As someone who has sustained two major back injuries early in my lifting career, I’ve become highly engaged in the current research on back pain and treatment/prevention protocols. Through this process of research and review, my position on back pain and its implications for training have changed rather significantly.

I have seen an abundance of information on back pain that makes definitive claims when in reality it’s not that clear cut. The spine is a highly complex structure, and injury mechanisms are by no means straightforward. This article is not meant to be prescriptive. The purpose is to shed light on this complex subject to impart a better understanding of the mechanisms involved in back pain and treatment. My position on injury is that you should always consult a qualified professional like a physical therapist. They will be able to assess your individual circumstances and prescribe the appropriate treatment protocol.

That being said, let’s dive into back pain and all its unique aspects.

Mechanisms for Disc Herniation and Back Pain

Injury can be defined as a tissue being taken beyond its functional loading capacity.¹ Whether it’s bone or soft tissue it’s essentially the same basic premise. For instance, when you go into an elevator there is a sign that tells you the maximal loading capacity of the elevator. Going beyond that puts the steel cables at risk of breaking because the weight has exceeded their functional loading capacity. The body works in the same way.

In the diagram below you can see the basic structure of the discs and the vertebral joints. A disc herniation occurs when a fragment of the disc nucleus is pushed out of the annulus and into the spinal canal through a tear or rupture in the annulus. Anterior herniations are very rare, with most herniations being posterior or posterolateral, as shown by the red arrows in the diagram below.

Tears in the annulus are the most common posterolateral because of the anterior longitudinal ligament which rests at the front of the vertebral column as shown in the diagram below.

A 2009 systematic review found “In people aged 25-55 years, about 95% of herniated discs occur at the lower lumbar spine (L⅘ and L5/S1 level); disc herniation above this level is more common in people aged over 55 years” and “19-27% of people without symptoms have disc herniation on imaging”.²

This is in line with what we currently know about the common injury/pain sites for powerlifters and bodybuilders.³

When we look at the mechanisms for disc herniation and back pain we can see evidence that points to acute increases in compressive force (ie. jumping and landing, falling, a heavy barbell on your back, etc.),⁴ high repetitions low load flexion/extension motions,⁵ high load flexion/extension motions,⁵ and flexion-rotation.⁶

However, disc herniations linked to back pain are rather uncommon and are estimated to be between 2-5%.⁷ When you flex your spine, especially under load, it compresses the anterior side which forces the nucleus of the vertebral disc posteriorly where the annulus has only a thin wall protecting it.⁶

This is not a direct mechanism for injury but under heavy loads and/or high repetition it may increase your risk.^4,7 High load compressive forces under flexion also increase anterior shear which is often associated with an injury.⁷

A vertebral endplate is a cartilaginous structure important in maintaining the integrity and functions of the intervertebral disc.⁸

Endplate fractures can occur under similar circumstances as herniations but the rate of pressurization/loading seems to have a significant impact on fracture rate.⁹

Wade et al (2015) found virtually no difference in the total amount of compressive force required to cause endplate fractures when comparing neutral to flexed positions.⁷

Keeping a Healthy Spine

Based on what we’ve reviewed so far it’s easy to see how flexion and rotation, especially done repeatedly and under load, play a role in back injury and pain. Unfortunately, it’s not quite so cut and dry. Studies have shown the positive characteristics of spinal movements including flexion for maintaining a healthy spine.^10,11 Beyond that, disc degeneration is complex.

Inconsistencies defining disc degeneration and creating clear distinctions between normal disc degeneration related to age, genetics, sex, and disc degeneration due to excessive loading or sports practice is difficult.¹²

Several studies have also found a strong genetic association to back pain that disrupts the commonly held belief that loading exposures is the primary catalyst for back pain.^13,14

One paper found that changes in compression forces were not predictive of damage type to discs and that its failure mechanism may be linked to fatigue.¹⁵

This suggests an adaptive potential that through mindful exposures can increase fatigue resistance increasing resiliency. Other studies have pointed out the limitations to in vitro models which are often used in the classical pain/injury model associated with flexion, rotation, and compressive forces.

Researchers have discovered that “an in-vitro model for studying fluid flow-related intervertebral disc mechanics. During loading, the outflow of fluid occurred, but inflow appears to be virtually absent during unloading. Pro-elastic behavior cannot be reproduced in an in vitro model.”¹⁶

Basically this means that the studies are limited because in-vitro models don’t account for certain adaptive properties of tissues. Spontaneous reabsorption of lumbar disc herniation is an observed phenomenon that according to the data occurs roughly 66.66% of the time.¹⁷

This is yet another aspect of the body’s natural ability to adapt which is often underplayed in the anti-flexion debate.

One study found “Total bending cycles have ranged from 4,400 to 86,400” before causing partial or complete herniations to the posterior annulus.¹⁸ From a practical standpoint, this shows that there is a significant range of unpredictability. I don’t doubt that flexion and compression may feed into the injury mechanism. What I question, however, is the degree of association that can confidently be reported.

Even research establishing that tissue remodeling is a response to compressive loading presents a potential case for intentionally going into flexion under specific circumstances such as sports practice.¹⁹

Physical activity strengthens the vertebrae and the discs potentially reducing your risk of injury.²⁰ The predominance of back injuries occurring in the lumbar spine brings a new layer of complexity to this discussion since spinal flexion in powerlifting typically occurs in the thoracic spine.

In fact, the number of elite dead-lifters that pull with a rounded upper back is by no means small. Beyond that, when an athlete is loaded maximally there will likely be an increase in spinal flexion anyway.²¹

Even with this occurrence powerlifting still maintains a relatively low injury rate estimated between 1-5.8 per 1000 hours of training.²² It’s likely that both sides of the debate are right, but to varying degrees and in varying circumstances.

I tend to agree that lumbar flexion is probably not the best idea when combined with axial loading. However, I do not believe flexion, in general, is a direct mechanism for injury. You only have to look at sports practice that has dynamic flexion/extension like golf, cycling, rowing, skiing, and snowboarding to know that it’s more complex than simply flexion. Beyond that, sports that involve a higher level of flexion do not report a higher rate of back pain.²³

The Body’s Adaptability to Repeated Flexion/Extension

Recommendations to avoid flexion based movements are made due to the research that demonstrated herniations and endplate fractures which occurred at the end of the neutral range of motion segment flexion.

The problem with this is that numerous other examples take the motion segments to the same end range and we don’t see any mechanism for injury. Squats reveal approximately 40 degrees of flexion, golf 48% of max flexion, kettlebell swings 26 degrees of lumbar flexion, and the list goes on.²⁴

So, why do we see a strong injury mechanism in one instance and a weak correlation in the next? I think it just reinforces how complex this subject is and how highly specific circumstances and variables can influence the risk and injury outcomes.

The adaptability of the body is a major factor in this, although it’s important to note that your body’s adaptability to repeated flexion/extension is not infinite. As observed with several other adaptive processes such as strength, endurance, and hypertrophy we will eventually run into our upper limit.²⁵

The problem is that in the case of flexion based activities we don’t know where that upper limit is which poses an inherent risk.

Below is a summarization of the literature on back injury and pain along with some practical recommendations.

Low Load Flexion

Low load flexion activities like tying your shoes, picking up your baby, playing sports and the like are not things to be avoided. Full steam ahead.

Low Load Repetitive Flexion

I don’t see low load repetitive spinal flexion as a bad thing especially when you consider the number of athletes who go into flexion and extension dynamically in their sport.

There is not an increase in the percentage of back pain or incidence of injury, so I find it hard to believe flexion in this circumstance increases risk. The caveat to this is if an exercise causes pain. In this case, adjust the exercise so it does not cause pain. If this is not possible then avoid it at least for the time being.

High Load Flexion

In this respect, I support the neutral spine position. First and foremost, when it comes to exercises like squats and deadlifts I don’t see an inherent benefit to flexion. So from an efficiency standpoint, neutral spinal position is in most cases better for athletic performance.

Flexion based movements aren’t necessarily dangerous, but that doesn’t mean they’re inherently safe and it certainly doesn’t make them better. All things being equal I would go the safe route and adopt a neutral spinal position when under heavy loads.

I hope the above recommendations are helpful in guiding you through your training. Good luck and lift big!

References:

1. Jones, Christopher M., et al. “Training Load and Fatigue Marker Associations with Injury and Illness: A Systematic Review of Longitudinal Studies.” Sports Medicine, vol. 47, no. 5, 2016, pp. 943–974., doi:10.1007/s40279-016-0619-5.

2. Jordan, Jo, et al. “Herniated Lumbar Disc.” BMJ Clinical Evidence, BMJ Publishing Group, 26 Mar. 2009.

3. Strömbäck, Edit, et al. “Prevalence and Consequences of Injuries in Powerlifting: A Cross-Sectional Study.” Orthopaedic Journal of Sports Medicine, vol. 6, no. 5, 2018, p. 232596711877101., doi:10.1177/2325967118771016.

4. Dulebohn, Scott C. “Disc Herniation.” StatPearls [Internet]., U.S. National Library of Medicine, 1 Aug. 2019.

5. Callaghan, Jack P, and Stuart M Mcgill. “Intervertebral Disc Herniation: Studies on a Porcine Model Exposed to Highly Repetitive Flexion/Extension Motion with Compressive Force.” Clinical Biomechanics, vol. 16, no. 1, 2001, pp. 28–37., doi:10.1016/s0268-0033(00)00063-2.

6. Hoogendoorn, Wilhelmina E., et al. “Flexion and Rotation of the Trunk and Lifting at Work Are Risk Factors for Low Back Pain.” Spine, vol. 25, no. 23, 2000, pp. 3087–3092., doi:10.1097/00007632-200012010-00018.

7. Revisiting the Spinal Flexion Debate: Prepare for Doubt.

8. Moore, Robert J. “The Vertebral Endplate: Disc Degeneration, Disc Regeneration.” European Spine Journal, vol. 15, no. S3, Jan. 2006, pp. 333–337., doi:10.1007/s00586-006-0170-4.

9. Veres, Samuel P., et al. “ISSLS Prize Winner: How Loading Rate Influences Disc Failure Mechanics.” Spine, vol. 35, no. 21, 2010, pp. 1897–1908., doi:10.1097/brs.0b013e3181d9b69e.

10. Adams, M A, and W C Hutton. “The Effect of Posture on the Fluid Content of Lumbar Intervertebral Discs.” Spine, vol. 8, no. 6, 1983, pp. 665–671., doi:10.1097/00007632-198309000-00013.

11. Holm, Sten, and Alf Nachemson. “Variations in the Nutrition of the Canine Intervertebral Disc Induced by Motion.” Spine, vol. 8, no. 8, 1983, pp. 866–874., doi:10.1097/00007632-198311000-00009.

12. Battié, Michele C. “Lumbar Disc Degeneration: Epidemiology and Genetics.” The Journal of Bone and Joint Surgery (American), vol. 88, no. suppl_2, Jan. 2006, p. 3., doi:10.2106/jbjs.e.01313.

13. Varlotta, G P, et al. “Familial Predisposition for Herniation of a Lumbar Disc in Patients Who Are Less than Twenty-One Years Old.” The Journal of Bone & Joint Surgery, vol. 73, no. 1, 1991, pp. 124–128., doi:10.2106/00004623-199173010-00016.

14. Battié, Michele C., et al. “The Twin Spine Study: Contributions to a Changing View of Disc Degeneration.” The Spine Journal, vol. 9, no. 1, 2009, pp. 47–59., doi:10.1016/j.spinee.2008.11.011.

15. Noguchi, Mamiko, et al. “Is Intervertebral Disc Pressure Linked to Herniation?: An in-Vitro Study Using a Porcine Model.” Journal of Biomechanics, vol. 49, no. 9, 2016, pp. 1824–1830., doi:10.1016/j.jbiomech.2016.04.018.

16. Veen, Albert J. Van Der, et al. “Flow-Related Mechanics of the Intervertebral Disc: The Validity of an In Vitro Model.” Spine, vol. 30, no. 18, 2005, doi:10.1097/01.brs.0000179306.40309.3a.

17. Zhong, Ming, et al. “Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis.” Pain Physician, U.S. National Library of Medicine, 2017.

18. Contreras, Bret, and Brad Schoenfeld. “To Crunch or Not to Crunch: An Evidence-Based Examination of Spinal Flexion Exercises, Their Potential Risks, and Their Applicability to Program Design.” Strength and Conditioning Journal, vol. 33, no. 4, 2011, pp. 8–18., doi:10.1519/ssc.0b013e3182259d05.

19. Brickley-Parsons, D, and M J Glimcher. “Is the Chemistry of Collagen in Intervertebral Discs an Expression of Wolff’s Law? A Study of the Human Lumbar Spine.” Spine, U.S. National Library of Medicine, Mar. 1984.

20. “Physical Activity and the Strength of the Lumbar Spine.” LWW.

21. Potvin, J R, et al. “Trunk Muscle and Lumbar Ligament Contributions to Dynamic Lifts with Varying Degrees of Trunk Flexion.” Spine, U.S. National Library of Medicine, Sept. 1991.

22. Montalvo, Alicia M, et al. “Retrospective Injury Epidemiology and Risk Factors for Injury in CrossFit.” Journal of Sports Science & Medicine, Uludag University, 1 Mar. 2017.

23. Foss, Ida Stange, et al. “The Prevalence of Low Back Pain Among Former Elite Cross-Country Skiers, Rowers, Orienteerers, and Nonathletes.” The American Journal of Sports Medicine, vol. 40, no. 11, Dec. 2012, pp. 2610–2616., doi:10.1177/0363546512458413.

24. Mcgill, Stuart M, and Leigh W Marshall. “Kettlebell Swing, Snatch, and Bottoms-Up Carry: Back and Hip Muscle Activation, Motion, and Low Back Loads.” Journal of Strength and Conditioning Research, vol. 26, no. 1, 2012, pp. 16–27., doi:10.1519/jsc.0b013e31823a4063.

25. Ahmetov, Ildus I, and Olga N Fedotovskaya. “Current Progress in Sports Genomics.” Advances in Clinical Chemistry, U.S. National Library of Medicine, 2015.

The post The Relationship Between Injury and Back Pain: Neutral Spine Versus Flexion appeared first on Breaking Muscle.

Substantial evidence supports the use of exercise as a therapeutic tool to improve impairments in back flexibility and strength. Exercise is safe for individuals with back pain because it does not increase the risk of future back injuries or work absence. In fact, patients can see a 10-50% decrease in back pain after exercise treatment alone.

A sedentary lifestyle is often associated with low back pain, due to muscle imbalances from poor posture. But in this article, I’d like to talk about low back injuries among active individuals, and how to optimize your recovery while still training.

Posture and Activity Come First

Before we go any farther, let me remind you that I am not a doctor or physical therapist, and this article should merely be used as advice, and not a prescription for a rehab program. If you have a low back issue that you think may be serious, make sure you talk to your doctor about what kinds of things you can and can’t do, depending on your situation.

Secondly, I’m going to be talking about dealing with minor low back strains sustained during activities like weight training and sports. If you have a back issue that stems from poor posture or a sedentary lifestyle, that’s a different topic in itself, but I’ll briefly touch on it.

Being physically active is one of the absolute best things you can do if you’re inactive and living with low back pain. First, you need to learn what good posture is and how to maintain it throughout the day. Let’s have a quick primer on good posture and how to hold it:

1. Stand up with your feet underneath your hips and toes straight forward.
2. Squeeze your butt tight and brace your abs like you’re pulling your ribs towards your waistband, but don’t slouch.
3. Brace like you’re waiting to be punched in the belly.
4. Now with that bracing, stand tall and pull your head back so it doesn’t trail forwards. Your spine should now be neutral (meaning not flexed forward and not arched backwards) and you should be standing tall with your eyes forward.

Deviations from this position, combined with bad posture while sitting and lying down, can lead to tightness in the low back and associated pain.

Once you know how to hold proper posture, you need to continue to focus on it while performing a full-body weight training program. Besides challenging muscles, using weights challenges your posture, and overcoming the weights to maintain good spinal position is key to keeping your low back healthy and strong. Your program should include a proper warm up, hip and middle back mobility, stability work for your trunk, and resistance work using compound movements like squats, deadlifts, lunges, presses, and other exercises that involve large muscle groups working together. You also need to work on your flexibility with proper foam rolling and other mobility work, along with static and dynamic stretching.

Now let’s move onto the topic of minor low back injuries that arise while lifting weights. A while back, I sustained a minor low back tweak, and at first didn’t focus on recovering correctly. I spent too much time dealing with the pain before systematically addressing my back pain and the root cause of my injury. After following this protocol, I recovered well, came back stronger, and have been able to use my minor setback to help others deal with similar issues.

The 5 Phases of Recovering Your Back

My injury came about after feeling a twinge on a heavy pause squat, followed by a trip to a trampoline park later that week. The episode left me in so much pain it was hard to sleep. Without an MRI I can’t be sure, but I believe I strained a low back muscle directly next to my spine where it met my sacrum (possibly multifidus or rotatores). I had pain in the left side of my low back that radiated outward while standing. It was accompanied by sharp pain while sitting or squatting.

The tightness and pain limited spinal flexion and made it difficult to lift anything. I was cleared of a possible disk injury by a chiropractor, so I surmised it was a muscular issue that stemmed from not holding a stable midline while squatting and jumping. I knew I needed to slowly and systematically work my way back. That’s when I came up with this 5-phase recovery program. While it is specific to my injury, you can modify it to your situation and slowly get back to your pre-injury strength.

Phase 1: Manage Pain and Restore Mobility

In order to get back to moving correctly and reduce your pain, you will have to stop doing the activities that cause it. Pain is your body’s way of saying it doesn’t like you moving a certain way. After an injury, even proper movement can still hurt, if the tissue hasn’t healed and the surrounding muscles have locked down to protect it.

In this phase, I cut out all jumping, deadlifts, squats, burpees, running , rowing, kettlebell work, basically any spinal flexion, standing overhead presses, and performed no metcons or circuits with my lower body. I know it seems excessive, but reinjuring yourself while recovering is an issue that’s probably all-too-familiar for a lot of you. I only performed upper-body movements, cycling, swimming, water exercise, walking, using a stepmill, and plenty of hip and leg mobility.

For my back-specific rehab, my go-to movements were:

• Single leg toe touches to drill proper hip hinging
• Clamshells, fire hydrants, and other gluteus medius work
• Hip raises and other gluteus maximus work
• Plank variations to work on midline stability
• Reverse hypers, and light back extensions to reintroduce some movement in my back, as long as they didn’t hurt that day.

This movement menu was huge for me during this time. I found core and hip movements that didn’t cause pain, and helped resolve my postural issues on certain lifts. I use these same exercises now as prehab, or preparatory exercises before my lifts, to make sure I move in good positions and stay safe while getting stronger.

Self-myofascial release (SMR) techniques were extremely effective, in the beginning stages especially, as they helped me gain back some mobility after the muscles around my strained muscle had locked down to protect it. I foam rolled my hamstrings and glutes daily, and used lacrosse balls to mobilize my thoracic spine and to rollout out my quadratus lumborum (a low back muscle to the side of my injury which was along my spine). If you’re experiencing tightness in the muscles around the strain, SMR can provide relief while not challenging the affected tissue like static stretching might, depending on where your injury is located.

During this time I also purchased a dual transcutaneous electrical nerve stimulation (TENS) and electric muscle stimulation (EMS) unit. The TENS setting was used to provide immediate relief to the pain, while the EMS later on allowed me to provide some bloodflow to the area, since I wasn’t able to move it.

Heat was also effective in calming the pain and tightness, and was a great relief right before bed and in the car on the way to work in the morning. Mind you, these last two methods are mainly for symptomatic relief. They don’t fix the issue, only rest and corrective exercise can do that.

As for rest, I took three full days off to start, so my body could focus on relaxing and healing. I didn’t want to rest so long that I became immobile, which is often the problem people have when they rest completely after injuries. After those three days, I returned to the gym with just upper body and core stability movements until phase one was completed.

Sleep is huge when you’re recovering from an injury. Just think about how your dog recovers when they hurt their paw: they sleep. I aimed for nine or more hours a night during this phase of recovery. It meant going to bed early, but I knew it’d greatly decrease the amount of time I spent recovering.

Regarding my nutrition, I focused on high-quality foods with tons of vitamins, minerals, and water during my recovery, as well as high doses of fish oil to control inflammation. Increasing my fat intake helped with growth hormone production, and upping my protein aided in repairing the damaged tissue. I was also less active during this phase, so I didn’t need as many carbohydrates. I cut out all alcohol (which I didn’t have much of before anyway) and all sugar so I could focus on high quality foods.

How long you need to stay in phase one of your recovery is individual, so do not put a timeframe on your recovery. Instead, commit to a minimum amount of time to spend in a phase (at least a full week). I continued phase one until I experienced zero resting/daily activity pain. After that, I tested my squat and deadlift form. When you’re coming back, tightness is fine and to be expected, but movements must be pain-free before moving to phase two.

Phase 2: Endurance and Stability

Even though you can put some lower body lifts back into your program at this point, your priority needs to be on absolute perfect mechanics throughout each rep. I still didn’t do any jumping or plyometric exercises, no kettlebell swings, cleans, or snatches, no slamballs, barbell back squats, or fast bilateral hip flexion or spinal flexion, and no circuits using my lower body. I did keep up with my upper body movements, but added in bodyweight and light kettlebell squats, deadlifts, lunges, and step ups, with a focus on pause/tempo reps.

With my workout routine, I had two lower body sessions per week, and still focused on upper body in lifting my sessions. I wanted to make sure my legs had plenty of time to recover, even though I wasn’t really challenging them that much. I performed high repetition sets (15-25) to drill the pattern without compromising my spinal position.

I kept up with my SMR, and increased the difficulty and range of motion on my rehab exercises while backing off on the TENS/EMS unit, and only using heat once a day. My sleep went back to eight or more hours, (mainly because getting nine hours a night is difficult) and my nutrition stayed the same as phase one, but I did add dextrose back in my post-workout shakes, now that my workouts were increasing in intensity.

At first, I did have some slight pain in my lower back after my lower body lifts, so I continued phase two until I had zero pain on all kettlebell squats and deadlifts. At that point, I tested my barbell front and back squats and deadlifts, and since they were pain-free, I moved on to phase three. But again, I’d advise you spend at least a full week reestablishing mechanics and stability.

Phase 3: Strength Endurance

The third phase was freeing for me, because I was able to reintroduce barbell lower body work and even running. I still stayed away from jumping, high velocity kettlebell lifts, and fast hip and spinal flexion. I still performed circuits only with upper body lifts.

My rehab continued with tons of planks, back extension and reverse hyper holds, and band antirotation drills to make sure I was holding a stable midline during all movements. My hips were loosening up, so the volume of my hip drills went down, since at that point I was able to squat lower and lower and work on my lower body lifts without pain . Rehab drills are great, but there’s no substitute for full range of motion, functional movements.

With phase three, SMR is used less as a pain management tool, and more as a method to restore resting length of the muscles, now that they are being challenged in higher repetition ranges at moderate loads. I was also able to add in more mobility and stretching drills, now that my entire posterior chain was starting to feel more human and less like steel. Even if you don’t have pain, recognize the importance of mobility and SMR’s role in it.

While the TENS/EMS unit was helpful before, once I started being able to challenge my entire body in the gym, I found I used it less and less as my lifts got better. You could still use it if you have the time to, but I didn’t see much of a difference on the days when I used it as opposed to the days when I didn’t.

In my routine, I was back to lifting with my entire body, but I stayed humble and tried to keep lower body weights light and controlled. Rushing recovery by trying to PR on your way back is the quickest way to stay stuck in an injury cycle.

Sleep stayed at eight hours, and I returned to my usual flexible dieting, with an eye on my sugar intake. Fish oil went back to the usual maintenance dose.

In your own recovery, I’d suggest you continue phase three until full control is established on all squats and deadlifts. Spend no less than one week working on these lifts. Full control here means zero deviations from your best form at lighter loads. There is no point in adding weight if you can’t control your spine throughout the full range of motion on lower body lifts.

Phase 4: Hypertrophy and Strength

Here’s where it started to get fun. Now that I was back to full body lifts, I moved into low, moderate, and high repetition ranges, while still focusing on control. I was back to sprinting and doing circuits with my lower body. To add weight on my lifts, I used bands on squats and deadlifts, and slowly brought the weight up. This was key in my recovery. By attaching resistance bands to the bar on squats and deadlifts, the weight is heaviest at the top of the movements where I knew I could control it, and lighter at the bottom where the spine is more at risk.

I still avoided any movement that caused pain, even if it was in the plan for that day. I also used caution with plyos, and used soft surfaces for box jumps. I completely avoided any lift with a hard deceleration or eccentric portion. Rehab exercises became prehab at this point, and were still incorporated in all of my warm ups. It actually got me into a good habit of doing preparatory movements in all of my workouts, and since then, has shaped the way I warm up my clients.

My workouts were written to gain the size in my lower body back after all of those weeks off. I still wasn’t pushing the weight a lot during this time, and made sure my routine was split enough to allow for full recovery. An upper/lower split is great for this, so you can still drill the movements multiple times a week, while giving yourself a full recovery between lower body sessions, where your lower back is taxed the most.

I continued to use bands in phase four to add resistance before adding weight until my strength was established on squats and deadlifts. Take your time on this phase to make sure you get the endurance and size back in your legs before you get back into the heavy stuff in phase five. Three to four weeks is not that long, considering how important your base strength is before adding intensity.

Phase 5: Reestablishing Maximal Strength and Power

Finally we’re at the end of recovery. In this phase, you shouldn’t have any symptoms from your injury. The focus is to gradually get your strength back on your big lifts, improve your ability to decelerate, and increase your rate of force production. Use a basic linear progression program, start light, move with intention and focus, and add a little weight to the bar each week as you slowly rise from the ashes like the barbell phoenix that you are.

Don’t skip your prehab. I kept it up and still incorporate posterior chain activation, core stability, and hip mobility into all of my warm ups before squatting or deadlifting. Not only will you increase your activation and awareness before loading up a bar, you will keep your hips and spine healthy and performing well so you don’t end up injured again.

Use SMR to stay nice and supple, and use your TENS/EMS if you feel like it helps you recover. Keep up the good sleep and nutrition habits that you developed over the first four cycles. I can’t stress enough how important sleep and nutrition was to my recovery and subsequent strength gains after my injury.

When you first start out in phase five, give it two weeks before you put plyos back in workouts and increase the load on your circuits. Remember, you have the rest of your life to train. Take it slow, and gradually work your way back. Phase five is more of a maintenance phase, than a rehab phase. After a month or two in this phase, you can go back to whatever program you like.

I moved into another strength program, but it did take me almost six months to get my squat close to what it was prior to my injury. Now, a year later, I’m squatting for 10 repetitions what used to be difficult for three reps before my injury. This is largely due to the lessons I learned throughout my recovery.

Train for the Long Term

All in all, it took me about eight weeks using this protocol to return to normal lifting. Occasionally afterwards I’d feel some tightness during an exercise, and I’d modify the movement to make sure I had complete control, and stop if I ever felt low back pain.

The biggest takeway from all of this was how important it is to focus on posture while lifting. I always thought that I kept my posture in mind, but the more I evaluated my movement, the more I saw small flaws that needed to be fixed. This didn’t mean that I stopped squatting, deadlifting, or pressing overhead; it just meant I lightened up the weight and focused on my form, while really hammering core stability work both in warm ups and after my lifts.

Looking back on my injury and how it’s shaped the way I program for my athletes, I’m kind of glad it happened. If I hadn’t tweaked that muscle, I wouldn’t have learned what it takes to recover from back injuries, and how to use those same prehab exercises in my programming to ensure the safety of everyone that I train. If you’re reading this while suffering from a low back injury, I sincerely hope this article can help you systematically address your pain and get back into your usual lifting again. Just stay patient, and listen to your body.

The post 5 Phases to Recover From Your Low Back Injury appeared first on Breaking Muscle.

Truth be told, Sam and I both share a rather unique combination of skill sets – we both have expertise in how to break things, and then put them back together again. I was overjoyed when Sam agreed to put something together for Breaking Muscle with me on our two favorite topics.

Sam and I are going to talk about the two most common injuries we seen in our offices from Brazilian jiu-jitsu and CrossFit.  We will share our thoughts on how to both prevent the injury from happening, as well as how to best heal it if it’s already happened. I’m going to talk about low backs and Sam is going to cover the neck.

This week we’re starting with prevention since we both believe a few minutes of preparation can save you months on the sidelines. Make preventative self-care as important as your workouts and training sessions are and you’re going to spend a lot more time on the mat and on the pull up bar.

Sam on neck injuries:

Cervical strain and sprain are two injuries I see often in Brazilian jiu-jitsu. The cervical neck is comprised of seven small vertebra, along with muscles, tendons, and ligaments that support the head. The cervical spine is the most mobile section of the spine, which in turn also makes it one of the most vulnerable. A sprain/strain is an injury that affects the soft tissue of the neck. A strain affects the muscles and tendons. A sprain affects the ligaments.

A strain/sprain is often caused by overstretching the neck and can result from something as subtle as sleeping in an awkward position, or sitting with poor posture for a prolonged time. Brazilian jiu-jitsu, a contact sport similar to wrestling, also permits strangulation. Strangulation can cause the neck to be pulled, torqued, and stretched. The first injury I ever experienced in Brazilian jiu-jitsu was a neck injury. It resulted from another white belt grabbing my head and then pulling it up while twisting my neck to the side and squeezing, in an attempt to choke me. My neck hurt for weeks and I experienced limited range of motion and stiffness.

This brings us to the most common symptoms one will experience in a cervical strain/sprain injury: a stiff neck, tension, spasm, and rigidity of the muscle on one or both sides of the neck. Limited range of motion, tenderness, and pain can also accompany.

The neck is an area of the body often overlooked in strength training and conditioning. The lay person going to the gym to workout often doesn’t think in terms of strengthening their neck. While it is common to focus on the development of both lower and upper body strength for sports performance, most often the neck does not come to mind. However, in a sport like Brazilian jiu-jitsu, it is imperative that one begins to develop neck strength to avoid future injury from the get go. As a general rule, I never leave the mat without doing something to exercise my neck each time I train. In fact, research has shown that as little as twelve minutes of specific neck strength training, twice a week for eight weeks, will increase neck strength and reduce perceived pain in those who suffer from long term chronic neck pain.¹

Rolling your head in circles, gently pulling your head side-to-side, front-to-back, and back-to-front for five minutes anytime before you get on a mat or lace up your Inov-8s will do wonders to prevent the adhesions and spasms listed above.

Using hand pressure as resistance is a great way to strengthen your neck. Place your hand on your forehead, with the opposite hand providing pressure from underneath your elbow. Press your forehead into your hand for 20 seconds with 5 seconds of rest. Repeat this 3 times.

Using the same format as above, repeat the exercise with your hand on each side of your head as well as using your interlaced fingers behind your head. Five to ten minutes later, you’ve taken a large step in strengthening your cervical area. Making this a regular part of your training routine is imperative.

Traver on low back injuries:

Lumbar injuries are far more common to CrossFitters than they are to grapplers, but both groups experience them and when they do it usually means a trip to the side line for at least a few months. No bueno. The two most important prevention strategies for low back injuries are strengthening the area consistently and losing your ego.

Strengthening your “core” gets talked about constantly. It’s why CrossFitters do so many of the movements we do, such as overhead squats, kettelbell swings, and glute/ham developer sit ups. Grapplers would do well to put such movements into their off the mat training routine, if they have one, and utilize them often.

So many grapplers spend a day slouched in front of a computer at work allowing all of their midline stabilizing muscles to go slack before rushing to class to torque their backs into all kinds of pretzel-like positions. Strengthen the core of your body – your abdominal muscles, your obliques, your glutes, your erectors, everything that holds you upright from the mid-thigh to your diaphragm – and make this conditioning work as much a part of your athletic practice as time on the mat is.

What’s the number one reason that CrossFitters hurt their backs? Ego. Yep, it’s true. Yes, there are definitely people who come into the sport ego-less but with a preexisting weakness in their low backs and get hurt. Far more often, it’s the jump from a shaky 285 pound deadlift to the attempt of a 316 pound deadlift – all in the name of knocking off the fifth place guy on the leader board who’s holding strong at 315 – that leads to a couple of months of education on low back injuries.

Arbitrary numbers should never trump common sense and form. Never. No athlete should risk permanent injury in the name of ego satisfaction. Think long term always. The saying, “live to train another day.” is the best mantra that one can have for lumbar protection.

So what do you do if you already have one of these injuries? Sam and I will be back next week with insights into self-healing techniques for both areas, stay tuned!

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