Back Tweaks

[Daltonar]

I'll try to keep this as brief as I can.

I have a friend (male, 35) who decided he wanted to get into some lifting. I started him through LP and things were going fine, everything progressing as expected without issue.
His deadlift got to around 250 and I switched him to DL every other session, alternating with chins. His second-to-last session he deadlifted 275 for 5. The set was slow, grindy, and clearly difficult, but form wasn't bad and after he caught his breath he was thrilled. No complaints of pain after the set or the following day when I saw him.

Fast-forward two days to his next (last) session, he shows up complaining his back 'feels tight'. I had him try to warm up and he couldn't even get to depth for his squats. His low-back just rounded when he tried to bend over no matter how hard he tried to 'set' it (not an issue he'd had up to this point). Instead of risking anything I had him move to a high-bar with less weight and go through 3 sets of 5, so at least he had some movement. No issues during this workout. This session was at the end of February 2023.

The next workday he said he went to step over something at a worksite, lifted his leg and felt a twinge/pang in his low back that he says put him down. Ever since he has had issues turning, stretching, bending over, etc. For better or worse he went to the doc and hasn't come out to lift since. They told him what we all know, he is a 30+ year old man who has worked a physical job, is somewhat overweight, and has some disc degeneration starting. They told him he had a slipped disc and sent him to PT, no luck. They are now suggesting surgery, which he absolutely doesn't want to do and from what I've heard has about a 50/50 shot of doing nothing/making the problem worse.

He's finally agreed to come back out for some level of assessment and to at least try and lift again.

Onto my question:

I have had a back-tweak before. I was pulling a heavy deadlift and lost the third rep. My back popped halfway up, it went down and I hit my knees. I could barely stand up from the bar and for the next several days it hurt like hell to do anything at all. I don't KNOW what I did (I don't go to the doc if I'm not dying), but it was debilitating for a few days. Eventually the pain subsided enough I COULD squat and such with partial ROM, so I began rehabbing by doing what I could, marking PRECISELY what that was, and making sure to progress it a little next time. I was able to start setting new PRs in 6-9 months after that tweak (I'd have to revisit my old logs for details). Regardless, I got better.

It seems to me that this approach is the most reasonable to trying to rehab this sort of back injury. Light weights, whatever ROM can be had with a steady eye towards progressing it and THEN adding weight slowly once proper ROM has be reacquired. However, I only have a sample size of 1 (myself).

Could any of you more-experienced coaches provide any input or recommendations for dealing with this sort of thing? I see no flaw in my logic, so tell me if there is one. If there isn't, same goes.

Thanks for your time.

[Matt James]

If you start with the understanding that back tweaks almost always represent a neuromuscular protective mechanism, often unconnected to a specific structural injury, it will inform how you rehab them. Basically, you have to recondition your body to trust that the painful ranges of motion and movements are actually safe. This includes things like getting out of bed, walking, and training. Lift as heavy as pain allows, wear the belt from the first warmup set on and focus on getting really tight for the liftoff and walkout on squats. You might surprise yourself. The last tweak I had, and by far the most uncomfortable I have experienced, happened while deadlifting a couple years ago. I actually ended up doing my scheduled squat work sets two days later and was basically back to 100% within a week. You just have to force yourself to keep moving through the inhibited range of motion, focusing on stability. It's not a muscle belly tear, so don't treat it like one.

[heinz83]

What's the popping noise then?

[Matt James]

What's the popping noise then?

I don't know. Cavitation would be my guess.

[Mark Rippetoe]

No, probably not. Probably a soft-tissue click. If it's even a noise. He may be feeling it and interpreting the sensation as having a noise associated with it.

[Daltonar]

You just have to force yourself to keep moving through the inhibited range of motion, focusing on stability.

Seems similar to what I did for my tweak. Appreciate the input.

[mbdonner]

A few years ago I had a quad muscle belly tear while squatting. I literally looked down at my thigh, thinking that my pants had ripped. Then I felt the pain. Did I hear it? I don’t know. It sure sounded like fabric tearing.