Back tweaks - QL and/or psoas?

[Soule]

Hey Doc,
2 part question here:

What methods do you use to determine if a back tweak is indicative of a QL strain vs a psoas strain?

What are the most effective methods in your opinion for stretching/releasing the psoas prior to or during warmup sets for squats or pulls?

Somebody I coach has a history of reoccurring back tweaks during squats and pulls, with his most recent tweak occurring during hip extension while approaching lockout (70% of the way up) in the squat. This was the fifth rep of his 2nd workset and he displayed no visible breakdown in technique.

Once every few months he will tweak what I believe to be either the QL or psoas. I arrived at this conclusion because of the pain reference points (around L1-L3, slightly right of vertebrae and deep in the tissue). Additionally, he will experience severe pain and tightness for about 2 days after the tweak and almost full recovery after 25x3 RDLs on day 3.

This individual spends most of his work/leisure time in a seated position and displays tight hip flexors. In theory, warmup sets of squats should be sufficient to release the psoas via reciprocal inhibition, but this individual typically experiences tweaks towards the ends of his work sets, with very little visible breakdown in technique.

I don’t want to overstep here in terms of asking for professional advice for free, so please feel free to let me know if I’m doing that. Thanks doc!

[Will Morris]

Hey Doc,
2 part question here:

What methods do you use to determine if a back tweak is indicative of a QL strain vs a psoas strain?

What are the most effective methods in your opinion for stretching/releasing the psoas prior to or during warmup sets for squats or pulls?

Somebody I coach has a history of reoccurring back tweaks during squats and pulls, with his most recent tweak occurring during hip extension while approaching lockout (70% of the way up) in the squat. This was the fifth rep of his 2nd workset and he displayed no visible breakdown in technique.

Once every few months he will tweak what I believe to be either the QL or psoas. I arrived at this conclusion because of the pain reference points (around L1-L3, slightly right of vertebrae and deep in the tissue). Additionally, he will experience severe pain and tightness for about 2 days after the tweak and almost full recovery after 25x3 RDLs on day 3.

This individual spends most of his work/leisure time in a seated position and displays tight hip flexors. In theory, warmup sets of squats should be sufficient to release the psoas via reciprocal inhibition, but this individual typically experiences tweaks towards the ends of his work sets, with very little visible breakdown in technique.

I don’t want to overstep here in terms of asking for professional advice for free, so please feel free to let me know if I’m doing that. Thanks doc!

In all honesty, I don't think I am intelligent enough, care enough, or am calibrated well enough to be able to really tell the difference. But, I don't think that it really matters because the intervention for back tweaks is relatively easy to perform so long as you take a very deliberate decision making strategy to address it.

Now, given the intervention (high rep RDLs) and the improvement over several days, what would be another hypothesis about the pain generator's origin?

[Soule]

Could be some damage to the cartilage of the facet joint. I’ve heard that a weak multifidus can be the culprit in reoccurring facet joint pain. He has displayed evidence of that, some days more than others.

Would you recommend the starr protocol in its entirety using RDLs for any of these cases (psoas, ql, facet joint)?