Introduction / To the top
If you are reading this because someone linked you here. It will help you figure out what type of injury you have and then how we can go about choosing what options we need to solve the problem.
Lower back pain and injuries are common among weightlifters and even non-weightlifters. As I have discussed in Shoes, Sitting, and Lower Body Dysfunctions a lot of this stems from shoes and sitting and how they may have chronic detrimental effects on our bodies. Combine this with poor technique, especially in lifting objects off the ground or during working out, and you have a recipe for injury, pain, and inflammation.
This short article is not going to be an end all article on how to solve lower back pain and injury. Rather, there are categories of lower back injuries that all need different attention depending on what has been injured. From there we can determine what the best course of action that needs to be taken for each individual because everyone is a bit different.
Disclaimer: Any information contained herein is not professional medical or physical therapy advice. Always consult your doctor or physical therapist before using such information.
Categories of Lower Back injuries / To the top
Flexion based injuries from lower back rounding tend to fall in 3 different categories.
1. Bulging or herniated discs
2. Sacroiliac joint (SI joint) slip or rotation
3. Strained/pulled muscles
These are the three we will learn how to identify which one you may have, and then how to obtain professional treatment if required or rehabilitate it yourself.
Other types of injuries are not very common and if obtained from lifting in particular may represent some inherent structural deficiency or faulty connective tissue usually due to genetics or improper nutrition.
If you suspect you have an injury that does not fall into any of the three categories above see a medical professional immediately. Also, if you have an injury which presents debilitating pain or presents possible insidious neurological symptoms such as sensory or motor deficits see a medical professional immediately. Motor deficits are critical enough that you may want to go to the ER ASAP.
Bulging, Herniation, and Spinal issues / To the top
Bulging and herniated discs will manifest pain on or in the spine itself. If you can sense the pain in the direct center of the back, it will be one of these problems.
Additionally, if the bulging or herniation is low enough on the spine it may also impinging on some of the nerve roots coming out to the sides. This tends to manifest itself as radiating pain out of the side or lower extremities. These are called radiculopathies (from the “nerve roots” and and the “radiating pain” caused by the impingement/pinching of these nerve roots).
The most common case with radiating pain is sciatica. In this case, a bulging or herniated disc in the low lumbar region (aka “around or just above the butt crack”) will impinge on the nerve roots for the sensory and motor nerves of the legs. Sciatica in particular is usually manifested as radiating pain into the buttock region and may continue down farther into the leg even as far as the foot.
For cases like this is it best to go to an orthopedic doctor to be assessed as to the extent of the damage. This may require an MRI as that will show what is going on in there. From there proper treatment can be determined.
Do not aggravate this condition with significant activity otherwise it may lead to permanent injuries.
In the meantime, in almost all cases there will be inflammation accompanying the pain. Decreasing inflammation and proper mobility work to decrease the amount of inflammation and pain will help ease the symptoms.
If you are eating large amounts of carbohydrates it may be a good idea to eat more protein and fat as carbohydrates are pro-inflammatory. Also, supplementing fish oil is a good idea as well.
For exercise, everyone is individually different with lower back pain. Thus, some exercise may worsen the pain or not help; however, some may help and work effectively. Play around with them and find out which ones work best. Here is a small selection to get you started:
If an exercise hurts, drop it immediately. Do not come back to it for at least 2-3 days. After that try again as it may help more at the different stage of recovery than initially. The same is true with helpful exercises – if they suddenly become bad then drop them for a couple days and come back to them later to see if they help.
The primary thing you will have to focus on the road to recovery is regaining mobility and strength in the ankles and hips, and improving core strength and stability in the arches, knees and especially lower back in this case. This is the conclusion we came to from the shoes and sitting article which rings true even here.
This article will hopefully help you find a quality health professional.
Sacroiliac joint issues / To the top
During improper lifting or bending one side of the muscles may fail a bit earlier than the other. This is common as we all have a dominant side. In this instance if the muscles do not strain or the weight is not immediately deloaded, the SI joint may slip or become rotated causing pain.
SI joint problems tend to manifest pain right above the butt crack but an inch or two to the right or left depending on which one has slipped or rotated. It is a very similar pain to the lower L4-L5 and L5-S1 disc issues like discussed above, and a slipped SI joint can manifest in sciatica and radiculopathies as well.
If you run your hands down your sides starting at the ribs, the first bony protrusion you will encounter is the iliac crest. This is at the level of the L4-L5 disc. If you follow the pelvis as it moves posteriorly and slopes down you will encounter your SI joint where the pelvis meets the sacral vertebrae. The SI joint is about 3-4” inches long so the pain may be anywhere along it. If the pain is located there you may have an SI joint issue.
A slipped SI joint will also manifest in one leg being functionally shorter than the other. If when you locate your iliac crest if one side is higher than the other this will indicate an SI joint slip.
Thus, if your pain is (1) 1-2 inches off center from the spine, (2) is an 1-2 inches lower than the iliac crest level, and (3) feels in the bony region of the pelvis it may be likely have you have an SI joint issue. Same with the functional leg length.
See a chiropractor or physical therapist. Competent health professionals in these two areas should be able to fix your dysfunction by popping you back into place or resetting the pelvis.
It is important that you limit inflammation again with fish oil and rest. Do not aggravate this condition.
Since the SI joint may be rotated and slipped, some muscles will be shorter or longer than usual. When this occurs with injuries, the tendency of the body is to lock down the muscles to prevent further injury. This is not good especially if you can get to a chiro or PT quickly. So what we want to do is keep the muscles loose with massage and possibly some heat (but not heat on the SI joint – just the lower back).
You may be able to check yourself with the long sit test – legs will be uneven lying on the back e.g. pelvis oriented upwards, but when you sit up they will be even because the slip doesn’t manifest when the pelvis is oriented forwards. If you find this is the case, definitely see a professional immediately. Also, even if this doesn’t work but you still suspect something I would see a professional anyway.
It is possible to reset the pelvis by yourself and/or another person, but if you are not confident do not try these yourself and get yourself to a quality health professional.
Another type of manipulation. Photo from www.prolotherapyhealing.com
Strains / To the top
Strained and pulled muscles will be located to either side of the spine in the muscle belly of the tissues. Strains will usually occur during lifting and in the spinal erectors – iliocostalis, longissimus, and spinalis – although they can occur in muscles such as the quadratus lumborum or others.
If your lower back pain is below the ribs and above the SI joint in the muscles, then it is likely you have a muscle strain.
In the case of muscles strains or pulls unless it is extremely bad where your tissues are turning black and blue and you absolutely need pain killers, you probably do not need to a see a doctor. This is because you will most likely just get a prescription for pain killers and be told to rest.
However, if you are that worried about your injury then do not hesitate to see a doctor. Better safe than sorry.
I have already written extensively on muscle strains which will help you get started on the road to recovery.
This picture is a “general” schematic of how to assess if it is spinal, SI joint, or muscular if you are having trouble with the descriptions.
Red — this area is all muscle and connective tissue and thus the things that tend to give first during exercises is muscles. Thus, this region indicates for the most part strains.
Yellow — obviously this is on the spine which indicates if there’s pain in or extremely close to the spine that either there’s a problem with the discs or the nerve roots coming out.
Green — The SI joints are located here, about an inch or two below the iliac crest (which is at L4-L5) a couple inches on either side of the spine. This or spinal problems can and may refer shooting pain down the leg.
The goal of this article was to provide information to help individuals assess what they need to do in case of certain lower back injuries. Getting proper treatment quickly will help shorten recovery time, and get you back to daily life or your workouts much faster. I hope it helps you in that regard. Good luck.
If there is enough interest perhaps I will write on this topic further.
Disclaimer: Any information contained herein is not professional medical or physical therapy advice. Always consult your doctor or physical therapist before using such information. For more details see our full site terms and conditions.