Few things can derail a lifter’s progress and send motivation spiraling into the gutter like lower back pain. The nature of powerlifting places high amounts of stress on the spine. Even when technique is on point and weight selection is appropriate, it’s common for lifters to experience lower back fatigue, tightness and even pain.
Because we’re all destined to deal with back pain during our training careers, whether as lifters, coaches or both, it’s helpful to familiarize yourself with why back pain occurs and how to work around it. This can lead to fewer disruptions in training and help you maintain progress as you get back to 100 percent.
It’s important to remember that is it not the job of a coach or lifter to diagnose and/or fix pain. That’s the job of a medical doctor, physical therapist, athletic trainer or other sports medicine professional. However, it is helpful to be familiar with the causes of back pain, the mechanisms that make it worse, and how to adjust your programming and coaching approach so that you (or your clients) can continue to train productively.
Also, pain is incredibly complex. Someone’s perception of pain and ability to deal with it comes from a combination of physiological, psychosocial and environmental factors that are so far above my pay grade that it would be slanderous to say that I understand pain at an expert level. Please do no interpret the information in this article as all-encompassing when it comes to understanding and treating pain. It’s simply a systematic way to help powerlifting coaches enable their lifters to keep training hard while minimizing the negative effects of an injury.
I’ve been fortunate throughout my training career to work alongside some brilliant physical therapists who taught me how to work around a host of injuries. I’ve observed hundreds of assessments and helped train athletes and lifters through the rehab process. This has led me to believe that anyone who’s serious about powerlifting or coaching powerlifters should familiarize themselves with the knowledge necessary to work around injuries so they can continue to make progress – or at least not make things worse.
The information and assessments in this article are primarily taken from the Selective Functional Movement Assessment (SFMA), which you can learn more about here. I am not certified in the SFMA nor have I been to any courses. However, the majority of therapists I’ve worked with over the years use the SFMA in some fashion and I’ve observed and administered countless tests to help guide my own programming and coaching decisions.
I use these assessments to help my lifters do 4 things:
- Figure out what type of movements cause pain
- Avoid those movements and replace them with pain-free ones
- Keep training hard
- Figure out if we need to see a specialist if their back doesn’t get better
I’ll explain the assessments I use, what they tell us and how I use the findings to guide our training decisions.
Multi-Segmental Flexion (Toe Touch)
The toe touch pattern is a quick test to see if a lifter can tolerate spinal flexion. We’d obviously never load up a deadlift in a position like this, but it’s a quick-and-dirty way to see if it’s worth keeping deadlifts in their program.
Flexion-based back pain is often related to the vertebrae or spinal discs more so than muscles. It’s often trickier to deal with than extension-based back pain because it’s not as simple as coaching better core bracing or using self-myofascial release to get muscles to relax. For those reasons, if someone can’t perform the toe touch without back pain, it’s a solid indication that deadlifting could be problematic.
The conservative approach would be to remove deadlifts and switch to an exercise that decreases the chance of the lifter going into spinal flexion under load.
Some coaches or therapists will claim that you shouldn’t have someone deadlift unless they can touch their toes. I disagree with this for a few reasons.
First, as mentioned, you’d never have someone deadlift heavy like this. Very few movements are inherently dangerous, but saying that heavily-loaded spinal flexion is a bad idea is about as close as you can get to a sure thing. You don’t have to access nearly this much range of motion to do effective deadlift variations, specially RDLs and high-handle trap bar deadlifts. Both these variations can be modified for most peoples’ movement capabilities and loaded without issue.
How to Do It:
With the legs as straight as possible, have the person reach down and try to touch their toes. Don’t allow the knees to bend or feet to lose contact with the floor.
If it hurts, consider avoiding:
- Deadlifts
- Kettlebell Swings
- Bent-Over Rows
- Other exercises in a hip hinge position
Instead, consider substituting:
- Squats (assuming the back bend test is pain-free)
- Glute ham raises
- Leg curls
- Hip thrust variations
- Seated or chest-supported rowing variations
Multi-Segmental Extension (Back Bend)
The back bend is the reverse of the toe touch pattern and tests a lifter’s tolerance for spinal extension. Whereas flexion-based pain is often osseous (i.e., related to bones and joints), extension-based pain is more often muscular in nature and can often be mitigated by coaching lifters to breathe, brace and ultimately use a less extension-based strategy when they squat, deadlift and do other axially-loaded exercises.
In my experience, the squat is often the lift that’s most troublesome if a lifter experiences tightness or pain with the back bend. Lifters tend to default to an extension-based strategy (i.e., chest up, back arched) when squats get heavy, so coaching the lifter into a more flexion-based approach (i.e., ribs down, core braced) is often warranted. Sometimes, back squats will need to be subbed out for more anteriorly-loaded variations like front squats, Zercher squats, goblet squats, etc.
How to Do It:
With the legs as straight as possible, the arms overhead, the head tilted back and eyes looking up, have the person bend backward and push the hips forward as much as possible. Don’t allow the knees to bend or feet to lose contact with the floor.
If someone experiences pain with this test but not the toe touch, I believe that most exercises can still be on the training menu. This is the one instance where strength coaches can try to “fix” what’s causing the back pain, because in most instances it’s an over-reliance on an extension-based strategy: using the spinal erectors (lower back muscles) to drive a chest-up, ass-out pattern when squatting, deadlifting, etc. By coaching the lifter to use a better bracing strategy AND using focused breathing to get the lower back muscles to relax, we can often get the lifter feeling normal again.
I think it’s best to take the following approach, in this order:
- Coach the lifter to breathe and brace their core (instead of arch their lower back) when performing axially-loaded exercises like squats or deadlifts.
- If that doesn’t feel better, try…
- Switch to anteriorly-loaded variations like front squats, goblet squats, Zercher squats, etc., which make it easier to engage the abdominals and less likely to use an extension-based strategy.
- If that doesn’t feel better, try…
- One or more flexion-based breathing drills to engage the abdominals, relax the lower back muscles and build context for how to brace during the big lifts:
- Then retest the back bend to see if it feels better.
Between these three steps, most lifters are going to experience less lower back tightness and be able to lift without issue. If these three steps DON’T make things better, it’s time to refer out to a doctor, PT, etc.
Multi-Segmental Rotation
This test observes a combination of rotation at all segments of the spine (cervical, thoracic and lumbar) as well as hip internal and external rotation. Luckily, we don’t have to rotate much at all (besides some hip rotation during the squat) when we powerlift, so this test mostly tells us if we should avoid certain unilateral (one-sided) exercises that may take the lifter into some rotation that could trigger pain.
How to Do It:
With the legs straight and arms by the sides, have the person rotate the head, shoulders and torso as far possible to one side without letting the feet pivot or leave the ground. Repeat on the opposite side.
If it hurts, consider avoiding:
- 1-arm rowing variations (DBs, cables, etc.)
- 1-arm pressing variations (DBs, landmine, etc.)
- Anti-rotation core exercises (Pallof presses, cable chops/lifts, etc.)
- Rotational core exercises (Russian twists, cable woodchops, etc.)
- Swinging/throwing movements (med ball throws, sledgehammer slams, etc.)
Instead, consider substituting:
- 2-arm rowing variations, especially supported ones (chest-supported rows, seal rows, lat pulldowns, etc.)
- 2-arm pressing variations
- Anti-extension core exercises (planks, body saws, rollouts, etc.)
- Sagittal plane power movements (jumps, med ball slams, kettlebell swings, etc.)
Lateral Flexion (Side Bend)
Side bending should ideally never happen when powerlifting either. But much like multi-segmental rotation, there are exercises we may perform in training that could flare up a lifter’s pain if lateral flexion is problematic. This test can also help you determine if a lifter’s pain is coming specifically from one side of the body, such as the quadratus lumborum (QL) or spinal erectors on one side.
How to Do It:
With the legs straight and arms by the sides, have the person slide one hand as far down the side of their body while tilting the head, shoulder and torso toward that side. Repeat on the opposite side.
If it hurts, consider avoiding:
- Loaded carries, especially 1-arm variations (farmers walks, KB front rack carries, etc.)
- Suitcase deadlifts
- Turkish get-ups
- Off-set loaded lower body variations (lunges, 1-leg RDLs, etc.)
Instead, consider substituting:
- Anti-extension core exercises (planks, body saws, rollouts, etc.)
- Bilaterally-loaded lower body variations
- If one-sided lower back pain presents with bilateral exercises like squats and deadlifts, consider reducing the load or switching to more anteriorly-loaded variations like front squats, Zercher squats, etc.
What If Everything Still Hurts?
Sometimes you just can’t figure out what the hell is going on and everything still feels bad. That’s OK. Remember, powerlifters and strength coaches aren’t doctors. It’s not our job to fix everything. But it IS our job to figure out how we can still train productively so that when we’re recovered, we can pick up where we left off.
In the meantime, you can still:
- Train upper body normally
- Use machine-based lower body exercises like leg curls, leg extensions, leg press, etc.
- Push/drag a sled
- Perform low-intensity aerobic work (e.g., walking, biking, etc.) to speed up recovery
The key is finding a way to keep training no matter what. There are few, if any, injuries that require shutting it down completely. Get creative, keep a positive attitude and use the information at your fingertips to make the best possible training decision for your situation
