5 Management Strategies for Training with Back Pain
If there is one topic I have had to learn a LOT about, it is dealing with both the psychological as well as physiological adjustments that need to be made when suffering from back pain. Back in April of 2016, at the end of what felt like a very solid training week, I felt a slight “discomfort” so to speak in my left lower back (far greater than any of the numerous back injuries I had previously experienced).
Over the next 24 hours, the swelling, stiffness and then incredibly debilitating pain that followed, would be to a degree that has changed my entire approach to training since then.
My personal back injury is not the topic of interest here, although I will use that as a post in the future to shed some light on how I personally have handled coming back to full training, as well as the adjustments I have had to make to still enjoy myself and feel like I am accomplishing something the way I used to, when I was competitive or training for sports.
My personal injury 2 years ago took my interest in back pain and management protocols to an entirely new level, and lead to me studying everything I could get my hands on, including as much of well respected and known spine expert, Dr. Stuart McGill’s work. I got so deep into studying how to improve both myself as well as my clients, that I travelled from Eastern Canada to Costa Rica to spend 3 days working directly with Dr. McGill himself, to better secure my understanding of dealing with back pained clients and high performance athletes.
Needless to say, I love working with individuals with back and hip pain, since I can wholeheartedly understand where they are coming from.
Below are 5 useful points that I regularly use for my clients and myself when we have issues arise. Some of the most common things that I encounter regularly, include:
- Discogenic pain, leading to femoral nerve pain, sciatica pain and most commonly, flexion intolerance
- Minor acute flare ups for people after a sports tournament, game or practice
- Individuals whom have been sedentary for some time, and are just getting started again with some level of training. They often complain of years of pain that comes and goes and has quite often, not been fully assessed
- Serious back injuries that require in-depth assessments and rehabilitation protocols, before beginning more strenuous physical activity
- High performance strength sport athletes, requiring technique adjustments in order to keep them lifting heavy and in the competitive world (powerlifters, Olympic lifters, strongman, throwers, etc…)
- Find someone who can assess you and determine the cause of your pain
This may go without saying, but after seeing more than 8 practitioners from various clinical fields of practice for my own injury, I came to one realization…not all clinicians and specialists are skilled equally at assessing everything. They are all skilled, educated and play incredibly important roles in the therapy setting, however any therapist will tell you themselves, that they all have their own areas of specific interest or where they are most experienced.
This can be a real misconception to the general public, since there is no specific resource to clearly identify this topic (at least not that I have been made aware of).
I work very closely with a multitude of clinicians and on any given day, I know who I would send people to for specific issues. A concussion goes to one person, a shoulder to another, a knee to another, and so on and so forth.
Most clinicians and therapists in general, if asked will tell you what they love working on, so it is always an awesome idea to simply ask the question…”Do you know how to specifically assess back pain and design a treatment plan for me?”.
I think this approach is so great for 2 primary reasons:
- You as the client are playing an active role in finding your best and most trusted person to help you
- The clinicians or therapists are working not only within their scope of practice, but also their specific area of interest and expertise. This is win-win for all parties and in my personal opinion, creates the greatest opportunity for success!
I’ll end this one with one more point. Receiving a treatment is not the same as receiving a thorough assessment. This could be a very lengthy and educational post in itself. However, for the sake of keeping things short, just remember to ask questions and do a few minutes of research, then make the best decision you can based on what you learn.
It takes very little time these days to get feedback or information from those close to you. Finding the most recommended plumber, mechanic or roofer is a few simple clicks away . I suggest you do the same when it comes to any specific injury, including back pain and selecting who will be the chosen one to help you.
Not everyone is great at everything, including me. Finding the right person to help you, at the right time is a great first step that you have a lot of control over.
- Know when to check your ego
It may surprise you that this is #2. However, it is the one I struggle with the most as a coach (and myself in the gym). One reason for me personally, is that I am fortunate enough to have a solid amount of motivated and competitive clients who would do almost anything to train at their normal capacity, and that includes often times trying too push too much, too soon.
This is an awesome trait to have, however it can also be the very thing that increases healing time. Highly motivated individuals are typically trying to do more, rather than less. I know this personally, because I am 100% guilty of doing it.
Training hard is awesome, and is necessary for improvement. Yet, when you walk into the gym with a flare up or current back injury, you simply need to be realistic, trust the plan that is in place and know that your adherence to it will be the fastest road to recovery.
Time and time again, when my clients report flare ups to me, I hear one of the following things:
- I went for a rep when I felt loose
- I breathed out and lost my brace on that last rep, but I kept going
- The discomfort was there when I came in, but I didn’t want to mention it. I thought I could “work” it out
- I felt pretty good after a few days off, so I tried to push it a bit today
These are all super normal responses for me to hear, and all I can do as a coach and educator is give as much information as I can, make adjustments for them and hope they adhere. I like to think that as I get older and at least a bit wiser, that I am learning to make changes that still satisfy their need to work hard. The jury is still out on if I am succeeding!
It may be really hard on the head to back your numbers off, avoid certain movements all together, or get bored performing bird dogs and breathing isometrics for a week. I know I personally felt that my years of hard work on squatting and deadlifting were wasting away. That pill, is really hard to swallow for a gym junkie or highly competitive athlete with a serious goal that they are chasing.
Trust me, they are not, and once healed, you can rebuild capacity and get back to normal, even if you have to find a new normal for yourself based on the nature or degree of injury.
- Be open and prepared to change the plan on the spot (auto-regulate)
This one can be a bit more strategic when it comes to knowing what to do. I do feel that it is of primary importance, due to how often me and my coaching team have to do it every day.
At Synergy Training Center, we have a basic saying…all programs are written in pencil (so to speak). This just means that at any given time, even if we have planned a training or rehab session down to the T, it may need to be adjusted for variables not account for, or something may come along that throws a wrench in what seemed like a good plan.
Whether you are a trainer, coach or someone handling your own training, you have to be ready to simply make the executive decision to change something that does not feel right.
Some examples here may be:
- Back squats replaced with DB goblet squats to lower the shear forces and compression
- Bi-lateral work substituted for unilateral/single leg work
- Dynamic exercises replaced with Isometric exercises
- Extending the eccentric component of a movement to increase neural control to the supportive musculature
- More advanced core exercises replaced with lower load, spine sparing variation
- More strenuous strength work replaced with lighter load endurance work to build pain free capacity
These are some major ones that we adjust on the fly all the time. This list could be a very lengthy post in itself, so this is just to give you an idea and to open your mind to what may need to be done in order to keep moving forward.
- Complete the homework you are prescribed
Chances are, you have been given some exercises by your coach, clinician or trainer. It is imperative that you do this work. Once given, it is assumed that an individual will play an active role in managing their own back pain. This may be specific exercises, movements and postures to avoid or new movement pattern to include.
One specific example that has become very common in my own facility, would be the way that Dr. McGill highly recommends you live and use spine sparing strategies throughout your day. He refers to these as “spine hygiene” and I can attest that some VERY simple adjustments can reserve a lot of capacity for more relevant and enjoyable tasks later, rather than using that capacity for relatively minor tasks.
By increasing your awareness and knowledge of how you move during daily mundane tasks, such as tying your shoes and picking up your child, you are becoming your own best source for pain relief.
This is again where finding the right person to help you comes into play, as mentioned in #1 above. You must learn to remove the pain triggers, postures and positions that are causing you sensitivity. Then, replace them with new habits. All of these steps, along with doing any at home exercises, will be essential for a faster recovery and long-term success.
- Educate yourself
Of course, even reading this blog post from me means that you are actively trying to learn, so high five for that! This tip is simple and does not need a lot of explanation. Find reliable sources that you trust, read their material, hire them for a short time to improve your lifting technique, get them to make you a program that suits your needs and abilities and then work hard to be proficient at what you learn.
When a flare up or injury occurs, follow the steps above and be open minded and ready to learn from the experience, rather than getting down. I realize being positive and happy about a setback or injury seems like a silly recommendation, but with the right work being done and mindset in place, it is more than possible.
Remember…“Injuries are education.”
That’s really is it. The injury or pain is there, accept it, learn from it and course correct as needed. Your recovery and training will be a lot more enjoyable and you will come out better on the other end.
I hope this helps and adds a positive spin to anyone experiencing back pain (or any pain for that matter). Feel free to share to anyone you feel can benefit!