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    Training around a back injury

    Edit:
    This thread has been summarized here:. Read the individual posts to see the discussion.

    _______________________________

    So I've tried numerous times to start a thread dedicated to training with a low back injury. Specifically I have a herniated disc in the L4 L5 region with sciatic symptoms on the left side.

    For a good while I had tried to continue incorporating squats and deadlifts into my p/rr/s, and other routines.

    It's just not working out. So I thought I might find some help in designing my leg abs and back day workouts

    I am able to do DB squats, and in truth I like them more than BB as they seem more compound (recruiting the traps, delt, forearms, etc). I also seem to do well by split squat (lunges) with DBs. My primary concern for DB squats is the form. I end up with my arms wide out at my sides, which involves a good deal of upper body tension, and then moving through the squat motion.

    I'm somewhat at a loss for what to do for my lower posterior chain, primarily QL, Deads are out, and to a certain extent hypertensions aren't that fantastic for me either.

    For Back I feel very comfortable with the following:

    Seated rows
    Lat Pull downs
    Reverse grip pull downs
    all variations of chin and pull ups

    I feel less comfortable with:

    DB Rows
    BBRows



    For legs I feel very comfortable with:

    DB Squats (aside from the issue of what form to use)
    DB Split squats
    Leg curls
    All kinds of calf raises

    For Abs:

    I am most comfortable doing cable knee tucks
    also standing oblique crunches with DB

    Generally anything that really loads up the spinal column or requires weighted flexion I would prefer to avoid if possible.

    Any additional advice on what exercises might be a good addition would be much appreciated.
    Last edited by Built; 05-02-2009 at 07:12 PM.

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    Single leg DB lunges will work the posterior nicely. Keep your back upright and flat and you should be fine.

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    Is there a double leg DB lunge? Is there a difference between db split squat and db lunge?

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    double leg would be a squat

    Lunge requires you coming back to feet beside each other.

    Split squat your feet stay in the seperated position





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    Since I am not there and don't know your specific case, I'll be general and tell you the recommendations I give my clients with disc pathologies:

    1) Take out flexion based exercise - crunches, bilateral deadlifts, bent over rows, exercises performed in a seated position (seated rows, seated pulldowns, etc).

    2) Work on stability - planks, side planks, 1-leg glute bridge (hug the other knee towards the chest), half kneeling chops and lifts, dead bugs, bird dogs, etc..

    3) For upper body pull movements get off the seated exercises. Instead, do things like standing 1-arm cable rows, half kneeling 1-arm cable rows, half kneeling 1-arm pulldowns, inverted rows

    4) Train the legs with unilateral movements - split squats, step back lunges, step ups, 1-leg/1-arm RDL, lateral lunge - make sure to perform the exercises properly to develop effective movement patterns/strategies that are spine sparing and allow for proper hip movement.

    5) Work on hip mobility. Spare the spine by developing proper hip mobility (this is something I just talked about in my blog). Typically people compensate for crappy hip mobility (and crappy ankle mobility) by increasing lumbar mobility. We want lumbar stability!

    6) Don't do things that hurt.

    7) When performing stability exercises like planks, don't get all caught up in trying to hold a 60sec side plank. If you don't develop proper endurance in those muscles first, then you will compensate in order to try and hold the plank for that length of time and the form will go to hell. Instead, use short holds and do reps. So, side planks for 5 could holds for 5 reps and slowly work up from there. Build endurance.

    8) Use the foam roller on your hips to help clean up poor tissue quality and enhance movement.

    hope that helps.

    patrick





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    Would this be a good start for hip and ankle mobility? I do a number of these things already.
    7 Dynamic Stretches to Improve Your Hip Mobility | StrongLifts.com
    How to Improve Your Ankle Mobility | StrongLifts.com

    Seated movements don't really hurt. Could I utilize them? I can't find a good example of half-kneeling pulldowns or rows.

    I can't do 1leg RDLs on the left side (which is symtompatic) without pain.

    What can I do to strengthen my lower back besides various planks and holds, which I already do?
    Last edited by RoosterTX; 04-16-2009 at 04:46 PM.

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    Those are some good mobility drills.

    I don't know where videos of 1/32 kneeling pulldowns or rows are. I know I have included them in my ebook.

    I would stay away from the seated work, even if it doesn't really hurt.

    If the 1-leg RDls hurt on the symptomatic side, then do not do them. Stick with the 1-leg glute bridge and the single leg split squats until your symptoms calm down.

    Planks, 1/2 kneeling chops and lifts, and bird dogs are all great exercises for developing strong abdominal brace. The error most people make is thinking that they need to "strengthen the lower back" with some special exercises. The lumbar spine gains stability by learning how to brace and then integrating that brace into movements (split squats, lunges, etc...) without having to think about it. I invite you to revisit your form, as most people do not do planks (especially side planks) properly and they do not perform the proper progressions of the movement.

    patrick





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    One note side to side leg swings on the left side (symptomatic) aggrevate the sciatica. To a LESSER extent so do regular leg swings on the left side.

    What movements could I replace these with?

    Any good links for proper form on side planks and planks?

    I realize I don't know enough about the movements of the body, at least to formulate a good recovery plan on my own, and was thinking of working with a good team.

    Could you vet these guys (know anything about them?) if not I understand and thank you for your help.

    Next Level Sports Performance, physical therapy, sports medicine, Denver, Colorado

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    I could see the leg swings firing you up. You may need some neural flossing, but that is not for me to decide via the internet.

    I don't have any good videos of planks or the progressions I use, sorry.

    I have never heard of those guys either. That doesn't mean they aren't good. I just have never heard of them.

    patrick





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    could you explain the proper progression for planks please?

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    Quote Originally Posted by RoosterTX View Post
    could you explain the proper progression for planks please?
    wall w/rotation
    prone on the knees
    side plank on the knees
    prone on the toes
    side plank on the toes
    prone w/rotation to side to side
    prone with leg lift
    prone with arms on stability
    prone with arms on stability ball with leg lift
    prone with toes on stability ball
    prone with toes on stability ball with leg lift
    side plank with hip abduction
    side plank with feet elevated
    side plank with feet elevated w/hip abduction

    obviously the side plank and the prone stuff may be going on simultaneously on different days of the program. Those are just some progressions I have listed down, but usually I don't use most of the (lol). Typically if they can hold the prone plank, the side plank and then perform the rotation from prone to side properly, we can move on to other exercises. If they still want/need (psychological reasons) to do their "core" bull shit, I let them do the other nonsense - but I would rather have them on their feet doing some real exercises after that point.

    patrick





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    Now, I am rarely motived purely out of altruism, and this particular problem affects ME (grade 1 anterolisthesis of L5-S1, and now a herniated disc in my neck).

    What I would like to have spelled out for me is how to incorporate these movements into something like P/RR/S or BGB or some other split that calls for heavy low rep work.

    In particular, I'd like to know how sprinting could work under this limitation, since for example in my case at least, sprinting doesn't aggravate my back injuries - and sprinters got some killer wheels!

    I'm specifically interested in hypertrophy for quads and hams, so I am talking about a caloric surplus - just so we're clear.

    So, for example, BGB - an Ian King type of arrangement - has four days:

    Horizontal push pull (optional calves and abs)
    5x5 bench
    5x5 T-bars
    3x8 lncline dumbbell bench
    3x8 one arm dumbbell rows
    (optional 12 rep stuff, abs, calves)

    Quad dominant, ham accessory (optional biceps)
    5x5 back squats
    3x8 front squats
    3x12 walking lunges
    (optional 12 rep stuff for quads, optional biceps)

    Vertical push pull (optional calves and abs)
    5x5 weighted chins
    5x5 millies
    3x8 alternating single arm lat pulldowns
    3x8 Oly bar corner press
    (optional 12 rep stuff, abs, calves)

    Ham dominant, quad accessory (optional triceps)
    5x5 RDLs
    3x8 GHRs
    3x12 front squats
    (optional 12 rep stuff for hams, optional triceps)

    If heavy squats and deads are out, how could this be adapted to encourage the wheels?

    I'm thinking sprints could work in here somewhere, and high rep squats - sprinters and speed-skaters' legs are HUGE so they must be doing SOMETHING right!





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    Quote Originally Posted by Built View Post
    Now, I am rarely motived purely out of altruism, and this particular problem affects ME (grade 1 anterolisthesis of L5-S1, and now a herniated disc in my neck).

    What I would like to have spelled out for me is how to incorporate these movements into something like P/RR/S or BGB or some other split that calls for heavy low rep work.
    This is a pretty loaded question. You would have to take into account the injury of the individual and where they currently are with regard to pain and function. For example, some people will have disk problems that may limit the individuals ability to move properly (or moving may cause pain), creating atrophy and decrease in strength. So, it is on a case by case basis.

    That being said, there are many people who have had herniated disks, spondy's, stenosis and other various back pathologies and can still go workout and lift (and some even can still play pro sports). A lot of it has to do with properly training and knowing what you can and cannot do. The purpose of training should be to make yourself better.

    In particular, I'd like to know how sprinting could work under this limitation, since for example in my case at least, sprinting doesn't aggravate my back injuries - and sprinters got some killer wheels!
    If sprinting doesn't bother you, then great. It may bother others though, so again, this is a case by case basis.

    I guess I'll just run through the program below and make some recommendations.


    I'm specifically interested in hypertrophy for quads and hams, so I am talking about a caloric surplus - just so we're clear.

    So, for example, BGB - an Ian King type of arrangement - has four days:

    Horizontal push pull (optional calves and abs)
    5x5 bench
    5x5 T-bars
    3x8 lncline dumbbell bench
    3x8 one arm dumbbell rows
    (optional 12 rep stuff, abs, calves)
    This day should be okay with those who have back pain. I'd just substitute the t-bar tows with one of the other variations I had above. The 1-arm DB rows may need to be substituted if they produce pain as well.


    Quad dominant, ham accessory (optional biceps)
    5x5 back squats
    3x8 front squats
    3x12 walking lunges
    (optional 12 rep stuff for quads, optional biceps)
    This is where things may get "dicey" for someone who is in back pain. The back squats will have to be dropped. Some can still do front squats; however, many have pain with any sort of loading like that, and if I am working with a client I just drop it all together because I would rather be safe than sorry.

    Variations in split squats, lunges, and step ups are fine. If you are seeking hypertrophy, work on performing slow eccentrics and even an isometric pause in the bottom of the movement. This will allow you to develop tension without having to load up insane amounts of weight. In addition, you can work on sets of 4-6 reps, just increase weight and still perform the controlled eccentrics.


    Vertical push pull (optional calves and abs)
    5x5 weighted chins
    5x5 millies
    3x8 alternating single arm lat pulldowns
    3x8 Oly bar corner press
    (optional 12 rep stuff, abs, calves)
    What are millies?

    This day looks fine and just swap anything out if it gives you pain.


    Ham dominant, quad accessory (optional triceps)
    5x5 RDLs
    3x8 GHRs
    3x12 front squats
    (optional 12 rep stuff for hams, optional triceps)

    If heavy squats and deads are out, how could this be adapted to encourage the wheels?
    Same type of scenario here as the previous leg day. I like the 1-arm/1-leg RDL, but even that flexion movement may prove to be painful for people. If you can do it and it feels okay, then go with it. Again, single leg movements and control the eccentric. Initially start with loads you can handle and slowly work up over weeks and you can increase to doing lower reps.

    Just because you can't squat or deadlift or perform them heavy does not mean that you can't have hypertrophy or strength. It just means that you have to adjust your training based on your limitations.

    For example, I have a friend (a physical therapist actually) who has had some significant disc herniations in his lumbar spine. But, he is still strong, he still plays hockey, still has huge legs and he still trains hard. His training program is just different than it used to be. He no longer does back squats or deadlifts. He front squats, but never for maxes and never under 5 reps. He still does power cleans and DB snatches. And everything else he does is lunges or step ups - split squats, lateral lunges, walking lunges, step ups, bulgarian split squat, etc.

    You have to adjust the program for you.

    I'm thinking sprints could work in here somewhere, and high rep squats - sprinters and speed-skaters' legs are HUGE so they must be doing SOMETHING right!
    If the sprinting doesn't bother you, then go for it.

    Patrick





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    Thank you for this Patrick. Much obliged.

    Millies are military press. I generally do standing push presses because I don't like to do seated shoulder work.

    What kind of volume would you recommend given the lighter weights being lifted?

    For instance, suppose I can do 3x8 back squats with 165 and 3x8 fronts with a plate a side, but my back goes out and I'm unable to do anything heavier than 95 lb fronts.

    For the sake of this thread (okay because this applies to me personally, sue me...) let's also assume that GHRs are okay but regular or single leg RDLs are not. SHELC and leg curls are possible, also hypers but not single leg.

    How would I set up my leg days with higher-rep fronts, the above movements and some sprints to stimulate hypertrophy?

    What would my quad dominant leg day look like?
    ie reps, sets, movements

    How about my ham dominant leg day? Or would I do both leg days basically the same?





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    Quote Originally Posted by Built View Post
    Thank you for this Patrick. Much obliged.

    Millies are military press. I generally do standing push presses because I don't like to do seated shoulder work.

    What kind of volume would you recommend given the lighter weights being lifted?

    For instance, suppose I can do 3x8 back squats with 165 and 3x8 fronts with a plate a side, but my back goes out and I'm unable to do anything heavier than 95 lb fronts.
    Okay, that is a good question. So 95lbs for front squats is your "limit" at the moment. You can increase the sets and perform the same reps (IE, 4x8, 5x8, etc). You can also keep the reps low (3-5) and perform more sets (IE, 8x4, 10x4, etc...). The slowing down of the eccentric and the hold at the bottom will also make things more difficult and create more fatigue then just doing straight sets, so all things are not created equal. From there, as you feel more comfortable, you may be able to raise the weight slowly. Initially though, you may not be able to get away with doing the front squats right out of the gait.


    For the sake of this thread (okay because this applies to me personally, sue me...) let's also assume that GHRs are okay but regular or single leg RDLs are not. SHELC and leg curls are possible, also hypers but not single leg.
    Stick with what you can do. Remember, it is case by case. Your workout may be something like bulgarian split squat (or front squat), GHR, and hypers (if those don't bother you - some people hate these).


    How would I set up my leg days with higher-rep fronts, the above movements and some sprints to stimulate hypertrophy?

    What would my quad dominant leg day look like?
    ie reps, sets, movements

    How about my ham dominant leg day? Or would I do both leg days basically the same?
    Could be something like this:

    Quad dominant Day
    1) Front Squat - 3count eccentric/1-count isometric - 5x6
    2) Lateral lunge - 3x8
    3) SHELC - 3x12

    I would actually do my sprints 1st and then lift (or sprint on a different day).

    Ham dominant Day
    1) Step up - 5x6ea leg
    2) Glute Ham - 3x8
    3) Hypers (since they don't bother your back) - 3x12



    patrick





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