T Nation

I Need Guidance


#1

I injured my lower back 7 months ago deadlifting. I was originally diagnosed with a lower back strain, and went to PT. I was released from them and said I was good to go, long story short they were wrong and here I am still injured. THe pain is gone and there's this tightness on the right side of my spine, kinda in the area of the top of my pelvis and next to the spine.

I have lost a ton of strength, but more importantly I can't lift heavy things which is what I love to do. I went to multiple docs and they were all far from helpful, telling my to strengthen my core and my back would just get better. One even made me show him my stomach and said that my back got hurt cause I "didn't have a six pack". I've been working on mobility and strengthening my core this entire time.

I put all my effort into fixing the probem and it just won't go away. I've tried training around it, but haven't made any great progress. I'm frustrated, I"m tired, and I'm desperate to get my strength back and start training the way I love again. ANy suggestions on where to go from here?


#2

Lastly I can offer tons more info and details on what I've tried thus far if needed. I just feel like I've been spinning my wheels for the past 7 months even though I've been putting all of my effort into fixing this injury.


#3

Have you had any specialists examine your lumbar region?

And yes, as much as details as possible will be helpful.


#4

You need a good doctor. Call local universities with good athletic programs and find out who they use for sports medicine. It may take some research, time and then driving to get to a good one, but it's worth it given this is something you've been dealing with for months.


#5

I had a specialist from physical medicine examine my back. He's the one who said to strengthen the core and that the problem would just go away on its own eventually.....


#6

Did he examine for bulging disc or herniated disc?


#7

Also, is the pain specific to one side?


#8

Yes he examined it for a disc issue. It's the right side, and this sounds weird but its not a pain. At first it was, but now it's just this tightness that will not go away


#9

Am I correct in theorizing that your workouts are primarily bilateral in nature?


#10

I would recommend going back to this person then and explain that you have done everything right and you still have pain/discomfort. You really don't want to have to bounce from doctor to doctor since that will just leave gaps in the evaluation, so if this is someone you can trust stick with them and hold them responsible for your health.


#11

I am beginning to suspect it's your quadratus lumborum.

I also suspect you're primarily a barbell-all-day-everyday type of lifter (with some db work thrown in from time to time).

And please refrain from telling me that you have good form. Everybody tells me that...yet they're injured or in some type of chronic pain.

Even if that barbell is moving in a near perfect line, it's no guarantee the body is working in ideal synchronicity. I've said this before in other threads but it's worth repeating.

If you can confirm with reasonable certainty that it's not a bulging or herniated disc, you may want to consider having your QL examined. Make sure it's a skilled and experienced person. The QL is attached to the last rib in addition to L2-L5 (I haven't read any case studies regarding the rare population who have L6). The portion of the QL that's attached to the last rib must be approached with great caution.

Also have the multifidus, erector spinae, and possibly the thoracolumbar facia examined. The QL, I suspect, is the primary candidate.


#12

Thanks for the help. I wouldn't say strictly a barbell guy but yeah I like to base my training sessions mostly around bilateral barbell movements. Since the injury though I've started unilateral training and also more body weight movements.


#13

I'm just extremely frustrated cause the doctors around here seem to be terrible. I even went to PT for the issue and it wasnt successful. It's ridiculous how you guys have given me better information for free than all of the doctors I've paid for. I honestly don't know where to go, and for my insurance to cover it i would have to go back to my primary which I'm changing soon anyways. It's an infuriating mess


#14

Also should I continue doing planks/single leg work? Or should I rest? I have made progress but so little, and I retweaked it front squatting a couple weeks ago, even though it was good form and a weight I could handle. In my mind I think strengthening my core and improving mobility will work, but I've spent the last 7 months doing that and it's still not better


#15

I figured you for a predominantly barbell guy. You're doing the right thing by incorporating unilateral and body weight movements. Give those two just as much respect as you did your barbell work and you'd be pleasantly surprised. Not unlike vegetables, those are things you should always include in your lifestyle.

Keep this mind: since the injury, your body has made compensatory changes in the way it moves, sits, stands, etc. This WILL effect even the unilateral and body weight movements. Therefore, UNTIL YOU locate the source of pain, even unilateral and bw movements will NOT yield optimal results.

Most MDs and PTs are (as I stated in another post) pathetically mediocre. I honestly lost track of how many people who have had the same scenario as you. I distinctly remember one of my favorite clients. She is a registered nurse who suffered from chronic lower back pain. The top ortho at the hospital she worked gave some incredibly vanilla advice that got her nowhere.

I still stand by what I said yesterday:

1) Make sure that it's not a case of bulging or herniated disc.

2) Have that right quadratus lumborum checked out by an expert in sports-related injuries. Also have the erector spinae, multifidus, and thoracolumbar fascia examined.

If the cause is definitively not 1 or 2, at the very least we can cross those off our list and move forward. I stated this in another thread; solving chronic pain is often a game of elimination.

A plank is a closed chain bilateral movement. Again, it bears repeating that your body is compensating even in isometric exercises.

As I stated earlier, your body is moving, sitting, standing, etc. with compensatory patterns at this point. Until we know the cause, I cannot recommend a training protocol.

I would prefer to keep it safe and advise you to rest until you get examined for those possible causes I listed above.

If you must do something to preserve your sanity, do the following. Actually, physically write down the exercises you've been doing. Rank them in the order of most provocative to the least. If you can honestly say the exercises on the least provocative section does not cause additional pain, you may - at your own risk - be able to do them AT A VERY EASY LOAD/VOLUME. In other words, just because a certain movement doesn't bother you, do NOT go balls out on them. This is very common error many make.

If you make the mistake taking all that angst out not being able to do your favorite exercises and place that energy (even aggression) into what is deemed as safe(r) exercises, you can very well end up with new set of issues.

I'm going to bust your balls here. Remember my post from yesterday? Here it is:

As I stated earlier, your body is moving, sitting, standing, etc. with compensatory patterns at this point. Until we know the cause, I cannot recommend a training protocol. I'm sure others will be happy to recommend various things you can do. I will not.


#16

Thanks a ton man, seriously. I know I sound frantic but I'm looking to go to school for exercise science in a year and eventually become a coach. I'm trying to progress in my training/knowledge as much as I can ( greatly needed) before then. I just want to get my strength back and keep making progress. I'm taking today off, and I guess I'll spend it trying to find a good doctor around here, easier said than done.

And you're right, my body obviously wasnt ready for that from squat weight and I paid for it. I videotaped it so Im prlly gonna look a what I may have done wrong a dozen more times haha. Thanks again man