camps’ of oversimplified models. Keep your cup empty, wise one. You’re about to see how this all fits together.

My Recovery:

Here we come to what I’ve done to eventually get out of back pain.

I identified some clear causes and perpetuants in my case:

  • Competitive powerlifting + gymnastics (which creates the perfect storm for a disc herniation according to Dr McGill: imagine constantly bending a bit of plastic back and forth, then subjecting it to compressive loading)
  • Family history
  • Infection/inflammatory triggers
  • Unfavourable anthropometry (long torso, narrow waist, long femurs → increased shear on the lower back).
  • Poor scapular mobility (combined with heavy overhead pressing = arching of the lower back and more force going through L5-S1).
  • Almost nonexistent lumbar spine ROM, so the upper back takes the flack during deadlifts. Injury is most likely to occur at a point where the spine goes from an immobile section to a mobile segment, hence L5-S1 being a common source of injury: L5 means the 5th vertebra of the lumbar spine, (which is mobile). S1 is the first vertebra of the sacral spine (which is fused).
‘weak abs m8. and its all in your head, couldn’t possibly be to do with going from sitting at a desk all day to trying to pick up 240kg’

While I adopted antalgic, pain-avoidant behaviour during flareups, fortunately I didn’t have many psychological risk factors, and I didn’t fall into the cycle of catastrophising.

Perhaps some of this sounds like you. By following the method below, I have been able to bring myself out of pain. I have had no major flareups for 2-3 years and day-to-day pain is now minimal. I’m back to doing fun activities:

https://www.instagram.com/p/BtQQnD4AhKm/

I’m confident that you can achieve a good result too.

Recommendations:

I’m going to be straight with you. The reason you likely won’t succeed with this section is not because of your back, but your ego. The movements here are boring as fuck. And you’ll have to STOP PICKING THE SCAB. This can be the hardest part if you’re a die-hard bobbydilder or piftywifter.

You need to make the conscious choice right now: do you want to heal from your back pain, or do you want to continue limping along out of gains FOMO?

Before starting:

  1. Rule out dangerous causes: Make sure you see your doctor first. Before trying to manage this yourself, you need to ensure there are no dangerous or medical causes of your back pain. See red flags below.
  2. If you do get scanned – take your imaging results with a pinch of salt. Listen to your doctor. If you’re feeling anxious, tell them and ask them for their perspective. . If you know that you’re prone to catastrophising, do not obsess over the findings. Look onwards and upwards to recovery.
via Rebelem.com

For example, I had focal neurological signs: loss of motor and sensory function down the left leg. This warrants medical review.

Here is your ladder of success:

Step 1) Heal, recover

Acute phase: You’ve pulled something. Stop and rest.

The primary goal here is reducing spasm. Analgesia as required. Hydrate, relax, and don’t be an idiot. Mcgill recommends a brisk walk with lots of arm swing and a 10lb loaded backpack to help grease the back in a coordinated, low-impact way.

The first thing you should do is begin a lying relaxation practice. Most people skip this, because it doesn’t feel relevant, and it’s ‘boring’. So without being sold on this practice, you’re also unlikely to stick to it. Benefits:

  • Gain conscious control over your parasympathetic nervous system: Overcome spasm faster
  • Feel more relaxed throughout the day
  • The more you develop the skill of no unnecessary tension, you become less fatigued. You’re no longer expending energy on neurotic tensions.
  • The more you do this practice, the more you see that it isn’t boring at all. There’s a world of scintillating internal activity to explore.

Listen to this audio daily to unwind your amped up nervous system, and you will start to break the cycle of hypersensitisation and threat perception.

Now that you can consciously relax your back at rest, it’s time to move up the ladder with breathing drills:

Cat-camel drill. Alternate rounding and extending the spine, with coordinated breathing. Via Tony Gentilcore
Band decompression. Once spasm has resolved, here’s a way to wiggle the hips in all planes under decompressed load. Via Donny Thompson

Step 2) Rehab, remove triggers, mobilise, strengthen

Stop picking the scab: We had an agreement, remember! Once you’ve made the commitment, keep the goal the goal.

Resist temptation to try for a max deadlift as soon as you see a smidgeon of improvement. I stopped deadlifting and squatting entirely. In hindsight, if I had made this choice before I was forced to, I’d have shaved years off my recovery time.

Next, identify your weaknesses: You may be aware of them already, but it’s worth exploring this with a good physiotherapist or sports massage therapist to identify your issues. Where are you immobile? Where are you weak? If you’re like me (and most lifters) you might have poor scapular and thoracic mobility, and not be using your glutes properly.

Dan Ogborn notes that his weak hip extensors were the root of his back rounding in the deadlift: “Flexing my thoracic spine was simply a strategy to improve the mechanical advantage at the hip and lower back, to compensate for deficient glute and hamstring strength and my lower back injury.”.

You need to exercise some judgement about what you need. This will likely need some assessment and customisation. Then, get to work with strengthening and mobilising as a daily routine. Listen to your body and be guided by feel. If any drills hurt or make it worse, stop. ‘No pain no gain’ does not apply here. A non-exhaustive list of ideas to get you started below, and remember it’s not about the magic exercise, it’s about following the principles of the ladder.

Examples:

Loosening a globally stiff spine:

Deep breathing into flexion: spring cleaning dusty parts of the spine
Sumo rotation: From ‘Overcome Back Pain’ by Kit Laughlin
Partner Assisted side seated stretch: From ‘Overcome Back Pain’ by Kit Laughlin

Jefferson Curl:

https://www.instagram.com/p/_KtiAKPmvW/?hl=en
A drill to regain control of the spine and strengthen the smaller muscles. My goal was to learn to move with the whole spine rather than hinge gross sections.

NB: Turns out loaded flexion was not good to push in my case due to my disc prolapse. The Jefferson curl is already controversial drill because people inevitably try to load it too heavy, too fast. My mistake was doing these types of drills too early in the rehab phase, and not just sticking to a broomstick. The goal is not to force new range, but to coax the spine to move normally and reclaim lost, pain-free range.

Wake your lazy ass up: gluteal amnesia & spinal stability

The Stu Mcgill Big 3 exercises – Via Vox

These are my keystone habit. Known as the ‘big 3’ for a reason: Most people will benefit from these three movements. The goal here is to restore coordinated stiffness in the spine, and wake up the hips. Reps are less important than quality of movement.

Great walkthrough by Layne Norton here:

Doing the big three is challenging because it’s boring and it doesn’t get instagram-points. Persist. You’re doing this for you.

The foundation series:

Video walkthrough here: More challenging than the big 3, but this is a Big-Ben-tower alarm clock for sleepy hips.

Step 3: Find alternative movements, repattern, phased return, find success

Hopefully by this point, you’re out of pain. The next challenge:

  • Reintroducing overload without overstepping your capacity
  • Finding pain-free exercise substitutions
  • Being aware not to suddenly ditch the rehab that got you here so far
  • Keeping ego in check
  • Find success” – rather than looking for what hurts, find movements you can do pain free.

We’re at the inflection point here. Going from injured → baseline, and soon to become stronger than ever. Work with your coach to figure out how you can progressively overload within your pain free range. Stick with the rule of avoiding movements that aggravate your pain.

Outside of the gym, the focus is on ‘spinal hygiene’: the concept of good movement quality. If you’re prone to melting into your chair at work, consider a lumbar support – I use this one. Take your new hip activation into your day-to-day movements. 

You’re always practicing something, consciously or not. Create new movement habits that now match the muscular activation patterns of someone who is pain-free.

Step 4) Dominate

You’ve made it 💪️. Next step:

Decide on the cost-benefit of your previous training programme.

Many of Mcgill’s patients have been able to return, compete and hit PBs in powerlifting. For me, I’ve been there and done that with competitive powerlifting. I don’t see the utility in continuing to push heavy deadlifts. I had the wakeup call that I needed, that squeezing out an extra 2.5kg per year while training through pain, and losing function of my leg isn’t really worthwhile. 

Consider the diminishing marginal returns from certain training goals. Do I still recommend others lift? Absolutely. You stand to gain so much strength, physique, confidence and health going from zero to a 2x bodyweight squat. Less so going from 2 to 3x. But spending the next 5 years going from 3x to 3.1x? Not so much.

For most, there’s more satisfaction in switching training goal and moving forward, but you do you.

End

So there we are. I’m at stage 3 of the ladder right now. I resisted doing the rehab exercises, I trained through my injury for too long, ignoring the pain. I hope this post helps you to avoid the mistakes I did, and you can become a pain free Propane-Athlete very soon 💪. 

As always, if you want personal guidance with anything mentioned in this article or others, get in touch to see if we have any coaching spots available, and how we can best help you.

Still hungry?

We have some cracking further reading/listening on back pain:

Podcasts:

Kit Laughlin interview: Relaxation, stretching and back pain.

Greg Lehman interview: Back pain

Orthopaedic surgeon on lifting and pain: A doc who lifts

Books:

Overcome Neck and Back Pain Book – Kit Laughlin

Gift of Injury: Stu Mcgill and Brian Carroll

Articles:

Stretching 2.0: A true game changer

Article/Video/Podcast: Posture 101: Ultimate guide to posture

Practical post by Iron & Tweed on living with his back pain

Antibiotics as a cure for back pain? – Off-the-wall concept, but then again so was H.Pylori at one point.

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