Summary
Highlights
Before starting any rehab, it's crucial to assess your pain to make informed decisions. Ask yourself: What is the pain intensity during training and at rest the day after? Where is the pain localized (sharp point, shooting down the leg)? When does the pain appear (specific exercises, ranges of motion, heavy loads, bottom of squat, start of deadlift)? Have you tried modifying anything, and did it make the pain better or worse (e.g., tempo work, bar position, conventional vs. sumo deadlifts)? More information leads to a more precise assessment and a more accurate rehab plan.
The goal is not to stop training but to reduce or manage painful exposures. Establish a training scheme where you adhere to specific pain rules: pain intensity during training must not exceed 3/10; pain at rest on non-training days must be under 3/10 (0, 1, or 2); and pain should not increase the day after a painful session. To achieve this, you might need to reduce load, alter the range of motion, or use variations that you tolerate better. Examples include zero squats for back squats or block pulls for deadlifts. Incorporate exercises that make your back feel better, such as mobilizations and pain-free strengthening exercises, and increase overall physical activity. Maintain this phase for at least 2-3 weeks to stabilize symptoms.
This step involves progressing your rehab exercises by increasing load, specificity, intensity, and range of motion, gradually moving closer to your regular training scheme. Continue with the modified lifts from Step 2, but increase their load, volume, and intensity. Reintroduce competition lifts on a second frequency, always respecting the pain rules. For example, make block pulls heavier and reintroduce light, full-range deadlifts in another session. Load rehab exercises like back extensions, Jefferson curls, and core work (V-ups, resisted rotations, side bends). At the end of this phase, you should tolerate load again, and your pain should be almost gone.
The final step is to challenge and simulate the movements, ranges of motion, and loads that were problematic before, in a controlled and intelligent way. This builds confidence. Use "simulated risk"; for instance, if you got hurt pulling heavy off the floor in a deadlift, work on heavy isometrics or sumo pulls from the floor. If the bottom of a squat was an issue, practice long pause squats. The key is to keep it simple, simulate the problematic ranges with specific exercises, and follow a sensible load progression. The four-step plan is: assess, adapt, rebuild, and simulate. Do not stop training or fall into the "rest and wait" trap.