Success, Back Pain, Recovery, Repeat

• Dr. Steven Ritucci Jr, D.O

Every athlete works towards getting stronger in the gym for game day, while push their bodies to the absolute limit. They eat, sleep and breathe training. Some athletes gain ground and become notorious figures in their sport. Some even start to feel invincible in training—— until they feel an undeniably dreadful back strain. A back strain can feel knife-like, cause shooting, pain. It can stop an athletes progress dead in it’s tracks and in some cases cause an athlete to fall out of training all together. Unfortunately bodybuilders, powerlifters, cross-fitters, and even olympic weightlifters are susceptible to lower, middle & upper back strains. The next step is to start the recovery process while improving any deficiencies that invited the injury to occur. Surprisingly, the most overlooked evil of training, is over training. These athletes without the proper guidance overexert their bodies to the point of injury. Of course, the most important question in the athletes mind is, will I recover fully or have I just past my “peak”?

Luckily, the answer to this question is usually yes, recovery is possible, given that the trainee is serious enough to learn from their setback and restrain them selves from the worst decision they could make in their career. Forcing Recovery.

The first few days and weeks in recovery are typically very painful and the ability to move is limited. Most people in this situation feel a new sense of urgency, and that is to recover as quickly as possible.

Thoughts of, “I’ve gone from hero to zero!” and self belittlement occur much too often. The wonderful thing however, is that more than nine times out of 10 this excruciating pain starts to improve over the course of the next several weeks into a more mild discomfort, and eventually no symptoms.

The best part of recovery, is that complete bedrest is not normally needed. Rather a return to mild or moderate activity as tolerated and slow, steady progress (often augmented by the help of good physical therapist and/or chiropractor) are the way back to full activity. Anti-inflammatory medications such as Motrin/Advil/Ibuprofen or Aleve/Naproxen or Acetominophen/Tylenol may also help alleviate pain in the beginning, and muscle relaxers such as Flexeril/Cyclobenzaprine may also be helpful to sleep. Ice, heat, Electric Stimulation/TENS unit, Massage, Acupuncture, Dry Needling, Trigger point therapy and Chiropractic care can all be helpful adjuncts as well.

Now here is the stressful part… What Is Best For Me?

You’ll have to ask your physician or physical therapist, and they will guide you. Be sure to find some one who you feel is well inclined to your situation.

Within three months, most people are back to 100% pain-free levels and may start to feel invincible again. However, for a select few people, the fear of re-injury will persist. It will drive away those that are not serious about their strength goals quite easily, “It just ain’t worth it.”  However, for those who wish to continue their progress but do not wish to re-injure themselves, this will pose a  new challenge— but it can be overcome….

As both a 25-year veteran strength athlete/coach and a physician (who has suffered through this as well as treated people like this many times), I will propose 4 steps to overcome post back injury fear and return to full activity, using the strength sport of powerlifting (the heaviest form of (controlled) lifting consisting of squats, bench press and deadlift exercises) as an example.

1.) Realize that back pain from an over exertion or a strain is an occupational hazard; and doesn’t make you an failure or a bad person!

Forget what your uncles told you about “your life being over once you mess up your back.” It’s just not true. Get up off your butt and get moving again. Slow and steady wins the race. Powerlifters and Athletes encounter back strains from overtraining or progressing in their weights too quickly about as commonly as people encounter the common cold from not washing their hands enough or wearing a mask around sick people.

2.) Make sure that your lifting technique on all your exercises and especially the squat and deadlift variations are optimum. This will prevent or greatly reduce the chance of re-injury, even if you plan on going heavy again.

Yes it’s true, we all have different body types and all have trouble being perfect all the time with our form. However, clean it up as best you can. It’s 2021 and everybody has videos now that they can take. Take a video of yourself from different angles particularly the side and back angles to see where your biomechanics are. If you still don’t know what you’re doing, hire a professional coach or physical therapist, whether it’s virtual or in person. This can be the difference between night and day in cleaning up your form and biomechanics and ultimately the strain on the muscle and fascia of your back muscles.

3.) Don’t be a knucklehead. Load the spine again gradually and don’t care so much about time constraints and having to peak your strength at a certain time. When your body is ready, it will be ready.

You can return to squat and deadlift variations very early after a back injury, assuming that the form is good and the pain is not excruciating. However, you shouldn’t go for personal records right away. Build up very slowly, doing only an empty barbell the first session, then adding a little bit of weight the next time, and then the same the next time, etc. until you get to an 80% maximum effort load comfortably in which case you can start slowly and gradually pushing the intensity up (example- adding 1 repetition per workout of that 80% load until you are at 6-8 reps without pain; at that point you’re pretty much back to normal).

Some people, particularly elite athletes or top notch powerlifters may wish to return to competition early particularly if they have a meet that they’re training for and they aim to be in shape for it. Chances are, if you injure your back muscles very close to a meet, either back out of it and do one soon after, or do the meet but don’t expect personal records. However, your risk of re-injury will be higher if you’re not fully healed and return to lifting max loads prematurely.

4.) Keep records of your progress over time and continue to make videos.

Assuming you’ve learned valuable lessons from your injuries and have made a full recovery back into powerlifting, don’t take this for granted! The body can sometimes unlearn what it has learned and go back to sloppy old habits, especially when trying to break through a plateau. Continue to video yourself and monitor your progress and changes over time. You will likely last a lot longer that way.

Tune in next time for part two, which will cover injuries of the back that do not heal as expected (the 10 or less percent of the population)