Structural back issues

[mcmountain]

Hello Mark. I was wondering if you've ever coached anybody with structural issues in their low back like lumbar transitional vertabrae that have caused back pain issues. If so are there any excercises like the power clean that these people should avoid?
I am a 32 year old male with a lumbarized sacral vertabrae ( what is supposed to be my s1 and s2 vertabrae were separated with a disk in between and no joint). As you can imagine, with no joint supporting it I experienced early disk degeneration at that level in my mid twenties and "blew my back out" a few times resulting me spending the better part of three years in pain ranging from "so bad I couldn't move" to "noticeable all the time but but still able to carry my ass to work". Now, my xray shows no disk at all and bone on bone at that level. Through a lot of pt and patience I was able to start being active again and actually completed a marathon last year, although it still hurts mostly when I'm not moving or if I'm doing high impact things like jumping.
I was 5'10" 178lbs and recently started doing the linear progression instead of running 3 weeks ago. Lifts have progressed substantially, I'm 188lbs, and I FEEL BETTER THAN I HAVE SINCE HIGH SCHOOL (THANK YOU):

Squat: 175 to 240 for reps of 5
Deadlift: 185 to 265x5
Press: 90 to 110
Bench:135 to 155


I know the program starts adding power clean soon, but trying it out at stupid low weight like 95lbs has caused shots pain in the low back/sacrum area. Other lifts that arent as "jerky" feel fine and i truly have experienced that getting stronger helps the pain. I would rather do the cleans than not, but im wondering if you guys have run into these issues before and what you tell people. Is it worth it to be doing the cleans at a weight I can curl and seeing if i can up the weight eventually or would you keep deadlifting only for longer if you were me?

I've learned through all my reading that up to 10 percent of people have some kind of "anomoly" in how there low back is structured so it may be of interest to a lot of people.


Thanks for reading.

[Mark Rippetoe]

I have never personally trained a client with a structural deformity like this, that I remember. No, cleans are not an option for you. Have they recommended a fusion?

[Will Morris]

I have never personally trained a client with a structural deformity like this, that I remember. No, cleans are not an option for you. Have they recommended a fusion?

You've trained hundreds of clients with the same structural deformity and probably hundreds with lumbarization of the sacrum. Either way, it saw you hundreds of times and you didn't see it. The correlation between transitional vertebrae and back pain is very loose, and it, in my reading and clinical experience, is that it is virtually no different than normal back pain. There is extremely poor inter-rater reliability in assessing stiffness or hypermobility of spinal segments, but, it is maybe more common in people with sacralization to report feeling stiff, and people with lumbarization to be hypermobile.

The best advice I would suggest to someone with lumbarization is to treat it like you have a hypermobile back, and therefore, strengthening and being cognizant of staying out of extreme extension would probably serve them well.