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Low Back Pain And Training

 

The goal of this blog post is to give you a big overview of lower back pain and weightlifting in the gym. If you want the answers to these common questions below, then I suggest you read on. 

7 Common Questions About Low Back Pain and Training

  1. Is it normal to have lower back pain after lifting weights?
  2. Why do I get sudden pain in my lower back from lifting?
  3. How long does it take for lower back pain from lifting to go away?
  4. How do you heal lower back pain fast?
  5. How do I know if my lower back pain is serious?
  6. How do you tell if lower back pain is muscle or disc?
  7. How do you treat lower back strain from lifting?

 

  • Is it normal to have lower back pain after lifting weights? 

 

The short answer is no. Many people successfully lift weights for long periods of time without having any lower back pain, but some people can’t seem to get through a week without it. 

 

Instead of normal I would consider it common. A large percentage of adults (84%) experience low back pain at some point in their lifetime1, regardless of whether they lift weights or not. The goal for most active people is to establish an exercise routine that will allow them to continue to lift weights without experiencing regular lower back pain. In our clinic, therapists frequently see two types of people with low back pain: the achy one or the injured one.  

 

Person 1, the achy one, is the person who has not yet had a major back injury but will say something like “my back is usually pretty sore/painful for 3-4 days after I deadlift/squat/etc.” They are usually concerned about doing something that will cause further injury, but they don’t take action beyond taking a pain reliever or a couple days of “taking it easy” because the problem is mild. 

 

For this person, a further investigation into the location, duration, and intensity of their symptoms is warranted to determine what they should do about this issue. Some people may be experiencing delayed onset muscle soreness (DOMS) in their lower back muscles, which is typical after exercising the back muscles. However, sometimes this feeling is actually mild swelling/inflammation in the joints of their spinal column from poor technique or too much volume/intensity. For this person, a focused conversation about programming and technique demonstration is an important step in preventing future injuries and optimizing workouts to support the individual’s body.

 

The second most common pattern is the person who knows that they tweaked their back; they were overdoing it and had an actual, traumatic injury. Sometimes the pain comes out of nowhere. Or sometimes these people will feel achy like person 1 where they experience shorter or less intense bouts of pain that they ignore until all of a sudden it becomes overwhelming. Examples would be feeling a pop/pull/pinch during an activity, which is followed by pain and difficulty moving immediately after. Person 2 typically requires more PT assistance to calm symptoms down to get the athlete back in the gym as quickly as possible. 

 

Whether you are an achy athlete or had a recent injury it is best to speak with a professional that is well versed in low back pain and lifting to help you get back on track. 

 

  • Why do I get sudden pain in my lower back from lifting?

 

As mentioned above, sudden pain in the lower back is different from chronic pain that developed slowly over time. This sudden lower back pain when lifting is most gym-goers’ worst fear. You’re in the middle of your working sets, go to lift the barbell off the floor for your deadlift and feel a sudden, intense pain in your lower back. 

 

What causes this pain? The most straightforward answer is that whatever tissue you overloaded is causing the pain. Muscle strains, facet joint sprains, vertebral fractures, disc herniations, and everything in between can all present as a sudden pain during lifting. Which exact tissue is causing the pain is not always important. What IS important in an event like this is to remain calm and get screened for red flags by a musculoskeletal provider to determine if any other testing is warranted or if you are safe to return to normal activities with modifications. 

 

Most lower back pain from lifting is not serious, but it is better to get checked by a professional to rule out serious injury, especially if you have any red flag symptoms (check them out in question 5). After checking for red flag symptoms, if you are looking for some help in the immediate aftermath of an injury, click this link for information on what to do immediately after a lower back tweak in the gym. 

 

  • How long does it take for lower back pain from lifting to go away?

 

The short answer – it depends. If anyone tells you that your back pain will be solved without a doubt in 4 weeks, run the other way! Why? Because lower back pain can vary widely based on the individual: severity of symptoms, time since onset of symptoms, lifestyle factors, and so much more. Some cases of low back pain are fairly simple and can easily resolve in 4 weeks or even less. More complicated cases could take over a year to properly heal. 

 

After a thorough evaluation I give clients a timeline of how long I think they will take to heal, but I am careful to always give a disclaimer that there is no way to tell for sure. What I can give them is more definitive guidance on the things I want them to focus on in the meantime (like how we can still maintain our strength and fitness) and what I would like to see from them to be cleared to return to unrestricted activities. 

 

The important thing to remember is that pain, or lack thereof, does not necessarily correlate exactly to the problem being solved. Oftentimes, pain is more complex than actual tissue damage. So pain can fluctuate quite a bit day-to-day, however the change in the quality of tissue tends to be much more gradual over time. 

 

  • How do you heal lower back pain fast?

 

The age old question! How do I speed this whole rehab thing up and just get back to my life? If you read through answers to all of the questions above, then you already know that the timeline can vary widely from person to person. 

 

What you consider fast and what I (having worked with lots of people with back pain) consider fast may be two different things. The good news is that we do know how to help you heal at an optimal rate. Whether that is “fast” in your mind is up to you (hint: it’s almost never as fast as you would like it to be). I will be fully transparent with you about your progress and the timeline throughout the whole process. 

 

How do we heal optimally? The basic foundations of health, of course! Good sleep, nutrition, hydration, stress management, adequately dosed rehab plan, and avoiding aggravating movements/loads that we are not ready for. Yes, other adjunct  treatments like spinal manipulation, dry needling/acupuncture, e-stim, soft tissue work, cup therapy, and more can be helpful to manage symptoms to improve how you feel, but it takes your body time to truly rebuild an injured area. See below for an example of an early rehab exercise. 

 

 

  • How do I know if my lower back pain is serious?

 

When working with people that have lower back pain, I always start with a screen for red flag symptoms. Red flag include any of the following:

 

  • Loss of bowel/bladder control (or change in control)

  • Numbness/tingling the lower extremities

  • Significant muscle weakness in the arms or legs

  • Unrelenting pain, especially at night

  • Constitutional signs (fatigue, fever, rapid weight loss or gain, change in appetite, etc)

If your lower back pain has any of these signs/symptoms associated with it, then it is very important that you are evaluated by a medical professional to see if further testing is warranted, especially if you don’t remember actually hurting your back. 

 

The vast majority of people, however, will not experience these signs or symptoms. In that case, the best plan of action is to start seeing a Physical Therapist: have them check your symptoms and story, then get to work on returning to your favorite things. It’s been shown that patients without any red flags spend far less time and money on care when they start seeing a physical therapist first compared to patients that started seeing a primary care or urgent care doctor2. If you want to get better without medications, injections, or surgeries then seeking out a conservative movement-based practitioner is going to be your best option. 

 

  • How do you tell if lower back pain is muscle or disc?

 

While there are some different tests and assessments we can do to form a hypothesis about what is going on, it’s important to note that our ability to reliably say what exact structure is the cause of lower back pain is poor, even with advanced imaging (MRI, CT Scan, X-ray). Those images do give us a picture inside your body, but pain is so much more complex than that. For more on that, check out this study, in which a woman received 32 different diagnoses on 10 different MRIs in the span of 3 weeks for lower back pain. 

 

Another issue is that if your back hurts mostly when moving, it can be difficult to extrapolate from an image that was taken with you lying still. So, when diagnosing lower back pain, we focus on using your history and physical exam to establish your irritability (how painful is the condition) and fit you into general categories (soft tissue, joint, nerve, or other) which will help me better predict your symptoms and plan what we need to do to start rehabbing. 

 

The good news? We don’t always need to know the exact tissue that is causing your back pain to improve it. Your general injury timeline, aggravating/easing factors, and assessing your response to movement is much more valuable in the long run. 

 

  • How do you treat lower back pain from lifting?

 

If you have read the rest of this blog post then you already know that it depends. In general, we are going to try to get a gauge on how severe things are. From there we will progress back into non-threatening, pain reducing movements, then gradually increase what you can do over time as your back is more tolerant. Early in your recovery, the more important factor is what you are NOT doing. The following list summarizes what we should NOT be doing when you experience lower back pain:

 

  • Just rest it (aka “do nothing”)

  • Pop ibuprofen or other drugs like candy with no activity change

  • Continue to push through the pain when it is worsening

  • Sleep poorly

  • Eat poorly (excessive sugar and other inflammatory foods)

  • Poor stress management

  • Drink lots of alcohol

  • Spend money and time on MRIs, scans, and injections without seeing PT first (assuming no red flags)

  • Catastrophize pain (“I’ll never get back in the gym after this…”)

 

Struggling with lower back pain? If you are located in NY state, fill out a consult form here and tell us what is going on. We have an expert Doctor of Physical Therapy contact you to discuss your issue within 24 hours of submitting your form. Out of state? We’d love to help you find the right PT near you – we have friends in many places!

 

References

 

  1. Deyo RA, Tsui-Wu YJ. Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine (Phila Pa 1976) 1987; 12:264.
  2. Frogner BK, Harwood K, Andrilla CH, Schwartz M, Pines JM. Physical therapy as the first point of care to treat low back pain: An instrumental variables approach to estimate impact on opioid prescription, health care utilization, and costs. Health Services Research. 2018;53(6):4629-4646. doi:10.1111/1475-6773.12984

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