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Identifying The Cause Of Low Back Pain

Identifying The Cause Of Low Back Pain

Let me lead off by saying that I am not a Physical Therapist or Chiropractor, nor have any certifying credentials to state that I should be treating back issues. With every instant that I discuss, there should be certified professionals involved as well. But that is not the purpose of this article, rather instead to identify certain positions and deficiencies that I have found that typically lead to back issues. From there, I will cover some approaches I have taken with athletes I have coached with back pain that have led to decreased pain and/or occurrences of pain in my specific role as a coach in programming and movement quality.

First, there are the obvious cases where someone has significant form issues where either they cannot perform a proper hinge, and/or they have excessive lumbar extension in the squat or deadlift. Even someone with little to no experience in resistance training can spot these and know something isn’t right. That fix has an easy answer, and that is to take a big step back and teach them proper form. Those are the cases where they no longer have the privilege to continue to work with heavy weights until the can properly maintain positions and form with even the lightest of loads. But that’s the obvious scenario, and what I would like to focus on is the less obvious scenarios. While this may not cover every case, in my experience I have found three specific “less obvious” causes of back pain. Two of these lead back to an understanding of active versus passive stabilization, so lets cover that first. While this description could be more in depth, in a simplified form passive stabilization is stability when a joint rests at its end range of motion, with the joint creating the stability. So with the back, this would mean the end ranges of motion of flexion, extension, and lateral flexion of the spine. Active stabilization on the other hand is that middle range of motion where muscle is stabilizing the joint, or what you would consider a neutral spine position. Active stabilization is where we want to be. Passive stabilization is where injuries happen. And when it comes to back pain, the three less obvious causes are lumbar extension, lumbar lateral flexion, and bar path.

So the first case is lumbar extension. Lumbar flexion is the obvious cause where someone’s back looks like the St. Louis Arch, but lumbar extension can be just as much an issue, especially in the squat. While I have definitely seen cases of people over-extending in the deadlift, it is less common and also a much easier fix. In the squat though it is extremely common, where you see someone who tries to sit back, but instead just anteriorly rotates their pelvis, goes into lumbar extension, and is now using the end range motion of their spine to stabilize. In each person the degree to which this occurs varies, with some cases more obvious than others. The less obvious cases usually occur when someone actively stabilizes and keeps a neutral spine during the eccentric phase, but as soon as they initiate the concentric phase they going into an anterior pelvic tilt and lumbar extension. The degree to that varies, but I have seen even the smallest degree of lumbar extension can cause pain. Below is a video of an athlete of mine with her before and after squat. On the left you will see her go heavily into lumbar extension as she goes through the concentric phase, and on the right you will see the improve neutral spine position throughout.

Lumbar Extension Example

The second case is when someone goes into lumbar lateral flexion due to a hip shift, which usually also entails some lateral movement and tilting of the pelvis as well. The typical thing I will see is during the concentric phase the lifter will pop their hip to one side and about half way up start to realign as they lockout, both on squat and deadlift. This specifically drives down on the QL (quadratus lumborum) of whichever side the person is shifting to. If you are not familiar with the QL, become acquainted with it, as I find that to be the most common culprit of back pain. If someone comes to me and says they suffer from lower back pain, but it is not diagnosed and they are pretty confident it is not a structural issue with the spine, 9 times out of 10 its the QL.

Lastly is a bar path issue. Bar path is dictated by the actual movement pattern, but if you watch the bar path it can tell you a lot. And for lower back pain, if the bar path during the concentric phase of the squat and deadlift moves forward of your midline at any point, it means you are putting extra and unneeded pressure on the lower back. Typically this issue also coincides with someone who shoots their hips back and chest falls in the squat, or someone on deadlift who either sets up with their shoulders too far in front of the bar or straightens their legs too early. Either way, as that bar moves over your toes instead of the midfoot, tension transfers away from the hamstrings and glutes and now goes to the lower back. Below is a link to 3 videos, the first showing an example of the bar path issue, and the second two showing examples of the aforementioned lateral flexion.

Bar Path and Lateral Flexion Example

So you’ve identified the cause of the low back pain, now what? I am not enough of an expert to give a detailed and perfect plan, nor do I think that is even possible, as each individual case will be different. But what I can tell you is that three things need to happen:

  1. Regress the weight.
  2. Slow the movement down.
  3. Repattern the movement

Whether the issue be lumbar extension, lateral flexion, or a bar path issue, you need to back off the weight and slow the movement down to where you can achieve proper form. For squats, this may mean adding a tempo to the eccentric and maybe even the concentric as well. For deadlifts, I wouldn’t recommend a concentric tempo, but you will need to regress the weight to a point where you can keep in a proper movement pattern. Something that probably needs to be included for many is improved bracing mechanics, as the issue could be that you are not bracing your core correctly through these movements. I’m sure you wanted an easy fix, but it doesn’t exist, and having a knowledgeable Chiro or PT than can help guide in this process is extremely beneficial. The two things I will leave you with is this QL lacrosse ball stretch that I posted on my Instagram a while back that has relieved the back pain of many people I know, so this is always worth a shot for a short term fix. The other is my go to for teaching breathing and bracing mechanics, and if you find that you have a lot of trouble performing this, it is probably safe to assume bracing is one of the components leading to your back pain.

QL Lacrosse Ball Stretch

90/90 Deadbug Breathing Technique

 

More Volume Without More Injuries

More Volume Without More Injuries

If you are anything like me, I am getting pretty achy after a high volume training period. If there is a specific time I know I am at the highest risk for bothering the chronic tendinopathy in my left knee, it’s during or right after a volume phase. So if this is the case, what we can do different programming wise? Blood Flow Restriction training.

BFR training is slowly becoming more accepted within the Powerlifting community when it comes to direct arm training. After benching and low bar squats, direct arm work puts even more of a beating on those bicep and tricep tendons. With that being the case, many have made BFR training their go to for direct arm work, allowing you to still receive adequate volume and stimulation but without the same wear and tear. Research has been very promising for BFR training as well. At first glance, seeing some guy cutting off the circulation to his arms while doing some standing barbell curls looks like some weird new fetish fad, but once you look into the actual scientific backing, it starts to sound like that guy might be onto something. It has been shown that using as little as 30% of your 1RM while blood flow restricted can produce similar hypertrophy and strength gains, and it has also made its way into physical therapy protocols for rehabilitation purposes.

So if it is so widely accepted when it comes to biceps and triceps, why hasn’t it caught on for lower body work as well? That’s where I come in and propose for the use of BFR training during lower body accessory work, specifically knee extension based movements, to reduce the wear and tear of the powerlifting grind. The best fit for this type of training would be during these high volume cycles, when less competition specificity is needed and volume is high. It’s great way to produce similar hypertrophy, volume, and metabolite benefits of higher repetition work in a less aggressive way. Look below at the example of how this could be implemented, one showing the original template, the following showing blood flow restriction being introduced.

Example #1: Non-BFR

Exercise Sets Reps Weight
Competition Squat 2 4 400
Competition Tempo Squat (3 second eccentric 2 6 315
Bulgarian Split Squats 3 8 200

Example #2: Blood Flow Restriction

Exercise Sets Reps Weight
Competition Squat 2 4 400
Competition Tempo Squat (3 second eccentric 2 6 315
Bulgarian Split Squats (Blood Flow Restricted) 4 15 60

 

So looking at these examples, after our competition movement and competition variation, we originally had some additional leg volume added in with Bulgarian Split Squats. Again, this would be an example of a volume phase, so competition specificity is lower, with one reason being to reduce the wear and tear on the joints of the heavy competition movements. But the second example takes this one step further with adding in blood flow restriction to the Bulgarian Split Squats, as well as increasing the sets and reps to account for volume changes due to the lighter weight. While I will be the first to say example #1 would be optimal in regards to immediate benefit, as I have mentioned multiple times in my writing, it’s not about what we accomplish today, but instead what we can accomplish long term. There is a higher likelihood of injury when performing 3×8 at 200lbs on Bulgarian Split Squats, versus 4×15 at 60lbs blood flow restricted. And if we can get somewhat similar benefits, I’ll take the option that is going to improve my longevity based on my past injury history.

I used Bulgarian Split Squats as the example here, but let’s cover some exercise variations that would be useful with BFR training, and ones that may not be. First, let’s look at what may not be the optimal approach with BFR training with the lower body. While there isn’t research that I know of stating this, usually barbell squats and deadlifts are not the best exercise for BFR use. There are just too many variables and muscles at play there, specifically the lower back, and our goal is usually to isolate the blood flow restricted area as much as possible. For quads, I recommend exercises that do not require high loads and for the most part take the lower back out of the equation. Below is a list of good exercises to try with blood flow restriction for quads:

Bulgarian Split Squats (there is some low back involvement here, but with light loads it is minimal)

Walking or Reverse Lunges

Belt Squats

Leg Press

Leg Extensions

Sissy Squats

There are others as well, but these 6 exercises seem to work the best due to decreased lower back activation and the ability to increase the focus on the quads. For hamstrings, I will usually stick to isolation movements, as most compound hamstring dominant movements are going to involve the lower back. Below are examples of my recommendations for blood flow restricted hamstring dominant movements:

Seated, Standing, or Lying Hamstring Curls

Smith Machine or TRX/Ring Bodyweight Hamstring Curls

Furniture Slider Curls

If your body is rock solid and you are resilient to injury, this may not be for you. But if wear and tear has been a continual setback for you in the past, maybe this a new way of looking at your training. It is just another tool for your arsenal to implement in achieving maximal strength. With the benefit that has been seen in blood flow restricted arm training within powerlifting, I think it’s time to start experimenting more with BFR training for the lower body as well. Beware though, the pumps are insane!!!

 

Most Common Individual Difference In Deadlift Programming

Most Common Individual Difference In Deadlift Programming

While there are an infinite number of minute differences in programming from person to person, something I wanted to touch on is the most common difference I see in deadlift programming. In my experience, deadlifts seem to be the most drastically different person to person. Fairly universally, people tend to respond better to lower comparative intensities and volume on deadlifts than for squats and bench press. But within that I have found some major differences, and to get more precise, I find people fit into 1 of 3 categories when it comes to deadlifts.

1.) There is the average person that responds to middle of the road deadlift programming. Which for my programming style would be somewhere around twice a week frequency, one main day and one variation day, at reasonable volumes and relative intensities ranging from 4-8 RPE in the 70-85% range, with most of the work being done in the 5-7 RPE range. I’d say 70% fall into this category. The other 30% are complete opposites though.

2.) 20% will require extremely low intensities, doing most of the work in the 2-5 RPE range around 65-75% while handling fairly high volumes of work. They can handle the volume, they just can’t handle the intensity. You might ask, “Why not just decrease the volume and increase the intensity then?”, but for these people it doesn’t work like that. Any high relative or absolute intensity works just seems to beat them down. I fall into this category myself as well as one of my athletes Joe. Give us one week of heavy deadlift work, and the following week our 1RM goes down 40-50lbs., no exaggeration.

3.) The final 10% are the exact opposite. They get immediately beat down by any type of higher deadlift volumes, but give them a bunch of singles and doubles and they feel great. While I don’t have a great idea of the lifter prototype that fits into numbers 1 and 2, number 3 is typically short arm lifters who have to go through a significant range of motion. Which that makes sense. When you track total work completed, the true calculation would also include distance traveled, so a set of 5 for a short arm lifter is in reality more volume than for a long arm lifter due to more distance traveled.

So what I hope this information helps you with is if your deadlift is stalled and you are not sure why, take a look at your programming and possibly see if you may fall into a different category than you think. I can say in my experience I have never had someone with deadlift respond to high volume and high intensity, so most likely you are going to be in 1 of these 3 categories.

What Percentages Of Your 1RM To Use On Variations

What Percentages Of Your 1RM To Use On Variations

I know a big question I had when I first started powerlifting was what percentage of my 1RM should I be able to do on different variations, and I don’t think I am alone in that. As powerlifters we know our 1RM competition squat, bench, and deadlift, but for all the variations and bar placements changes, it’s usually just a guess. But over my course of coaching experience, I’ve programmed for enough athletes now that I’ve started to see general trends on what percentage 1RM most athletes can perform these variations at. These are not universal and there will 100% be outliers above and below what I recommend, so it always comes down to finding your own individual differences and programming based off that. But I hope the below information can at least give you a starting point, because as far as I know, there is not another article online that breaks this down in this manner. 

Squat (assuming you are a low bar squatter): % of Competition Squat 1RM Notes
High Bar 90.0 – 97.5% The biggest thing that will dictate where you will fall within this range is femur length. Shorter femurs equals a higher % of 1RM on high bar, longer femurs equals a lower %.
Safety Bar 87.5 – 90.0% This seems to be fairly universal, but there is a learning curve. Most athletes will have to start lighter but as they build up they should be able to tolerate around 90.0% of their 1 RM.
Buffalo Bar 97.5 – 100% Buffalo bar could very well equal 100% of your 1RM comp squat, but just because it has a slightly different feel, I will typically stay conservative and go with 97.5%.
Cambered Bar 90 – 92.5% This seems to be fairly universal, but there is a learning curve. Most athletes will have to start lighter but as they build up they should be able to tolerate around 92.5% of their 1 RM.
Tempo Squat 87.5 – 90.0% This range will be based on how many reps you are performing. 5 Reps or less it will fall more towards 90%, and anything over 5 reps will be around 87.5%
Pause Squat 92.5% This seems to be fairly universal.
Pin Squat 87.5% – 90% If someone can perform these correctly, athletes usually can do around 90% of their 1RM, but the fact is most people cannot do these correctly and will use more weight than they should. Typically long femur lifters have a harder time with pin squats and short femur lifters will have an easier time.
Front Squat 80.0 – 87.5% I do not program these often, so I would say I am less confident on the accuracy of this, but generally this is where I have found front squats to be.

 

***If you squat high bar, the real main thing that changes is that your Safety Bar squat will now be at 95% of your 1RM.

 

Bench Press: % of Competition Bench Press 1RM Notes
Close Grip 95.0 – 97% This is with the assumption of a standard width bench press for most powerlifters. If an athlete’s grip is already close, this % goes up. If they are a max comp width grip, this could very possibly go down. But for the most part 95-97% of their 1RM on close grip bench press will be fairly accurate.
Wide Grip 92.5 – 97.0% This is with the assumption of a standard width bench press for most powerlifters. If an athlete’s grip is already wide, this % goes up. If they use a close grip though, I have found that some people really struggle with wide grip and may have to decrease the percentage down to possibly 92.5%
Tempo 90.0 – 94% This range will be based on how many reps you are performing. 3 Reps or less it will fall more towards 94%, 4-6 reps around 92%, and anything over 6 reps will be around 90%
3 Second Pause 92.5 – 95.0% This range will be based on how many reps you are performing. 4 Reps or less it will fall more towards 95%, and anything over 4 reps will be around 92.5%
Spoto Press 92.5% This seems to be fairly universal. Grip width can change this to an extent, but not by much.
Pin Press 1/2-1 inch off chest 92.5 – 95.0% This seems to be fairly universal. Those who train with a pause consistently in training tend to be better at pin press, and those who touch and go have a harder time with it.
T-Shirt Touch Press 92.5% This seems to be fairly universal. If an athlete soft touches they typically will be better with t-shirt touch press, and if they sink they typically will be worse at it.
Feet Up 90.0% This seems to be fairly universal, but if there is deviation from this it will be based on how much the athlete relies on leg drive. If they rely heavily on leg drive, feet up bench press will be much harder than for those who use little to no leg drive.
Slingshot 100.0 – 107.5% This will be based off the purpose of the movement. If it is to overload, typically people can handle up to a 7.5% increase over their comp bench pres 1RM, sometimes even 10%. If it is used for extra volume work though, or to work around a shoulder/pec injury, then I plan it to equal an athlete’s comp bench press 1 RM.
1 or 2 Board 100.0 – 107.5% This will be based off their profiency through this range of motion. Typically athletes can handle over their 1RM on board presses, but that is not always the case. Typically on a 1 board I will program based off their 1RM, but for a 2 board I will start to assume a slight increase up to 7.5% over their comp bench press 1 RM.

 

Deadlift: % of Competition Deadlift 1RM Notes
Pause off the floor 90.0 – 95.0% I don’t have a good reason why, but some people are just really good at this, and some people are really bad. Find which one you are, then program the percentage range based off that.
Pause just below the knees 92.5 – 95.0 % Typically a bit easier than pausing just off the floor, so there is less deviation here between athletes.
Deficit 85.0 – 90.0% This is for conventional deadlifters. I have never programmed deficit for sumo pullers, nor really would recommend it, so I do not know a % of 1RM for that.
2 Inch Block Pulls 100.0% This will be pretty similar to someones comp deadlift, as 2 inches doesn’t drastically change the movement. Short arm lifters have the most to gain from those 2 inches, so they possibly could program over their 1RM comp deadlift.
Rack Pulls just below the knee 100-107.5% An athlete should be able to rack pull more than they can comp deadlift, but that range is based off of what these are programmed for. I typically do not program these for lock out work, but rather added posterior chain volume, so I usually keep the % of 1RM fairly close to their comp deadlift. This may also change if you are doing these conventional when you typically pull sumo.
Trap Bar 105.0 – 110.0% Most athletes can trap bar deadlift more than their sumo or conventional deadlift, but typically I have found conventional deadlifters are better with a trap bar, so that is the reason for the percentage range.
Romanian Deadlift 80.0 – 87.5% This seems to be fairly universal, but if there is a difference, I would say conventional deadlifters tend to be a bit better at RDLs in comparison to their 1RM than sumo pullers

 

Biggest Misconception About RPE Training

Biggest Misconception About RPE Training

“RPE” is not a training program.

The single biggest misconception about RPE training is that it is a training program, and it 100% is not. Just like Conjugate or DUP, it is a training principle, not a program. And in reality you could have a Conjugate DUP program that is RPE based. They are all just tools within programming.

So what is RPE? It is a subjective loading parameter. Percentages and weight on the bar are objective loading parameters, meaning exact numbers, but RPE is a subjective way to rate the load on the bar. 3×3 at 80% and 3×3 @ 6 RPE are essentially stating the same thing, so let me explain further. (If you are unfamiliar with RPE training in general, make sure to read What is RPE training? before reading on)

To go deeper into this, let’s say you have a 3×3 at 80%. You are stating the objective load at 80%. Going further, if your 1RM is 400lbs., then you are performing a 3×3 at 320lbs. Both of these mean the same exact thing, and when written in an “Instagram post”, they are relaying the objective difficulty and/or load of the set(s) being performed. There is one big issue in my opinion with that first example though of stating 3×3 at 80%. That issue is that 80% for a set of 3 is not the same for everyone, so it really isn’t stating the difficulty of that loading parameter in relation to you. There was actually a study done recently where trained participants performed an AMRAP with 70% of their 1RM on squats. The average number of reps completed was 15, but there was a range of 8 reps all the way to 25! The main correlating factor? Femur length. Shorter femurs tended to get more reps, longer femurs less reps. So at any given percentages, each individual will have a deviation in how many reps they can perform.

So how does this relate to RPE? If we use the example of 3×3 at 80%, the majority of people can get about 7 to 8 reps with 80% of their 1RM. So this could very well be written as 3×3 @ 6 RPE. It means in sense the same thing. But the difference with those two programming methods is that if I give you 3×3 at 80%, that gives you a set number that I am using based on the average person and the average difficulty of 80%. But what if you don’t fit into that category? What if you could perform 10 to 12 reps with 80% of your 1RM, or maybe you are on the opposite end of the spectrum and you could only get 5 reps with 80%? Then that 80% means something different than what was intended.

That is where RPE is used as a subjective loading parameter. For the average person, 3×3 at a 6 RPE will be 3×3 at 80%. But for the examples of those outliers, or maybe on a day where you may feel weaker or stronger than normal, the 3×3 at a 6 RPE allows for variable loading parameters to adjust for individual differences and is why it has become a popular tool in modern day programming. Even if you haven’t used RPE intentionally as a tool in your programming, the fact is unintentionally you have. Let’s say you performed that 3×3 at 80% and you wrote in your “Instagram post” that you smoked it and it was super easy. With that thought process you are subjectively rating the difficulty of that set. The only difference between that and RPE, is that RPE is giving a set subjective parameter to describe the difficulty.

What it comes down to is whether you have 3×3 at 80%, 3×3 at 320lbs., or 3×3 @ 6 RPE, all 3 are in reality the same and all 3 are just different ways of writing the same loading parameter. 2 of those being objective and set, 1 being subjective and variable. There is a time and place for both. All of these principles are just tools for progression in strength and the application is based on individual preference and need.