Back pain. The common cold of orthopedic injuries. It happens to all of us in some capacity throughout our lives. This can be a very debilitating injury, but we should not live in fear of it. If you have spent some time in or around a gym, I’m sure that some of you have heard someone say something along the lines of “you shouldn’t deadlift, it’s bad for your back” or “I don’t deadlift any more, I have a bad back.” or “I can’t squat heavy, it hurts my back.” If you have heard this, or potentially wondered this yourself, you are in the right place.
Before we dig too deep into lifting form, mechanics, and corrective exercises, we should first talk about mechanisms of low back pain. As I stated before, low back pain will affect all of us at some point in our lives. It can come when trying to pull a heavy deadlift, or it may just start with tightness in your lower back and over time turns into a nagging pain. For others, it might not start in the gym. It may come from picking something up off the ground, or sleeping in the wrong position. Whatever the cause is, it can be annoying, frustrating, and debilitating, and if that’s not enough, low back pain can be chronic, lasting months or even years.
Enough of the bad news- time for some good news. Fortunately, the majority of time, low back pain gets better over time (1). It has been shown that staying active and returning to our activities as soon as we can will result in better and quicker outcomes.
More good news. Low back pain gets better with strengthening (2). Once we get stronger and get out of pain, completing a regular strength training program has been shown to prevent recurrence of back pain (3).
While we said that back pain is a common thing that affects most people, we need to be aware of more serious conditions that may cause back pain, such as infection and cancer. For this, we need to be aware of a few red flags.
Unexplained weight loss
History of Cancer
If you are experiencing one or more of these, it is a good idea to reach out to your primary care physician and voice your concerns.
Now that we have talked about the mechanisms of low back pain, let’s get back to our question- “Should I avoid lifting because of back pain?” To answer this question, I give you a resounding NO! As stated above, getting stronger and strength training has been shown to improve back pain and prevent reoccurance.
That being said, we have to take a multi-step approach to lifting with pain.
Modify and adapt strength training program to allow low back pain irritation to decrease
Identify any mobility and strength limitations in ankles, knee, and hips to take stress off of spine
Correct technique flaws in your lifts
Progressively load the spine to allow it to adapt to demands placed on it.
1.Modify and adapt your program.
Like we said previously, we are not going to stop lifting because of our back pain. Instead we are going to change our program to allow for decreased stress and load that we are placing on our body. This may include changing the load, changing the capacity (sets and reps), or changing the element (trying a goblet squat instead of a back squat). By changing all of these factors, we are altering the loads that we are placing on our body and this can play a huge role in being able to continue to strength train during an injury.
2. Identify any mobility and strength limitations in ankles, knee, and hips to take stress off of the spine.
The majority of the lifts that you perform, whether they are power lifts or olympic lifts, are highly dynamic movements that require large amounts of mobility and stability. In a perfect world with required mobility and stability, the ankles, knees, and hips dissipate the forces placed on the body. If any of these joints have limited mobility, these forces must be absorbed somewhere else and can lead to higher injury risks.
3. Correct technique flaws in your lifts.
Another major factor that plays into increased injury risk and re-aggravation of injuries is poor form and technique while completing these lifts. This is a place where an expert can come in and help clean up your form.
4. Progressively load the spine to allow it to adapt to demands placed on it.
After we have experienced an injury, we are not going to be able to withstand and tolerate the same loads that we could prior to the injury. We have to progressively load the spine to allow it to adapt to these loads.
If you are experiencing back while lifting, these are 4 major steps to take in order to fix your problem. While these may appear daunting these are many extremely qualified experts that are able to help you. At UpSlope Physical Therapy & Performance, we utilize this framework to keep our clients moving and get them back
to getting stronger in the weightroom. If you are having back pain while lifting, we would love to help you through your problems and get you back to feeling better and moving better.
Delitto, A., George, S. Z., Van Dillen, L., Whitman, J. M., Sowa, G., Shekelle, P., … Godges, J. J. (2012). Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy, 42(4), A1–A57.
Welch, N., Moran, K., Antony, J., Richter, C., Marshall, B., Coyle, J., … Franklyn-Miller, A. (2015). The effects of a free-weight-based resistance training intervention on pain, squat biomechanics and MRI-defined lumbar fat infiltration and functional cross-sectional area in those with chronic low back. BMJ Open Sport & Exercise Medicine, 1(1), e000050–e000050. doi:10.1136/bmjsem-2015-000050
Shiri, R., Coggon, D., & Falah-Hassani, K. (2017). Exercise for the Prevention of Low Back Pain: Systematic Review and Meta-Analysis of Controlled Trials. American Journal of Epidemiology, 187(5), 1093–1101