Acute Management of Low Back Pain after Deadlifting

Many of us have encountered low back pain during our training, especially from lifts like the deadlift, squat, or Olympic movements such as the snatch and clean. The biggest challenge is figuring out the best course of action on Day 1 to effectively rehabilitate and reintegrate these lifts into your routine.

This article will focus on ACUTE low back pain, defined as pain that arises suddenly and within a short period. It can present as sharp pain during a lift or as significant discomfort later in the day after training. Usually, this pain is new and without prior warning, although some athletes may experience a flare-up of earlier issues, making it challenging to manage. In a later article, we can explore how to address CHRONIC low back pain management (which will have some underlying similarities).

First, let’s start with what we don’t recommend:

 **Complete Rest:** Many athletes take weeks off from training in pursuit of alleviating their pain, opting for complete rest and avoiding the gym entirely. While pain might temporarily decrease due to the absence of aggravating activities, this can create a false sense of healing. Extended rest can lead to significant deconditioning in both load tolerance and aerobic capacity, which will diminish load capacity and influence the onset of pain, instilling frustration in the athlete. Without addressing the underlying issues or gradually reintroducing activities, they risk reigniting the cycle of pain.

 **Training with Restrictions:** While we as fitness and health professionals may advocate for a temporary offloading of aggravating factors, while continue to train other movement patterns/variations that allow you to train at the same stimuli’s, we don’t advocate to eliminate a certain movement from training altogether. Many individuals continue to train, but avoid the specific movements that caused their pain, for a long time to follow. For example, if someone hurts their back deadlifting, they may conclude that deadlifting is inherently harmful, adopting a mindset that they must have a “bad back”, and it’s no longer necessary or helpful for their training. However, while it's true that no one *needs* to perform any particular lift, re-integrating movements like deadlifts is crucial for building low back strength and resilience as we age. It's important to learn how to safely incorporate these activities to enhance overall movement capabilities. 

To be fair, many athletes simply don’t know what the best step-by-step processes are for addressing pain, restoring movement, improving load tolerance, and re-integrating back to strength training. It’s normal to want to avoid painful stimuli altogether when you don’t have the guidance or support. Let’s talk through these steps together!

1.  **Pain Modulation Phase:** The primary objective here is to help the athlete reduce pain and maintain that relief during daily activities. Since pain can present in various forms—such as localized discomfort in one area of the spine, diffuse pain across the back, or radiating pain down the leg—pain modulation exercises will differ from person to person. Often, practicing a PRESS-UP is beneficial for those experiencing acute low back pain.
1.  A press-up involves laying on your stomach with hands shoulder width apart, pressing your arms straight to put your low back into extension. The goal is to straighten the arms all the way, relax the hips and glutes, and exhale here. Hold this position for a few seconds, then go back down. This is known as the McKenzie Method, as part of the extension protocol. If moving into extension is painful and difficult following low back pain, performing these repetitions can be both effective and helpful to reduce what’s causing pain. I have programmed these DIFFERENTLY for all patients. Sometimes, they benefit from putting a few pillows under their chest, and just resting in this extended position while working on controlling their breathing. Other times, I have them place their hands far in front of their head before pressing to reduce the range of motion to something tolerable. It is going to vary person to person. 
2.  The idea here is that these are used to help reduce and manage pain while going throughout the day. Sometimes, gym activities take a temporary pause while in this phase, depending on the severity of the case. Programming the pain-relieving strategies will also vary person-to-person. I have a personal preference for, instead of prescribing reps and sets, to tell someone to work for 2 minutes at a time, spread throughout the day. Therefore, they’re gently working through extension for quality, focusing on relaxing and allowing their body to adjust to this new range of motion. 
3.  Another thing to work on in this phase is any exercise that addresses secondary pain problems. For example, nerve glides may be helpful for those with severe sciatic nerve tension. 

It's crucial to remember that the process does not end here! I've seen physical therapists provide this exercise as a catch-all solution, but they often neglect to progress to subsequent steps. As a result, when athletes encounter pain while trying to return to lifting, they are left with only press-ups to rely on! How could this help them progress to the demands of load under a broad range of movement patterns? It doesn’t— it’s extremely effective to help athletes improve pain and restore generalized movement tolerance, but the next steps are crucial for the rest. 

 2) **Movement Restoration Phase**:  Now that pain has calmed down some, we can start to let the body adapt to moving again. Here are some examples:

•  Stationary Bike! Get some cardio and blood flow throughout the body, and adjust to generalized movement.  

•  Bodyweight Movements: air squats, push-ups, etc can be implemented to continue restoring generalized movement. Even if these need to be performed in only partial ranges, depending on the severity of pain, this is still pushing you in the direction of healing. 
•  Move into Hinge-Patterns. Get used to letting your body bend again. This can be done as a wall-hinge, bending and touching a bench, using a ski-erg, and more. As you can see, hinging can be broken down to partial ranges and supported ranges, but the idea is to fluidly move through pain-free movement as the body 
•  Train other movement patterns! Keep bench pressing! Do some seated cable rows! Crush some pull-ups! Start working muscle groups that surround the spine — this will ONLY help improve blood flow, load tolerance, and healing to that area anyways!

This is arguably my favorite phase, as it often marks a turning point in helping patients regain confidence in their movement. Enhancing overall blood flow and increasing tolerance to a range of motion across various patterns are essential for tissue healing. The psychological benefits during this phase are also substantial. When an athlete discovers they can simply MOVE again, it triggers a significant release of dopamine, boosting their mood and motivation. This newfound sense of freedom not only fosters a positive mindset but also encourages them to engage more actively in their rehabilitation process. As they begin to explore different movements without fear, it paves the way for more complex exercises and a gradual return to their previous training regimen!! 

Important to note: If you can still engage in CrossFit or fitness activities in different ways, keep it up! If you have bodyweight workouts, cardio sessions, or weightlifting options that don’t trigger your pain, take full advantage of those!

3) **Isometrics & Gradual Loading Phase** This phase follows closely after the previous one, often continuing concurrently. The aim here is to introduce load and graded resistance to the area of pain, helping to restore load tolerance and promote physiological adaptations essential for tissue healing.

•  Glute/ Low back isometrics:
•  This can be done as a hip thrust, an elevated bridge, using a Roman Chair, a Chinese Plank, etc. Activate the glutes and low back, holding under a period of time. For more sensitive cases, this duration maybe lower, but for others, we can push for 45-60s. We can progress these with load as well. 

•  Low Back Extensions:
  •  Weighted hip thrusts
  •  Reverse hypers
  •  GHD back extensions
  •  And more!
•  Build upon the isometrics by loading throughout ranges of motion! 

• HINGE Loading: 
  • a crucial step! Get the body in a bent over position, and find comfort loading here! Great examples:
    • Bent-Over Banded Rows (from overhead)
    • Bent-Over DB/KB Rows (from floor)
    • Sled Pull (pulling rope while standing in hinge position) 
    • Hinge Plate Turnovers

•  Core work: 
•  Learn how to control the spine under static and dynamic load. Some of my favorites include: Zercher holds, Copenhagen Planks/Side Planks, Rotation Punches, Bent Over Rows, Weighted Pull Planks, Offset Squats, and more. The thing is, simple core exercises like a Dead Bug can be helpful especially for more sensitive cases, but sometimes won’t challenge the core to the stimulus it needs to progress to higher level loading. 

•  Dynamic Loading: 
•  add in some Farmers Kettebell Carries/Banded Farmer Carries, Yoke Carries, Sled Pushes, etc. The Kettlebell Carry work will challenge dynamic core control, while the Sled pushes and pulls will put the body in a hinged position and challenge load dynamic load tolerance here. In various movement patterns. 

4) **Re-integrate to Deadlifting**: If you’ve managed the previous steps effectively, it’s time to start reintroducing the movements that once caused pain. This will not only help dispel any fear surrounding those movements but also set you up for a safe and stronger recovery. In fact, as stated before, the previous steps will likely still CONTINUE here to ensure gradual progress. 

•  Lift-Off’s — some may require beginning here. Work on core control and lat engagement in the set up position, and lift the bar off from the floor (or an elevated surface) a few inches, then back down. This helps the athlete build tolerance with the initial motion of leaving the ground. 
•  Elevated Deadlifts — work on deadlifts from a reduced range of motion, such as from your knee-height
•  RDL’s/ hinge holds — if the mid-range or return of the deadlift is the tricky part here, these are great to implement to build this load capacity.
•  Deadlifts from Floor — doesn’t it feel good to pull weight from the floor again? I sometimes have athletes start with higher volume (8-12 reps) under 50-60% load to build conditioning and load tolerance before progressing. 

As you can see, the process involves a gradual reintroduction of hinging and loading movements. Throughout this journey, we emphasize the importance of staying active rather than discouraging movement entirely. Maintaining an active lifestyle is crucial for recovery and overall well-being. Engaging in alternative exercises that don’t provoke pain not only aids in healing but also helps build confidence in your body’s ability to move. This balanced approach ensures that you’re not just focusing on rehabilitation but also fostering strength and resilience for the future. By carefully reintegrating these movements, you set the foundation for a stronger and more functional body, enabling you to return to your favorite activities with renewed confidence and capability! 

Ready to learn more? Have specific pain problems that are limiting your performance goals? Czarbell is here to help. Reach out at [email protected], or schedule an appointment with me through the main page of this website, to learn more!