Training Around and Through Lower Back Pain
Lower back pain sucks... but that doesn't mean you have to stop training.
In this edition of Momentum you’ll learn exactly how I train around and through lower back pain.
If you're like everybody else on planet earth you will probably experience some back pain.
Up to 84% of people experience back pain at same point in their life.
Lower back pain is the 5th most likely reason for someone in the US to go see a doctor.
Fortunately, lower back pain is rarely indicative of anything serious and it usually resolves as spontaneously as it arrived.
Most episodes resolve in just 5 to 21 days.
Even though most back pain is benign, it is still the leading cause of disability worldwide.
Basically… lower back pain sucks, but it is rarely a serious medical problem.
As a chiropractor and trainer I work with people every single day that have lower back pain.
It’s either their primary concern or it comes up during the course of a performance training cycle.
One thing I never do, however, is advise people to completely stop all physical activity if they have lower back pain.
So, if you’re reading this you probably like to train. And, if you’re human there is an 84% chance you’ll get lower back pain at some point.
Don’t let it interfere more than it has to with your athletic and strong life.
Here is what today’s post covers:
The basic premise of how I approach most pain rehab
How I personally train around and through lower back pain
How to know if an exercise is appropriate while having pain
A disclaimer that you should not get medical advice from an article and if you have symptoms that concern you should see a qualified healthcare provider about them
Let’s get to it.
How I Approach Most Pain and Injury Rehab
The body has an amazing capability to heal itself; it just takes time.
This is the guiding principle behind my injury and pain rehab programs.
While the body is healing itself and we let natural history take its course I try to: maintain fitness and strength, sure up any functional impairments, fill in any gaps in fitness, and not get in the way.
Nothing in this article helps you heal faster. While things can help you feel good in the short term, the natural history of lower back pain will probably remain unchanged.
(Metallica’s “Sad But True” plays in the background)
But the contents of this article will help you to continue to train and feel good despite having back pain.
So, here’s how we do it.
Extend the Warm-Up
It’s very common for lower back pain to feel better with activity. Further, there is no evidence that exercising with lower back pain worsens the condition. Save of course common sense examples like doing a one rep max deadlift following a severe lower back muscle strain.
A common presentation of lower back pain goes like this: it hurts worst or is most stiff after periods of inactivity; like getting out of bed first thing in the morning or standing up after a long car ride but after going for a walk or after being up for a few hours the back feels better.
So, generally speaking: more move-y = more better-y.
Extending your warm-up can help to loosen up stiff feeling joints or muscles and desensitize a painful area a bit more so that you can train without issue.
Here is an example of an extended warm-up for myself or a client who is currently having some lower back pain.
10-15 minute brisk treadmill incline walk
10/side Dynamic Supine Crucifix Stretch
10/side Dynamic Prone Scorpion Stretch
2 x 20 sec Front Plank
2 x 20 sec Side Plank
2 x 10 QL Side Bends
You don’t have to do this exact routine, but here is the typical formula I’ll follow:
Cardio to break a sweat
Spine and hip dynamic mobility exercises to loosen up
Core and/or hip isolation exercises to desensitize the painful area
Now that you’re warm, let’s get to training.
Make Modifications to Training as Needed
It’s hard to predict what may hurt and what may feel good when you have lower back pain.
Sometimes, you just have to try some things out.
Here are a few ways I continue to train and make gains despite occasional aches and pains.
Nice rhyme, Nick.
First, trying reducing the range of motion
If you can do most of an exercise, but not all of it, should you just nix the whole thing? No.
If the very bottom range of a deadlift is bothersome right now, just get rid of it for a few weeks. Instead of doing deadlifts from the floor you can do rack pulls or deadlifts from blocks.
A high-handle trap bar deadlift is a great way to reduce the range of motion and still train the deadlift.
You can do the same thing with box squats, setting the box just above the painful range.
You can change the way the weight sits on your body
If a barbell back squat causes increased pain then you can try to adjust how the bar or weight is loaded on you.
Simply changing the biomechanics of an exercise changes how force is put through your body.
Front squats, heel elevated goblet squats, leg presses, or hack squats could all be great ways to continue to train the squat motion without symptoms during a back pain episode.
You can choose more stable exercises
Having more external stability can reduce the force you feel going through the lower back, or other body parts.
This comes up a lot with rowing exercises like barbell bent over rows or Pendlay rows. Simply doing a T-Bar row, any chest supported rowing machine, or even just bracing yourself against a bench for rows could feel great despite having some lower back pain.
You can switch it up and try unilateral variations
Sometimes you need to really change up the exercise to be able to train without symptoms.
I’ve worked with people who have trouble with a back squat, front squat, goblet squat, and leg press but can do a lunge or split squat without any issue.
It could have something to do with the angle of the torso, or axial loading, or who knows! I try not to ask too many questions. I’m just trying not to get in the way.
Unilateral variations change the stimulus to the body quite a bit and usually make us use less load. This combination could be a great choice for training around lower back pain.
The most important thing to realize is this:
Just because something hurts now does not mean that it is causing more damage or that it is how you got hurt in the first place. Additionally, it does not mean that you can never do the painful thing again, you’re just sensitive to it right now.
If you’ve ever gotten a bad sun burn then you know that a hot shower feels like torture. Does this mean the hot shower caused the sunburn? No. Does this mean that the hot shower worsened your sunburn? Also no.
In this example your skin is just sensitive. And, in many cases the lower back is just sensitive.
Do Some Stuff That Feels Good
There’s nothing wrong with doing things for pain that just feel good, as long as you know that you are just giving yourself temporary pain relief and not fixing anything.
I frequently recommend people to use things like TENS, topical creams like Tiger Balm, or a massage gun or foam roller if it makes them feel good for a bit and they don’t mind spending the money or time doing the activity.
I especially like this if they enable the person to move around and train more!
Listen to Your Body
Of course, depending on the cause of your symptoms certain movements or exercises may be aggravating to the injury.
If you have a true muscle strain in the lower back then certain exercises may in fact delay the healing process or cause more pain.
Like sprinting the day after a hamstring tear wouldn’t be the smartest idea.
I put together this article to help you figure out whether or not the exercise you are doing in the gym is a good idea or not while working through pain.
If you want guidance about training around or through pain reach out to me for one-on-one performance rehab coaching: nickotrainingsystems@gmail.com
Disclaimer
This article is meant to be general information to help people stay active despite having pain. Always consult a qualified healthcare professional if you are experiencing severe pain or symptoms that concern you.
Wrapping Up
Lower back pain sucks but it is rarely a serious medical condition. I strongly advise most people to stay active during most lower back pain episodes. You can try the tips in this article to get the most out of your training despite having some lower back pain. Make sure that you listen to your body and consult with a qualified healthcare professional if needed.
Now, let’s keep building Momentum together.
Nick is a sports chiropractor, strength and conditioning specialist, assistant professor of exercise science, and writer.
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