What I learned from getting injured
The last thing anyone wants when pursuing a fitness goal is to get injured, however it’s something that happens all too frequently when people are pushing themselves in their training without paying proper attention to their technique. Whilst you shouldn’t fear hard work in the gym (it’s crucial to achieve any reasonable fitness goal) you should be mindful of lifting with the best technique you can (and if you don’t know how to, learn) as well as understanding how to listen to your body so you know when to pull back and rest – or go see a specialist if you think you’ve injured yourself.
I’ve recently had a flare-up with my lower back injury over the last few weeks, I believe as a result of A) Getting too ambitious in my last training block, and B) Becoming complacent with my core work and prehab. Thankfully I’m on the mend now and have improved drastically, thanks to these key steps:
I stopped training during the acute phase of re-injury (48-72 hours)
I booked in with my spinal + bodywork specialists straight away
I examined my daily spine hygiene practices to see what I had been getting slack on and adjusted them
Once pain had decreased, I re-introduced my core stability routine to be done every day
Although I am now back training, I wanted to take you through my journey from the initial injury to where I am today and highlight some of the lessons I’ve learnt (and re-learnt) to hopefully help you avoid the some of the troubles I faced.
Where it all went wrong
In mid-October of 2019, I was getting ready for a trip to Hamilton Island where I would propose to my girlfriend (spoiler alert – she said ‘yes’ and we’re married!). In regards to my training, I reduced the intensity on my main lifts (Squat, Bench and Deadlift) as I wanted to feel fresh going into the trip and not be limping around. Unfortunately, as I was feeling great from not smashing myself to pieces with these lifts I increased the intensity on my accessory movements. Whilst I don’t think that this was the only thing that hurt me (as the stress to my back was likely cumulative from years of lifting with not-always-great technique) this ultimately did not end well.
This 300kg Hip Thrust was somewhat ill-advised.
When I first injured my back I didn’t get it checked out because I thought it would go away by itself. I didn’t even have any actual back pain, more of a tightness down the back of my right leg. It didn’t have a serious effect on my lifting initially so I figured it wasn’t that bad, right?
What I didn’t realise is that I was only making my long-term dysfunction worse by not getting it checked earlier where I could have started addressing what was wrong, instead of just thinking about the symptoms (leg pain).
When you have pain as a result of exercise, the first thing you think of is rest – take a break off training and do as little as possible to allow whatever is busted to heal. Whilst I agree with this for the acute phase of a soft tissue injury (48-72 hours), when pain persists it’s time to go see a specialist. This is something I did… about 6 months after I first injured myself, which was enough time for my pain type to be upgraded to chronic. Can you guess what waiting that long did to my movement mechanics?
That’s right, it messed them up real good! From being in continual pain for so long, I had tried to move as little as possible. It began with reducing and then completely cutting away my lower body training. This then escalated to cutting away any sort of outside walking activities, and when I would walk it would be with a pronounced limp. I began to lean on things more and more and would try to hold my own weight as little as possible without sitting down - sitting in the car was an absolute nightmare after 3-4 minutes of driving, and if I had to drive for 10-15 minutes I would be screaming in pain. I basically tried to spend as much of my free time lying down as I could get away with.
Eventually I got an MRI which showed a disc herniation at my L5-S1 – essentially where the lumbar spine joins the sacral spine and connects to the hips. So what does this mean exactly?
An example MRI of a disc bulge - observe the protrusion between the lower vertebrae. Good times.
A disc herniation injury occurs when a disc in between two vertebrae develops a bulge, which then presses on a nerve. As my injury occurred down near the base of the lumbar spine, the disc bulge would press on the sciatic nerve, which runs down through the hip and the posterior of the leg. For me it was all on the right side (hence the initial symptom of tightness in the back of my right leg) – any time I would try to reduce pain, it would be to alter the position of my right leg and hip. As you can imagine, continually avoiding loading the right side of my body led to some pretty gnarly imbalances and movement dysfunction. I began seeing some bodywork specialists here to release some of the tight areas I was constantly getting, but I didn’t yet put in a concerted effort to improve the way I move.
Artists’ depiction of my posture during this time.
When I eventually reached out to a doctor for help my first thought was pain management, and so the logical solution from that perspective was a cortisone injection to reduce inflammation around the nerve – which does not reduce the size of the herniated disc, and in my case was only a temporary fix. The pain dropped down for a few months which allowed me to start training my lower body again, before coming back with a vengeance the first time I attempted a straight bar conventional deadlift.
Why? Because I hadn’t addressed the cause of the problem, only the symptoms.
This time I looked more deeply into the spinal specialist and movement side of the house, studying up on the works of Dr Stu McGill and others who had followed him (such as Dr Aaron Horschig and Dr Andrew Lock). I began to understand that my injury and subsequent pain was not only a product of how I had trained previously but was still following me because I hadn’t yet changed the way I moved and thought about recovery.
Spine Hygiene
When first looking at the rehab process for an injury like mine, before we try any fancy or intense exercises we must understand what positions and movements in our daily life cause us pain, and then find alternatives that bring us relief. For me it was having my lower spine in flexion (rounded), particularly whilst sitting down. To correct this I did the following:
Ensuring my lower back was supported any time I was sitting (especially when driving)
When standing, slightly bracing my core and standing tall so I didn’t slouch and force my back to work any harder than necessary. To this end I also avoided crossing my arms, as this would shift more weight to the front of me (thus making my back work more).
Avoiding leaning to one side or leaning forward on anything, as that would typically reduce the immediate pain but promote further imbalances and sabotage my future efforts to rehab my body
Once my pain triggers had been eliminated I looked at the next step; strengthening the weak areas.
Core Stability and Daily Movement
Rather than attempting to get a strong core through doing sit-ups, crunches, leg raises or any other core movement, the first thing I needed to gain was core stability – teaching the muscles around the spine to prevent motion, rather than cause it. For this I turned to the McGill ‘Big 3’ – a series of exercises designed by Dr Stu Mcgill to teach core stability at the base level. To learn more about this I’d recommend checking him out here or reading this article by Dr Aaron Horschig.
As I was beginning to stabilise my spine I begun to institute a daily walking routine – starting with 5 minutes a day of brisk walking and eventually working up to 30-40 minutes a day. The goal here is to keep it at a decent pace to force your core to turn on and stabilise your spine and hips, as well as keeping the pace up to encourage you to swing your arms higher (allowing for a gentle stretch down the back).
After about 5-6 weeks of this I was feeling great and my pain had drastically dropped down, to the point it was time to return to lower body training. I will admit I was nervous, but I had a plan and I was going to see it through.
Training Progression
The first movement I brought back into training was the bodyweight box squat, one of the easiest progressions of the squat pattern. I started with 3 sets of 10, twice a week, which I did for 2 consecutive weeks. It was incredibly frustrating starting back here, but I knew had to get pain-free movement before progressing.
From there I changed one of the squat sessions to free squats to ensure I wouldn’t lose familiarity with that movement pattern (as well as begin the journey to regaining my strength and chasing my 1RM squat goal of 200kg). I started the next week with 10kg goblet squats, first to the box then to full range of motion.
The next week was 20kg goblet squats, following the same set and rep scheme as the prior week.
The week after that I moved to an unloaded bar on my back and began to enjoy the rehab process a bit more as it felt like I was finally training.
From there, each week I would add 10kg to the bar. One week at 30kg, the next week at 40kg and so on. As the weight increased I began to drop my reps down, hitting 5 reps once I moved up to 80kg, then 3 reps when I moved to 100kg. As I moved further above 100kg I brought the reps down to singles until I hit 140kg – I was stoked!
Feeling good - so far.
As I had been increasing my squat intensity I had been introducing more lower body movements – lunges, dumbbell and barbell RDLs and glute-ham raises, as well as some load carries for good measure – but no deadlifting from the ground just yet. I was still cautious from last time so I left that for the next training block.
Where it all went wrong – again
I took a deload week after hitting 140kg to allow my body to recover before beginning the next block with a firm target in mind; hitting a 160kg box squat. Alongside this goal I wanted to reintroduce deadlifting but in a spine-friendly variation – with the trap bar.
Like with my initial squat progression I started this block with the trap bar weight low, hitting 3 sets of 8 reps at 60kg once a week with the idea of adding 10kg each week. In hindsight the progression was a bit too much as I was now beginning a strength phase with my squats, starting the heavy box squat days at 110kg for sets of 3 and the volume free squat days at 80kg for sets of 8. Alongside this however I had foolishly grown complacent with the daily walking routine (doing only 5 minutes before training most days) and had not progressed my core routine – I was still following the Mcgill ‘Big 3’ but nothing more than, when it is simply designed to get you out of pain and moving again; not squatting heavy weight!
I followed this rate of progression relatively successfully, eventually arriving at the final box squat day; 3 singles of 160kg were on the menu. I warmed up with my standard – McGill Big 3, hip + ankle + shoulder mobility, then sub-maximal sets starting with bodyweight and climbing up by 15kg-20kg until I felt I was ready.
I got under the bar and did the first single, which moved great. I was stoked! I had successfully hit my goal for this training block and should have satisfied – but I wanted to push it a bit further. I decided that for the second set if I felt good after the single, I would go for another rep. I rested for a few minutes, then got back under the bar and walked it out of the rack.
As you can probably guess, this is where I got too ambitious. As I came up from the first rep I felt my core bracing loosen on my left side, causing the right side of my lower back to overload and tighten up. I got to the top and felt that something was off, and instead of re-racking it I chose to focus on my core and hit the second rep. This was not the smartest move.
Although I completed the second rep and re-racked the bar, as soon as I stepped out of the rack I felt my back giving me some warnings pangs, which I promptly ignored as I had already mentally committed to hitting 3 total sets of 160kg that day. I was full of adrenaline, the music was pumping and it was the heaviest I had lifted in 6 months – I rested for a few minutes before getting back under the bar and hitting the last set, this time just for a single.
Whilst I had grand designs to finish my accessory work after squatting I chose to lay down for the next 20 minutes as this was all my back would allow – I’m glad I listened to my body at this point but I should have been paying attention earlier when my back first started giving me warnings that all was not well.
The tightness subsided over the next 24 hours and I got back in the gym a few days later feeling good – I hit a volume lower body session, starting with 130kg squats for sets of 4. No problems so far. Two days later I came into the gym ready for my Pull session, which started off with trap-bar deadlifts – in line with the rate of progression I had planned, I was going to attempt 110kg for 3 sets of 8.
As I was warming up with some sub-maximal sets, something felt… off. I was finding it hard to get down into position to grip the bar, despite my attempts to focus on my core bracing, glute activation and leg drive. I loaded the bar for the first working set and did 5 reps before cutting the set short – something didn’t feel right, but I couldn’t quite understand what it was (my back massively tightening up). I attempted another set of 5 and dropped the bar – yep, I had definitely hurt myself again. Dammit.
Pain.
I cut the session short as I already knew what was coming – I was going back into the hurt locker. Over the next few days my back completely seized up to the point where I could hardly move. Anti-inflammatories, Voltaren and heat packs barely put a dent in it, and when I saw my bodywork specialists to loosen the area it quickly tightened back up shortly after. I was basically spending all my time lying down again, which was incredibly frustrating given all the progress I had made over the past few months. 1 step forward, 2 steps back.
Well well well, if it isn’t the consequences of my own actions
After a few days the tightness receded, and the familiar pain down the back of my right leg returned. The disc was once again pushing on the sciatic nerve. Whilst it was incredibly disheartening at least this time I knew how to handle it:
I had to re-evaluate my spine hygiene practices and make some adjustments to the way I sat, particularly whilst driving
I had to stick with the corework and progress it as necessary
I had to maintain the walking routine I had initially established
I had to be smarter with how I programmed progression for deadlifts, taking into account any other lower body loading I had planned
This brings us up to today. After a few weeks of working on the above points I’ve successfully eliminated my pain triggers, which is much better than the initial 6 months I spent in constant pain before seeking out proper help, as well as the subsequent re-injury phase I experienced before taking responsibility for my own active rehab.
I’m getting ready to start training lower body again, as I still have a long-term goal of hitting a 200kg squat. It may not happen in the next 12 months, but it will happen eventually – provided I follow through with the above points. Along with the spine hygiene practices, core work and overall mindfulness with regards to posture, the main things I’ve learnt from the last 2 years of pain are:
Technique always matters –as alluring as hitting a new personal best can be, letting your ego take control when loading up the bar for a lift will eventually result in you getting hurt. Take the time to build your foundation before progressing.
Learn to recognise when to pull back – whilst muscle soreness is normal when strength training, if you feel any sort of strange pop/twinge/tightness after a set then you need to stop and evaluate whether or not you need to cut the session short and rest. Whilst you can get in catch-up work the next day/week, you can’t un-injure yourself.
Rehab is an active process – you should of course defer to your doctor/medical professional when coming back from an injury, but eventually more rest will not equal more recovery. Learn how you need to move in a way that helps your body, and do it consistently.
Don’t get complacent - the absence of pain doesn’t necessarily mean your injury has disappeared! Once you have completed the initial phase of rehab and have returned to training, there will likely be things you need to keep doing to prevent re-injury. Do those things!
If you’re currently in pain from experiencing your own injury and don’t know what to do, please don’t give up hope – consulting your preferred GP is a good first step, but I would recommend seeking out a specialist relative to your injury. From there I’d recommend also seeking out a bodywork specialist such as a chiropractor, myotherapist or physiotherapist. If you’re in the Sunshine Coast area I’d recommend the following:
I hope you’ve been able to learn a few things from my journey through navigating my back injury. Best of luck with your own training and rehab – just make sure you stick with it!
Talk soon,
Alex
