T Nation

Lower Back Sprain - Keep Lifting?

I have what i think is a sprain/strain of the lower back. It happened when squatting, i was too close to the rack and came up under the low level pins so basically got half way up and then hips rose and i was good-morninging the weight against the rack and it wasnt moving. Kept irritating it by trying to squat heavy again and doing bent rows, RDL etc.

It’s been a few weeks now and it did start to get better but has since got worse again. The pain is in the left side of the lower back, no radiating pain or anything and i could still do heavy bent rows etc so no real loss of strength, but it would hurt afterwards. Touching toes or extending dont cause pain, certain twisting motions seem to aggravate it a bit.

Should i go back to doing bent rows, heavy benching, RDL etc? Or should i continue trying to avoid anything that puts a load on the back, which makes for a pretty shit routine!

you could have strained the piriformis. Try stretching/ rolling this area.

That could be a good shout. The pain tends to be higher than that, but i have noticed it can originate from the piriformis area sometimes, especially when im on the treadmill.

An overactive piriformis can negatively alter the way the SI joint functions. This, in turn, can result in lower back pain.

So, if you go on the premise of an overactive piriformis, smr/stretching may be justified.

If you have strained the piriformis, I would be careful to smr/stretch the area. A strain, by definition, is a tear in the muscle. To further aggravate the area with smr/stretching, in the initial repair stage, is not a good idea.

However, we don’t know if it is the piriformis. Based on what you describe as the possible cause of the lower back pain, I find it difficult to imagine how the piriformis can be the culprit. Of course, AFTER the injury (to exactly which area we’re not sure of), you may have gone through compensatory movement patterns which, in turn, altered pelvic alignment which, in turn, may have resulted in an overactive piriformis.

The injury, again based on how you describe the occurrence, could also be at the quadratus lumborum, multifidus, erector spinae.

In short, rolling and stretching the piriformis may not be the best use of your time and energy right now for two reasons:

  1. This may not be where you initially injured yourself.

  2. If the piriformis has been strained, smr/stretching in the early stages of repair may not be prudent. It’s just too aggressive.

One more thing. You’re not going to enjoy reading this but you need to brace yourself for a worst-case scenario. So make sure you get tested for a possible injury at the discs.

[quote]56x11 wrote:

The injury, again based on how you describe the occurrence, could also be at the quadratus lumborum, multifidus, erector spinae.

[/quote]

I have googled those and if i had to pick one i would say the quadratus lumborum seems to be where the pain is. It was feeling a lot better a couple of weeks back until i went to my doctor for a different reason and she squeezed that area it seemed to make it worse than ever since then. I’ve found that as im laying down, with my back sort of propped up at an angle, if i try to arch my back further there is muscular pain in the quadratus area.

[quote]stinger70 wrote:

[quote]56x11 wrote:

The injury, again based on how you describe the occurrence, could also be at the quadratus lumborum, multifidus, erector spinae.

[/quote]

I have googled those and if i had to pick one i would say the quadratus lumborum seems to be where the pain is. It was feeling a lot better a couple of weeks back until i went to my doctor for a different reason and she squeezed that area it seemed to make it worse than ever since then. I’ve found that as im laying down, with my back sort of propped up at an angle, if i try to arch my back further there is muscular pain in the quadratus area.[/quote]

This makes sense based on your description of how the injury took place. I suggest you get it examined again to confirm. Physical therapy may be worthwhile IF the PT is above average.

The QL is also a postural muscle so you’re engaging them while performing the most mundane of tasks. Furthermore, depending on the severity of the strain, it could take as long as 16 weeks for complete recovery. Keep those things in mind when you go to the gym.

Those neoprene wraps people place around the waist for spot reduction does a good job of keeping the area warm (just don’t expect it to do much for actually burning adipose tissue). And a lifting belt should be utilized more generously. As you heal, you can wean yourself off the belt and use it for the more aggressive lifts.

For now, certain movements are contraindicated even with the use of the wrap/belt.

Whether or not you take this last bit of advice is up to you. This may sound cynical on my part; unfortunately, I’ve long given up trying to convince someone out of a dangerous path when he or she foolishly believes they are bullet proof.

Very much appreciate your advice, i dont know your background but you seem knowledgeable. Originally i was still doing heavy bent rows but with a belt, seemed to keep aggravating the injury though. Im pretty sure i could still deadlift close to maximal weights, obviously i wont be doing that, but it seems strange that i have a fair bit of pain with no loss of strength.

I’m not sure how much of what im doing in the gym is prolonging this injury, im going generally lighter and higher reps on everything as even benching or any standing movements put stress on the area. Totally avoiding anything bent over, and doing most things seated where possible. I was thinking of using a neoprene wrap so i will give that a try to take some stress of it.

If it is a QL injury then side bending would hurt as shown in the video http://www.youtube.com/watch?v=FFXYWBXf5UU however if that does not hurt then try the other movements.

no that doesnt hurt at all, so i guess its something different then.

The side-bend test that’s been mentioned (and the one you performed) is a common one for QL injuries.

However, simply passing one provocative test and making a determination from that is NEVER wise. And the fact that you performed the test on yourself reduces objectivity.

You said yourself that when you saw the doc for another issue, she “squeezed the area and it seemed to make the area worse.” This area, based on your research, appears to be where the QL is located.

Well, guess what? Another method of testing for muscle strain is direct touch - which is what the doc did, albeit inadvertently. People pass one test and fail another all the god damn time. This is quite common with low back injuries.

We are working with a few possibilities here:

  1. If it is the QL, you may have healed just enough to pass that test but more aggressive stimuli (such as certain movements in the weight room) will cause discomfort. Since the injury, your body may have learned enough ways to compensate so that the test did not cause discomfort. This is quite common.

  2. It indeed may not be the QL at all. I’ll say it again: in an earlier post I also stated that it could be the QL, multifidus, erector spinae, or even at the discs. I also advised you to get another examination so you can confirm.

You’re intelligent enough and humble enough to ask for advice. The members on the forum gave our theories based on our backgrounds. For example, I’m a Strength and Conditioning Coach who specializes in bridging the gap from rehab to the playing field.

The advice that I gave you was the equivalent of pointing the compass in the right direction. This really is the best that any ethical individual can do in an internet forum. If you have any desire to reach the exact destination, you will need to take this to the logical next step. This next step, which I’ve advised you of before, is a direct examination by a qualified clinician.

Describe to her the nature of the pain, the location, how long you’ve experienced it, and when and how it started. With this information, allow her to do her job. Once you’ve done that, feel free to get another opinion if you don’t feel quite right about the visit. Until you take this step, you’re just chasing your tail.

After the exam, feel free to give us a report. However, this next step IMO is an important one.

Just an update, i declined to see anyone about my back, have taken 2 weeks off all back and leg training. It is feeling better, still a faint pain triggered by certain things. I have found an extremely sore spot which is possibly my piriformis area. It is right at the bottom of my back, on the pelvis, the bony part at the top. On the side where the injury is, it hurts like hell to foam roll this area. So perhaps the piriformis is to blame after all.

Actually, scrap that, its definitley the sacroilliac joint. Thats the exact area that is painful to touch, and all the symptoms stack up.