Let’s be real: back pain sucks. If you’re reading this guide, you’ve probably tweaked your back at some point during your training. Hopefully, it was long ago, you’re on the mend, and you’re checking this out for the preventative strategies. If it was recent, then I hope you find all sections of this guide to be of use.
A little bit about me: I am NOT a doctor, nor am I a physical therapist. I am a coach – I coach strength, conditioning, CrossFit, nutrition, health, wellness, etc. I CANNOT diagnose your ailment, nor prescribe a remedy. What is contained in this guide are my SUGGESTIONS, and a method of progressing your training based on your own, individual tolerance.
Who am I to give such advice? I have 15 years of coaching experience. I have hours upon hours of experience working with athletes who have experienced back pain. I’ve gone through it myself, and I’ve worked with athletes who have suffered from bulging and herniated discs, pinched nerves, sciatica, and spinal fusions (C, T, L, and S. Everything but the Coccyx).
This guide is based on my experience. In working with many of these clients, I have consulted with their doctors and physical therapists. When I have concerns, I consult with my cousin, Dr. David Essig. Every situation is unique, and I encourage you to work with your health care provider. This guide is for general suggestions and recommendations.
UNDERSTANDING BACK PAIN
Unfortunately, this heading is misleading. Back pain, and pain science in general, is not well understood. Many with back pain have no history of trauma, nor any underlying condition that can be blamed for it (e.g. bulging or herniated discs, spinal fusion, degenerative disc disease, etc.). Others may go through life pain free, yet when they undergo an MRI, they are diagnosed with conditions like degenerative disc disease, even though they are asymptomatic.
The point here is that we may not understand the root cause of the pain you experience, but that’s okay. We can still manage it. I’m not trying to deprive you of hope; I just like to manage expectations.
Before we dive into management techniques, I want to cover a few universal principles.
- Injury prevention – it’s not possible. We can work to reduce risk, we can work to build resilience, and we can work around it. But we cannot eliminate injury with 100% certainty.
- Resilience is your second-best mitigation strategy. We increase it by building strength through full (and unconventional) ranges of motion. Tissue quality also factors in here. Tendon and ligament elasticity can be trained and maintained.
- Stress management and sleep are your best mitigation tools. I have worked with numerous clients whose back pain was not associated with any underlying conditions. I’ve also worked with many who have underlying conditions, but have worked hard to build resilience, do all the right things, and still suffer a relapse. The common denominator in every case: periods of high stress, and/or too little sleep.
WORKING AROUND BACK PAIN
Now we want to give you some strategies to work around your pain, and to gradually build back to where you were pre-injury. Bear in mind that each case is different, so what works for you may not work for someone else.
Step 1: IDENTIFY. Identify which movement patterns/types of movements cause pain, and which do not. Make a list of what hurts and cut those movements out for now. It’s important to keep a positive mindset when dealing with injury. Focusing on what you CAN do, rather than what you can’t, is essential.
In general, I find that immediately following a flair up, dynamic movements are a no go. More static variations tend to be better. Furthermore, excessive/rapid spinal flexion and extension tend to hurt, so we want to find substitutions wherever possible. What does this look like in practice? Check the table below.
Keep in mind, this is not a complete list, and it will be based on what you can tolerate. For some, rowing may be a good substitute for running. For others, the hinging involved in rowing is painful. For some, overhead movements don’t pose any problems. For others, any kind of overhead pressing hurts. For some, back squats of any variation cause pain, requiring alternate loading methods (belt, front or goblet). Others can tolerate back squats with a limited range of motion, such as a box squat. For some, very limited hinging (e.g. Romanian Deadlifts) are tolerable. For others, hinging is out. The point is, find what you can tolerate, what you cannot, and start there.
Ultimately, the goal with these movements is to limit spinal flexion or extension, particularly with the lumbar spine. If you have a solid hip hinge without excessive flexion, that will probably be an okay movement pattern for you. The same is true for back squats – if you have a fairly vertical torso (more commonly found in high bar / Olympic variations), you may be fine. Alternatively, if you have a low bar position and tend to squat with a more forward inclination of the torso, that may cause pain, requiring a substitute suggested above.
When it comes to spinal compression, which we experience when we load the bar on our shoulders, this, too, comes down to flexion due to the compression. In a push press, push jerk, or bench press, we experience a back arch, which may cause pain. We can modify by either substituting, reducing the load, or both.
Step 2: PROGRESS. In other words, build what you’re able to do over time. When you first being working around your pain, you’re going to be moving gingerly. This will continue as you complete Step 1 and identify which movements don’t cause pain. This is normal. As you get more comfortable with these limited movements, both physically AND mentally, they’ll start to feel more fluid. From there, you can start to increase the load.
In instances where you’re limiting the range of motion, you can progress that as well. For example, if you’re squatting to a box, you can decrease the box height. If you’re elevating your deadlifts, you can work your way back to the floor. And so on.
Step 3: REINTRODUCE. As your pain subsides and you grow comfortable loading the movements you’ve determined to be safe, you can tentatively begin attempting some of the movements you’ve cut out. We want to follow the same pattern here that we did in step 2 – start light, limit range of motion where possible, and progress from there.
What might this look like? The Olympic lifts are great examples. If hinging feels good, maybe you want to try something more dynamic like a clean. Rather than performing a complete clean, starting from the floor and ending in a squat, start with a hang power clean. This variation begins from above the knees, and ends in a quarter squat. If that feels good, maybe you progress to a power clean, where you pull from the floor and catch in a quarter squat. Next would be a hang clean, where you begin above the knees and receive the bar in a squat. And then, if all that feels good, you can reintroduce the full movement.
Similarly, for KB Swings, start with the Russian variation (ending at eye level) before progressing to the American version (ending overhead). For burpees, start by elevating your bottom position, so that your hands are planted on a bench or box rather than the floor. This will limit the amount of spinal flexion. Over time, decrease the box/bench height, and work your way down to the floor.
BULLETPROOF YOUR BACK
When the pain has completely subsided and you’re performing the same movements with the same loads as before your injury, you’re pretty much back to normal. But we don’t want normal, because normal is what got us hurt in the first place. We want to be bulletproof.
So, now is the time to focus on some preventative measures. Again, you cannot ever completely inoculate yourself from injury, but we can build resilience by working extreme ranges of motion, building strength through them, and maintaining/improving our tissue quality. That is what this section is about.
STRENGTHEN YOUR FLAT BACK POSITION
If, like me, you tweaked your back while squatting, then we need to build strength in a flat back position. Actually, this is a good idea regardless of how you hurt your back – building strength in a neutral spine position is a great precursor to building it through flexion and extension. As with rehab, start light, build load and volume over time, and MAKE SURE not to push it if you’re sleep deprived or stressed.
FLAT BACK STRENGTHENING EXERCISES:
Conventional Stance Romanian Deadlift
Sumo Stance Romanian Deadlift
Conventional Stance Good Morning
Sumo Stance Good Morning
While training your flat back position, you can also begin exploring increased ranges of motion. In other words, rounding your back, and progressively loading it. ~GASP~ WHAT!? But won’t my spine immediately explode if I round my back?
Contrary to popular belief this is not the case. In fact, throughout our daily lives, we regularly move in and out of flexed and extended spinal positions. So, it’s a good idea to train these positions.
And for those concerned about further injury, I would like to point out that while back pain is not well understood, it is well established that tissue overuse is a good indicator of pending injury. Loss of form under load exposes underdeveloped tissues to that load, which could result in injury.
So, for hinging movements, it’s not a rounded back that causes problems per se; it’s the fact that we don’t tend to train that way, and therefore cannot handle load that way. The solution: train with a rounded back and build some strength in that range of motion. Call it a loss of form buffer.
So, we have two great reasons to train with a rounded back. What does this look like?
ROUND BACK STRENGTHENING EXERCISES:
BONUS! THE REVERSE HYPER
The Reverse Hyperextension was created by powerlifting legend Louie Simmons to rehab his back after breaking it for the second time. If you have access to one, it’s a great tool for strengthening your back. Start with the swing through option (linked below).
This option builds strength through the concentric portion (the positive) of the lift, along with a little bit of isometric contraction by squeezing at the top. By relaxing on the eccentric (negative) and allowing the weight to pull you legs under, you get some spinal traction as well. So, you get concentric only strength plus traction.
From there, you can do top emphasis reps to focus more on the glutes, strict reps as another flat back hinging option, or single leg variations to focus on staying balanced. Check out some variations below:
MOBILITY
The low back is tough area to mobilize, because so much insert into the spine there, and by that, we mean the nerves that enervate muscles in different parts of your body.
From a muscular standpoint, it’s hard to isolate what might be causing pain. Your lats, hip flexors, obliques, glutes, hamstrings, and spinal erectors all meet in the low back as well. Not to mention, just because you feel pain in an area, doesn’t mean that that’s the affected area. You could have a problem upstream or downstream from what hurts. For example, if you have a crick in your neck, more often than not, it’s your low trap (right above your shoulder blade) that’s the issue. Yet, you feel pain upstream in your neck.
So, from a mobility standpoint, we want to make sure that we take care of the tissues upstream and downstream from our lower backs. This means taking care of your upper back, your hamstrings, hips, and calves. How to do that?
Start with some low hanging fruit. we want to make sure that tissues are sliding, and not getting stuck. As with any machine (yes, I’m calling you a machine), this means lubricating the moving parts. In other words, STAY HYRDRATED! Make sure you’re drinking AT LEAST 1/2 of your bodyweight in ounces. More, if you’re exercising or it’s hot out.
Beyond that, we want to prevent adhesion that occurs from using our muscles and bracing, sitting for too long, and everything else we go through during the day. This means foam rolling, stretching, self massage, etc. For specific mobility protocols based on body parts, check these out:
Thoracic (upper back) Mobility
I hope you found this helpful. If you need additional help structuring a protocol, or modifying individual class workouts, please reach out to a coach. As I said above, each case is unique, and while this guide is great for the general, you may need more specific interventions. And as always, make sure you’re consulting with a physician as well, especially if you have an underlying condition.