Back Pain Blog part 2, written by Robert Stirling
When You’re Back in the Gym
This is when you really need to be careful. The golden rule here is the same as it always is: if it hurts – don’t do it! There are ways that you can get a pretty meaty lower body workout, even with a back injury. The key is to use exercises with little to no loading on your spine. The exercises I’ve found to be most effective are:
-Dumbell Bulgarian Split Squats: these absolutely hammer your quads. Doing them with dumbells means very little loading on your spine, so you can load them up pretty heavy once you’re used to the technique. Start light though! There’s a large balance component and if you sacrifice form for weight you can still injure yourself, so be careful. Consider these a replacement for squats. Regular lunges can work too, but I find the static nature of this exercise makes it a little safer. The less movement, the better when there’s back pain involved.
-Barbell Hip Thrusts: these train a similar hip hinge movement pattern to deadlifts, and are a great way to load up the muscles of the posterior chain without any load on the spine. Form is really important though, so use a 3 second squeeze at the top of each rep. Focussing on form in this way will ensure you’re not jerking the weight and using your low back muscles to hyperextend your spine. That would be a bad thing, just so you know.
-Glute-Ham Raise: this is an awesome exercise to totally hammer all the muscles in the back of the lower half of your body. It’s way harder than it looks. If your gym doesn’t have one then you can hook your feet under the knee pad of a lat pulldown. It has a slightly different feel, but is more or less the same.
-Front Squats: these are tricky, and won’t work for everyone. Due to the weight being in front of you, there’s more activation in the core musculature than a back squat, so your spine is a little better protected from any unwanted rounding. I can’t really make the blanket recommendation to front squat to everyone with back pain as it still involves quite a bit of loading on the spine. You might be better off treating this as an intermediate step between the Bulgarian split squats and back squatting.
You can obviously do machine exercises like leg curls and extensions too, but stay away from the leg press! It’s a killer. When you do these exercises, the important thing to remember is that you need to go slowly with the weights. If you get carried away and start piling the poundage on the bar, then it’s very easy to let your form loosen up and hurt yourself. Remember, this is REHAB. Treat it as such.
How To Stay Injury Free Once You’re Back To Normal
So you rested up until you could get back in the gym, then you trained using the above exercises to keep the load off your spine. Now what? I know you’re itching to test your deadlift max, but not so fast.
Firstly, you need to pay attention to your mobility and movement quality. Start each session (or at least every lower body session) with a core/glute activation warm up. For glutes, try:
-side lying clams
There’s some evidence to suggest that a static contraction works better for activation purposes than multiple reps, so consider using resistance bands wrapped around your knees when doing these exercises and holding the top position for time instead of doings sets of x amount of reps. Reps will work fine if you don’t have bands or can’t get the hang of using them.
For core activation, I find bird dogs to be sufficient. Bring your hands/knees further away/closer to the midline of your body depending on how challenging you can handle them. Planks would work too, but don’t push the boat out too far. Remember, we’re just trying to activate the core, not fatigue it. If you try to squat/deadlift with a fatigued core then you’ll just end up injuring yourself again.
Once you’re back doing the big, heavy, spinal-loaded lifts like squats and deadlifts you’ll need to lower the weight. Chances are you’ll have a loss of strength following the injury (some people seem more susceptible to strength loss following injury than others) but even if you haven’t lost a significant amount of strength you’ll still need to lower the weight right down and really concentrate on form. In some cases you may need to regress the lift to an easier variation, or even just stop doing the exercise completely. I had to come to terms with the fact that I’ll probably never deadlift again. It sucks, but I was just injuring myself too often and losing too much training time for it to be worth my while. You may have to make a similar decision and just stop doing an exercise because no matter what you try it always hurts. One more time: if it hurts – don’t do it!