My treatment philosophy is guided by 2 core principles: 1. I optimize my patients' time frame of recovery as much as possible. 2. I empower my patients to be as independent in their rehab as much as ...
This article is very personal to me. It is about how I treated my very first patient: myself. It details my 7-year-long journey fighting low back and sciatic pain with deadlifts. In those 7 years, I have injured myself 3 times deadlifting. I will talk about what I tried and ultimately, what my treatment plan was. The reading may be quite bleak at first but stick to the end for the good ending and the valuable lessons I learned.
Through this article, you will see many similarities with how I treated my previous two back pain patients (case study 1, case study 2) and how I applied my own treatment philosophy to myself (Part 1, Part 2). These similarities are normal: consistency of quality of care is vital and I strongly believe in my own treatment methodology. This is why I applied it to myself. I will spare no detail in explaining exactly what I did to make myself better.
This all started when I was 18. My father had introduced me to the gym about 2 years ago and I had been going regularly. I was given a few reminders about safety, shown how to do some exercises and how I could use Google to look up any exercises I was unsure of, then left to my own devices. Things were going swell so far: I was getting stronger and had developed a passion for the gym. It was a way for my awkward teenager self to feel like he was improving himself, at least until I had my first injury.
During a set of deadlifts, I felt a sharp stab in the center of my low back and I dropped the weight and stood upright. Something was wrong.
Physically speaking, I was not in that bad of a state. After having seen numerous low back pain patients as a physical therapist, my symptoms back then would definitely be considered quite typical by my current standards. For an 18-year-old with no knowledge of physical therapy and who just had his first “serious” injury, however, I thought the world was ending. I felt a hard knot in my back at all times, and it was worse when I was sitting. This was awfully inconvenient since as a CEGEP student, I had to spend many hours at a time sitting to study and do my exams.
The largest impact this injury had was mental, however. The gym no longer felt like a safe place: it felt like a danger zone where any exercise was a trap that could make my back seize up.
I needed help. I could no longer do my favorite sport and could barely tolerate sitting for longer than an hour.
As most would, I decided to go see my doctor. I was told to “lift with my legs more”, which was advice I had already heard before and didn’t address the current pain I was in. To his credit, he did refer me to go see a physical therapist, but I was too stubborn at the time to follow that advice. I thought the pain would just leave on its own.
I also went to an athletic therapist who massaged my back. This helped decrease the pain which was very valuable during the exam period, but the pain came back after a few weeks.
My physical pain did end up leaving on its own after 4 months, but my fear did not: for the next years, I was afraid of going back to the gym. Eventually, I did restart working out when I started my undergrad, but I completely avoided any leg exercises for fear of having pain again.
Skipping ahead 3 years into the future: I was now 21 and in my 2nd year of undergrad. My back pain had been on and off. It was never as bad as when I first injured itself but it still came back whenever I spent a long time sitting. I was still far from being a physical therapist but knew that it was possible for me to “treat myself” and to return to deadlift progressively. After obtaining advice from friends with more experience working out, I decided to start deadlifting again.
Things went well at first. My weights were going up week by week. Unfortunately, things went downhill when in the middle of a deadlift rep, I felt a great pulling in my right hamstring followed by immense pain. This was even worse than my back pain. I stood still in the middle of the gym for a few minutes, catching my breath and moving very slowly. I then mustered the strength to ask another gym member to help me unrack the weights and put the barbell away before I went back home.
Despite the more severe onset, I knew that this new injury was not as bad as my first one. It did not take a physical therapist to know that I had torn my hamstring and that I would recover much faster than my back pain.
My pain left after only a week but my fear of deadlifts came back with a vengeance.
“Maybe deadlifts are just not for me”, I thought. And so, like when I was 18, I continued working out but resumed avoiding this exercise.
My latest injury when deadlifting happened when I was 24. I had been working for half a year as a physical therapist and was starting to get more and more comfortable treating low back pain, one of the most common reasons for patients to consult in physical therapy. I had even had the chance to treat patients with the exact same problem that I had: back pain when deadlifting.
If you read my 2nd article on my philosophy as a physical therapist, then you know that bringing patients back to their activities and overcoming their fear is a key component of my practice (if you didn't, here it is).
On my 2nd day of doing deadlifts, despite doing so with a low weight compared to my other exercises, I started feeling a pain of 6/10 (10 being the worse). Not just back pain, however, but a pain in the right side of my low back which radiated down to my right thigh: a sciatic nerve distribution, also known as sciatica.
Out of my 3 injuries deadlifting, this was clearly the worse. Not an isolated back pain or hamstring strain, but a pain that involved a nerve.
But this time, I had no fear. I knew exactly what this was and had helped patients overcome it. So why not me?
Before we dig into my self-treatment, let’s address the question of why I kept deadlifting. Why did I keep doing this exercise? Didn’t I learn from the first injury, let alone the second? There is no shortage of exercises to do at the gym, why keep doing this one? 3 reasons.
My treatment plan, as with all my treatment plans for my patients, had 2 components to it: therapeutic education and exercise prescription (more information on what these are here).
My first step was to identify my directional preference. The directional preference is a movement or position that, when executed at the right frequency and intensity, helps quickly relieve pain. In the case of sciatica where the pain was spread from my right lower back to my right thigh, my directional preference also had to centralize my pain.
Centralization is “a phenomenon where pain originating from the spine and referred distally, moves or retreats back towards the midline of the spine in response to repeated movements or guided positioning” and “in patients with sciatica, centralization was common and associated with improvement in activity limitation and leg pain” (from Centralization in patients with sciatica: are pain responses to repeated movement and positioning associated with outcome or types of disc lesions?).
This may be an overdose of scientific information, but I promised that I would be giving you all the details!
To find my directional preference, I used the same process as in my treatment of Mrs. O.’s low back pain: I identified baselines, namely my pain’s location, and tested a few exercises. The ones that significantly decreased and centralized my pain were repeated cobras, and so I continued doing it. For a complete explanation of this process, please read Mrs. O.’s case study.
After a few days of doing cobras, my sciatica was not entirely gone, but it had centralized to my lower back and was now a 3/10. It was more tolerable and less worrying. More importantly, I now had control over my pain: I could do the cobras in case of any flare-ups. And so, I started the strengthening phase of my exercise program. The selection of exercises followed the principle of load management, which I’ve explained in my knee case study.
Conventional deadlifts were still painful for my back, so I replaced them with sumo deadlifts, which involved the legs more and my back less. Thanks to sumo deadlifts, I could strengthen myself in this movement pattern without provoking any symptoms, and regain confidence in lifting from the ground.
After 3 weeks, my back pain was mostly gone in my everyday life and I was getting closer to my pre-injury state. I knew that I had neglected to strengthen my low back extensor muscles, so I added 2 more exercises to my program: good mornings and Jefferson curls. These 2 exercises were great for my posterior chain, but also to reintroduce my back to pull the weight up with low loads.
The biggest benefit was that being able to perform these exercises helped restore my confidence in my back’s ability to support weights. This confidence grew every week as I increased my weight.
After 2 months of doing my exercises, I decided to confront my demons: conventional deadlifts. As with almost anything in life, things did not go as planned. My pain had not magically disappeared and I was not suddenly capable of deadlifting Herculean weights with zero pain. My pain still woke up to a 2/10 during my last set of deadlifts.
I dealt with this pain by performing my directional preference exercise (cobras), which abolished it completely. I then waited a few days and then did deadlifts again. It was not instantaneous, but my progress was consistent: week by week and set by set, my pain was going down. 3 months after resuming deadlifts, the weight was now heavier than it was when I injured myself and I had no more pain deadlifting.
Performing an exercise at a reduced load and with tolerable pain is the essence of load management rehabilitation. By making sure that my pain was always Good Pain and that it remained in my control, I slowly got better with deadlifts until I had no pain at all.
At the time of writing this article, it has been about a year and a half since my recent injury and I have been deadlifting for over a year now with no issue. I’m pulling a lot more weight than I did at each of my injuries. More importantly, this is the longest I’ve ever gone without injuring myself. Deadlifts (along with squats) are now by far my favorite exercise to perform at the gym because they make me feel good. They not only help me get stronger, but also remind me how far I’ve come, both as a patient and as a physical therapist.
If any of the information or stories in this article speaks to you, feel free to check out my profile to read more of my articles or to book a 1-hour private room evaluation with me.
If you’d like to discuss any of the points raised in this article in more detail, I would love to speak to you. You can contact me by email at firstname.lastname@example.org or by phone at 438-801-0417. I currently offer free no-strings-attached 15-minute phone call sessions to discuss how I can best assist you.
Here are some suggestions of articles I have written recently, organized by topics.
Knee pain: case study 1
Shoulder pain: case study 1
Albert, H. B., Hauge, E., & Manniche, C. (2011). Centralization in patients with sciatica: Are pain responses to repeated movement and positioning associated with outcome or types of disc lesions? European Spine Journal, 21(4), 630–636. https://doi.org/10.1007/s00586-011-2018-9
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