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Saturday, 13 June 2015

How I cured my back pain(almost)

A few disclaimers before we begin:

1. I am not a medical practitioner by any means, and this rant merely serves the purpose of sharing my observations about the back-pain specific issues I experienced during my training and how my hypothesis worked in my case.
2. The methods employed by me may or may not prove that effective for most other trainees reading this blog post, since:
 a. They may have different training age than mine.
 b. There might be very different set of conditions/pathologies revolving around their spinal health.
3. I haven't touched upon the clinical aspect of what exactly caused the pathological conditions leading to my back pain(which also lies out of my scope of practice). The post brushes upon the immediate fixes I made to my training program to counter and improve my back injury/pain condition, so that my training did not halt.
4. The back inury I experienced resulted from improper technique employed while doing deadlifts. This does not at all mean that doing deadlifts is bad for your back. Any exercise done for the right purpose and with the right technique can be one of the nicest ways to strengthen yourself. 

...and as such I would love this post to be a help and a handy reference point to research and use in your cure for training or lifestyle induced back pain.

How it started

I'm a software professional and prolonged sitting(often in a fixed position for hours on end) is an occupational hazard every IT professional has to go through almost inevitably. And not unlike other professionals in my industry, and no matter how much I'd like to avoid it, I DID develop a lot of sitting oriented deformities. Especially, the following:

1. Tight Hip Flexors
2. Thoracic spine kyphosis
3. Shoulder anteriority
4. Gluteal inactivity

...and a host of other things you may not want to happen to your body. Especially when your day involves lifting things way heavier than you, for repetitions.

The king of all mass builders, the deadlift requires you to pay proper attention to technique

Now, I also happen to be a long-time weight training enthusiast and like any other enthusiastic gym-rat, deadlifts formed a prominent part of my training program. So, like every other invigorating session, I was in the gym that morning, preparing to get my next set of deadlifts done. It was the fourth of five sets of five reps each, progressively increasing in poundage throughout. Everything seemed to be going as per the plans. And then, THIS happened:

Set 1:     298.6 Pounds  5x5
Set 2:     320.6 Pounds  5x5
Set 3:     331 Pounds     5x5
Set 4:     343 Pounds     5x5... aaaaand, ouuuuch!!!

 On my last rep for this fourth set, everything seemed fine.Except on my way down on the eccentric, as the weight approached the ground, a trigger of pain originated somewhere in my lower back and sent a shocking wave of trauma throughout my body,almost paralysing me for a fraction of a second. All hell just broke loose. It made me let go of the bar, which got dropped down and I, dumbfounded by what the hell just happened, grabbed hold of the nearest bench and slowly, deliberately tried to lie down on it without exacerbating the excruciating pain I was in. By this time, I was in such an agonizing situation that any amount of movement involving my lower back was resulting in a painful and numbing sensation radiating from my low back, towards the hip joint.

To add insult to this injury(which I was yet to figure out), I went on to finish the rest of the session which consisted of multiple big lifts, with this deadlift being only the first one of them all. I tried using the weightlifting belt as a psychological cue to take away my worries and woes during the workout(Yes exactly, a very wannabe and obsolete idea), and replaced the unsupported rowing variations with the machine based chest supported row version.

The pain by the way was centered way down(which felt like my coccyx or tail bone) and somewhat skewed towards the right. A couple of thoughts crossed my mind and the entire scene of my villainous deadlift got reenacted in front of me. The terrible nature of the pain stopped me from being able to even bend down to pick up things and tying my shoelaces or pulling up my socks became a nightmare. Everything placing my lumbar spine in a flexed position was resulting in magnification of the pain. This further led me to safely assume that the injury and the resulting pain was a combined effect of my constantly flexed posture on my office chair and the slack and lackluster technique used on my deadlift sets.

The solution thus, had to be something which reversed these actions primarily.

Looking back at the training day when I got injured, there were some caveats which I could recollect:

1. I could remember a somewhat unevenly distanced grip which kept the bar out of being fully horizontal. This may form a part of explaining why the injury seemed concentrated only on one side rather than being felt balanced. More precisely, it represented assymetrical loading.
2. I was not consciously thinking about CRUSHING the bar with the grip
3. My body wasn't really all tight and tensed while doing those deadlifts. Possibly, this was because the weight was not my maximal weight and I somehow held the notion in my head that I can really handle well any weight that is below my max(which I believed to be in the neighborhoods of early 400s)
4. The very moment when the snapping pain happened to appear in my low back, I was busy lowering the heavy bar while not at all focusing on controlling the eccentric. The entire manoeuvre of lowering the barbell looked more like dropping it; only with the bar still being in my hands and not going out of the palms. And here lies a crucial difference which could have made or broken my back's sanity.

For a visual distinction, here is a controlled eccentric Deadlift (The one I was supposed to do)

And then we have a version where the ecentric lacks all that necessary tension. Unfortunately, this is what I ended up doing:(I have picked up this video from . Head over to the awesome blog and you will thank me for it)

Anyway, the day went in complete agony and all my time in office, on the road and at home went in utter self-cursing and angst at what happened. I had a few physiotherapy sessions involving TENS activation sessions  which did provide some superficial relief for a few days. However, the imminent rising of the pain several hours later did tell me that the injury is still rooted deeper and until I somehow realign the mobile mechanism of the involved joints, I may not be able to get a substantial pain relief.

This led to several nights of soul searching until I pounced upon the previously read articles of Bret Contreras, the guy who knows more about Glute training than anyone I know in the world. Having read most of his works, one idea that kept being retouched upon there was how strengthening the glutes using a specific loading vector can result in a reduction in the flexion based back pain which is quite common among the training populations these days.

How can training the glutes in this manner help with reduction in back pain? The glutes are one of the biggest muscles of our body in terms of the topographical surface area. They act as the primary stabilizing mechanism when the spine is placed in a compromising position(such as the bottom position of a squat or a deadlift). If the glutes are strong, we will be able to generate more force using our glutes. Generating more forces is like gripping something with a tighter grip. The result is a tighter foundation and more supportive apparatus to keep spine in place and preventing it from getting broken. This activation and stabilization phenomenon explains why investing a part of our training time to strengthening the glutes to their maximal potential is a superb pre-hab for injury proofing ourselves.

In particular, the barbell hip bridge was what evolved as the starting step for my correctional/strengthening exercise. The following is what the exercise looks like:

Essentially, the hip bridge is one of those rare exercises where you can load the gluteral muscles in an anterio-posterior loading vector with a really big avenue for increasing the poundage, through a very less range of motion, and with very little or negligible stresses on your spine. As such, it is a very obvious choice for hip strengthening for anyone who is suffering from chronic back pain issues and are generally advised to stay away from other forms of hinging patterned exercises such as deadlifts or swings.

In other words, the barbell hip bridge was a big savior here.

Now, I also strongly felt the need for an ancillary move for strengthening the posterior chain(Glutes, hamstrings and the entire hip hinge movement pattern and the muscles that orchestrate it) and my quest brought me upon a second strengthener of choice: The Low Cable Pull Through.This video has been taken from Eric Cressey's blog.

Again, the exercise becomes a perfect glute and hamstring strengthener because of the little to no amount of stresses places on the low back. Although the total amount of weight which can be lifted in this movement may be limited by the size of the weight stack in the cable station used, it is since viable since you may not want to load up a ginormous amount of poundage while you are injured.

And then I pulled out my workout journal and replaced the Deadlifts and Romanian Deadlifts with these two moves for a period of up to six weeks in order to reverse the effects of my back injury and expecting the pain to subside substantially. Along with this change, I replaced the bent over rows with supported and machine based rowing options during this pain-sprinkled period. 

The application and observations:

And then began my ghetto changes applied to the classic training template I was following. the very first day of its application was a pleasant relief indeed.

Not only was I able to Hip Bridge Pain free, I almost felt an innate sense of reduction(though really minute) in the amount of pain I was having in my lumbar region. Although I attempted the hip bridge with very conservative numbers, the exercise overall turned out to be a very positive addition to my program, making it a right choice.

Moving ahead, the cable pull throughs were stable and pain free as well. I stayed low on my poundage and high on tension, which resulted in a very safe and activating strong mix.

Furthermore, adding the supported back rowing resulted in a very stabilized set up for the rowing variations too, mostly enabling some decent weight being used for those exercises. This ultimately did help me with some hypertrophy gains.

All in all, I ended up getting rid of my back pain in a gradual manner, strengthen my glutes in a more efficient way, learning a new exercise technique and experiencing newer hypertrophy gains. A total win-win, if you ask me.

Key Take Home Lessons:

So, from this not so fun filled, yet highly enlightening intrigue in the regions of injury and back pain, I did get along with some crucial lessons and take home notes. Here's how I may put them in a cliff notes version:

1. Generate more tension throughout the body while you lift. This means right from the point when the bar leaves the ground, to the point when it touches it back and gets parked. As I realized, I lost tension substantially on my last rep where I got injured. Generating more tension in a lift can be as simple as tightening and tensing each and very muscle of your body, whether you feel it is involved in the movement or not. In other words, do not let any of the muscles get relaxed or slacked.
2. Crush The Bar. Grip it with the maximum amount of force you could generate, with an intent to literally crush it. This seemingly simple change tenses the entire muscle groups through irradiation and makes the lift stable, and as a result, safer.
3. Strengthen the glutes using Hip Bridges etc. That is downright one of the best insurance policies you can invest in against injuring your back.
4. Pull the bar up AND BACK. Pulling back and up in comparison to merely pulling in one direction results in a larger combination of muscle groups involved in the lift. We may always want more muscle groups to get involved in the deadlift in particular for that additional safety due to the stability it provides.
5. Be more mobile in general during work and other parts of life and never let your back get affected by lifestyle based postural disorders.

Well, fast forward to about three months from then, I have embarked back upon my journey of deadlifting again and have made a decent beginning with significant amount of poundages and have been able to stay predominantly pain free durig this time. If there is something I can attribute all this progress and recovery to, it is the above tactics I experimented with successfully. Feel free in trying them out of you are stuck in a back pain rut. I would be really happy if they helped you.

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Would love everyone's thoughts about making this place even more helpful and useful, and totally more entertaining in the future. Thanks for the reading!