T Nation

Lower Back Injury After Squats

Hey guys,

I’ve been doing the SL 5x5 program. I started 3 months ago, this is week 12. I seriously love it. I’ve never been big into lifting, but after doing this program, I’m hooked.

Today, I was doing my squats. I’d done my warmups, and was on my second set of squats at 215 lbs. On the fourth rep, something happened to my lower back. After setting the bar down, I could barely stand up. The pain started in my lower back, but depending upon how I move, it moves down into the back of my legs. I have no idea what happened :S

I’m a reasonably fit guy. I’ve always been slim, and I eat a pretty typical paleo diet. I’ve done the program without a problem up until now.

Now I don’t know what to do.

I’m from Australia, but I’m living on the island in the Philippines. The local gym is, well, the sorta place you could expect to find in a third world country. There’s a local doctor, but there’s definitely not going to be anyone specialised on the island.

I know that seeing a special doctor would be the best option, but I don’t have that option right now. What can I do - massage? stretching?

Also, what’s the most likely cause - bad technique? I thought my technique was fine, but maybe not.

I just wanna fix this and get back into the training routine.

Please help :slight_smile:

[quote]johnnymac12 wrote:
I just wanna fix this and get back into the training routine.
Please help :)[/quote]

Best case is it’s a strain. Do the basics…
Pray to the Lumbar Gods and ice the area for 15-20 minutes every hour and take advil for the first two days. Begin simple stretches & light massage (if pain allows) on the third day. If there is no improvement in a week or ten days, it’s not ‘best case’.

First thing i notice is that you when on the second set to 215, that to me is too much, but young guys do.
Ideally you need to be evaluated is it just muscular or a herinated disc? Moving down into you legs suggest sciatic nerve was involved. But this is not a foregone conclusion. I suspect it will be sore for quite a while depending what it is.

If it were me I’d take some anti-inflammatories at around 1100 mg per day with food. I’d do this for 2 weeks. I would not lift or do anything that compresses the spine during this time. Stetching is fine pain allowing for this, as is walking if you can. Don’t do any flexion type exercises. As what was said ab ove hopefully its a sprain, if not you still would be wise to have it evaluated.

If its a disc hitting a nerve and you don’t have it taken care of you could have permanent nerve damage, so that you will end up with sciatic ( for the rest of your life). I hestitate to say the rest of your life since, who knows what medical science will come up with. The wise course if you still have leg pain go and get it evaluated.

Read up on triggerpoint massage with a lacrosse ball (hard rubber ball). Do you foam roll? PVC pipe and tennis balls can be used too.

Here are a couple links:

Some intro/background:

http://www.triggerpointtherapist.com/blog/trigger-point-therapy-101-series/comprehending-cause-trigger-points/

Maps of triggerpoints / pain patterns (I’ve used this as a quick reference to determine where I should start massaging)

http://www.triggerpoints.net/

This one has a drop down menu on the left of various pain locations and then better descriptions of the trigger points and pain. It also links back to the triggerpointtherapist site. Here’s the one for lower back pain.

http://www.painwhisperer.com/ptpath/ptpath/ptpath/lowbackpain.html

You can see that the primary culprits tend to be the Quadratus Lumborum, Gluteus Medius, IlioPsoas and Rectus Abdominis. I’ve found Wikipedia to be very helpful in teaching me where a lot of muscles are. The QL can play a major role since as it gets overused, other muscles step in to compensate and then they get overused. I’ve found this true in my case. As I clear up all other trigger points, it seems to come back to that muscle.

http://www.triggerpointtherapist.com/blog/quadratus-lumborum-trigger-points/ql-trigger-points-masters-low-back-pain/

Here’s another directory of muscles with links to video clips of foam rolling:
http://www.learntosquat.com/7/7.5.patternsoflegjointpain.html

Here’s my trigger point favorites directory. I have a whole subdirectory on the IP muscle:

Don’t forget the root of your problem may be poor form, using too much weight too soon, structural, lack of mobility or some combination thereof…

Did you feel a “pop” near your spine? you said “something happened.” Care to define that more?

Does it feel more comfortable when lying down on your back to have your knees elevated rather than legs flat?

Can you tie your shoes without pain or stiffness?

If it isn’t getting much better and you’re still having the pain running into your butt/legs then you may have a disc issue. Ice your lower back frequently. Do anterior-posterior leg swings and side-side leg swings with minimal range of motion first while grasping onto something with your hands (say standing inside of a power rack or something and grabbing the pillars of the rack, one in each hand). Do piriformis stretches, IT band stretches, hamtsring, and hip flexor stretches (do all of these from a sitting or preferably lying position… do NOT bend over from the waist for anything). Hang from a pull-up bar throughout the day if possible for multiple sets of ~10seconds. Walk a lot (if manageable). As it starts to get better do bird-dogs and reverse hypers. Examples of all of these you should be able to find on the internet.

Best wishes

DTC

I am not going to give you advice here, because I can legally get in trouble for that, but, here are some thing you may want to consider:

  • A Strain/Spasm of the Quadratus Lumborum typically makes it impossible to stand upright. It makes you feel “stuck” when you stoop over, like you just can’t seem to stand upright. Trigger points of the QL have also been know to cause pain in the buttocks/leg.

  • A disc rupture will likely be extremely painful IF it happened quickly. It would feel like lightning, burning, tingling pain, likely down the back of the thigh. It can possibly travel past the knee into the lower leg. Discs sometimes don’t even cause back pain, though.

  • An SI joint disruption can also send sclerotogenous pain that refers down the back of the leg. This never travels below the knee, however, since it is not nerve pain (as in the ruptured disc/sciatica). This is commonly associated with a QL problem.

  • Pretty well ANY back condition where you hurt yourself doing squats is going to mean that you should NOT be bending your low back or tucking your pelvis any time soon. Learn to hinge at the hips and pick things up like a golfer.

Since you can’t get to a doctor, you’re going to have to do some learning on your own now. Hope I at least gave you some stuff to research some more.

According to research conducted by a surgeon in the 1950’s named Dr George Hackett, the ligaments of both the Long and Short Posterior Sacroiliac ligaments at their attachments to the Ilium can refer pain down into the lateral undersides of the feet. The Sacrospinous and Sacrotuberous ligaments can refer pain into the back of the heel. He conducted this research by needling, and by injecting irritant solutions into his subjects and mapping out their corresponding pain patterns.

According to research conducted by Dr’s Thomas Ravin, Mark Cantieri, and George J. Pasquarello, injury to the capsular ligaments of the Facet joints can refer pain outwards into the surrounding structures such as the Quadratus Lumborum. Dr Hackett’s position on this was that pain reffered outwards into the Erector Spinae, and the Quadratus Lumborum was caused by injury to the Sacrospinalis tendons at their insertions to the Transverse Proccesses.

Dr Ross Hauser and Dr Mark Johnson are both of the position that “true sciatica” is rarer than most people believe it to be. Their view is that sciatica tends to be continuous, and is accompanied by constant sweating (a common syptom associated with nerve injury). Dr Hauser believes that disc herniations generally are accompanied by sprains to both the Supraspinous and Interspinous ligaments of the Spinous Proccesses. One of his reasons for stating this is that to create disc hernitions in an animal, researchers typically injur both the above ligaments and then let the animal walk around for a few days, upon re-examination a hernitation will appear.

Douglas Gillard of chirogeek.com has written about the differences between disc bulges, protrusions, and extrusions. As well as the possible neuropathic symptoms related to both Disc Degeneration and Internal Disc Disruption (the latter generally being something only chiropractors tend to diagnose).

[quote]vexeN wrote:
According to research conducted by a surgeon in the 1950’s named Dr George Hackett, the ligaments of both the Long and Short Posterior Sacroiliac ligaments at their attachments to the Ilium can refer pain down into the lateral undersides of the feet. The Sacrospinous and Sacrotuberous ligaments can refer pain into the back of the heel. He conducted this research by needling, and by injecting irritant solutions into his subjects and mapping out their corresponding pain patterns.[/quote]

OK. I had never heard this before, since I was under the impression that SI pain rarely travels below the knee. Perhaps accepted research has changed since the 1950s, but perhaps not. Or, perhaps when I said “never”, I should have said “typically” (as that’s what I have since read in one of my Differential Diagnosis texts).

I also fell in love with SL 5x5 but I went up too fast on the squats (strong legs from futbol/ mt. biking) and a combination of poor form and a sore legs from futbol match lead to bone marrow edema/ degenerative meniscus tear.

In a similar situation as I work in China and the sports docs here are all skinny chain-smokers who tell me to stop all sports for 3 months and take some herbal pain spray and glucosamine supplements.

I had some bad back pain from Deadlifts but it was because I did an extra 3 reps after my intial 5 and just too much strain. I’d say your pain sounds like a strain/muscle thing that just may take some massage/ice/advil but thats being hopeful

With no medical specialist, and particularly no diagnostic imaging available, the local doc will not be able to make an accurate diagnosis - the part of your back that you injured is laced with myriad muscles, connective tissue, intervertebral discs, etc., any number or injuries to any of which could produce the symptoms you described.

The first poster has it right - best case is a severe muscle strain. The fact you could barely stand up in the rack suggests its a relatively bad one. Worse is a disc rupture. Worse still is disc rupture and muscle or ligament damage.

The main thing is to rest it as much as possible, see what the body’s normal healing process does over 10 days. The dumbest body is smarter than the smartest internet therapist. But since you asked . . . Forget ice - that’s dumb. It reduces circulation and swelling - the very things your body is trying to do to immobilize and pump repairing fluids and cells to the injury site. If anything, heat it with hot water bottles etc. And forget the lacrosse balls, massage, stretching, etc. - for the same reason you’d be stupid to rub a raw blister - you don’t need any more mechanical force reefing on already torn tissue - that’s what got you into this mess. Don’t make it worse. If in doubt, assume that it will make it worse. If you are going to do that stuff, save it for when the tissue you are working on no longer has a nasty bleeding gash running through it and your entire CNS is all but screaming at you to leave it the hell alone.

If its much better in 10 days, great, it was a muscle strain. Wait until it is completely pain free - CNS no longer screaming at you – then and only then, return to training gently over a couple of weeks. If its not much better in 10 days, its more than a muscle strain - you’ve queered a ligament or disc or both. And if that’s the case, you have to get off that island, and back to a competent orthopedic spine specialist in Oz. Anybody who tells you they can tell what the injury is by looking or feeling it with their fingers or having you bend your legs etc. is blowing smoke up your ass - educated guesses at best. You’ll have to have appropriate diagnostic imaging (MRI, discography, etc.) for anyone to actually see what is injured, where, and how. You’ll be looking at months to a full year or so before you are back to your former self. Back injuries, when serious, are just awful things. But they do get well over time. Been there, done that, don’t want to do it again.

Just don’t stop lifting or let this make you afraid to do squats, deadlifts, etc. Your injury almost surely happened because of too much loading, too soon. You can fix that when you are back in action with better programming. The best thing in the world for your back is to get it strong as hell and keep it that way - especially so now that you have had an injury.

Hang in there, this too shall pass.