Note: The first version of this article was released on 1 October 2020 and updated on 1 February 2022
Earlier this month, I had a bad back tweak while squatting. It felt really bad the next day as it had gotten very stiff. Waking up and walking was painful. It was terrible. I was limping for almost a week. At one point, it was so painful to wake up from bed; I was shaking for a few minutes standing up.
However, within 7 days of my back tweak, I was able to resume my normal daily activities and I’d like to share what to do when you get a back tweak.
What is a back tweak?
It is a muscular strain around the lower back or hip muscles or tendons. This strain caused some inflammation that causes motions such as bending over, rotation to be uncomfortable or even painful.
It can be very uncomfortable, but it will not be the end of the world. People can recover from the tweak in a matter of days or a few weeks, and the better you manage it, the faster it will heal.
How did it happen?
It happened during a warm-up for the squat. You can (or maybe can’t) see it from the video below. If you watched it closely, there’s a subtle moment where I twitched during the ascend. At that time, I felt a sudden sharp pain in my hip and lower back. You can see the video below. WARNING: GRAPHIC CONTENT
If you watched it, you know that I was kidding about the graphic content. I squatted just fine. I didn’t fall with the bar; nothing scary happened. The weights used were also light for me.
Are you sure it’s not a Slip disc? “Snap city bruhh!!”
It’s doubtful that your bone is fractured during a lifting event. Slip disc is also unlikely if you are training with a consistent small progression as described in the Starting Strength method.
Do you tear your muscles from a tweak?
The short answer is unlikely.
If there’s a tear on the muscle belly from the injury, normally it causes bruises to appear within 1-2 days. I have never seen this on any back tweaks.
Martin, our client, had a hamstring tear on a deadlift on an unrelated injury and recovered within just a few weeks and did a PR on his deadlift. If you are curious about this story, you can read the full story here. Interestingly, we treat back tweak with the same protocol as a muscle tear.
Why does it hurt so much?
This video explained it very well, and it is a MUST to watch. Therefore, I won’t write anything so that you watch it.
If you have time, you can also read this article by Dr. Baraki.
So, why did the back tweak happen to me? Is it my form?
Well, it can be one of the reasons. Good form will help you to lift with higher mechanical efficiency. It also needs to be said that lifting with good form means a high degree of movement consistency between rep to rep. No doubt, a good form could reduce the risk.
I saw cases of people lifting with perfect form having a back tweak. But, conversely, there are also people with horrific form who had never gotten a back tweak.
So another important thing is the amount of stress you are exposed to, a.k.a the load and the volume you are lifting.
I suspect that this is the case for me. Training has been very strenuous for the past few weeks leading to the injury. I was doing volume PR for all of my lifts. All lifts felt really heavy, and I could feel it taxing my body and recovery.
However, I managed to sneak enough recovery to allow more weight increments. Then, together with my coach, we decided to prolong it a little more and push through to get a target deadlift number.
I got to that number but got injured the next training while warming up for an easy squat.
It might just be a bit of bad luck, or I might deserve that for pushing too hard. But, unfortunately, sometimes back tweaks can happen unexpectedly, and it’s hard to pinpoint a single cause.
What do you expect to happen after having a back tweak?
It differs from person to person, and it depends on the severity of the tweak. It usually feels uncomfortable for the next few days to a few weeks. On average, it will take around 1-2 weeks to get it out of your system.
In my case, for this particular injury, it hurts much more than what I had experienced thus far. Bending down and walking was painful. If I sit or lay down too long, it would stiffen up even worse.
I was also worried!
Even though I know what to do, I also feel worried that it’s more severe than what I understood. There was some swelling at the hip base, right at the centre. So I visited a doctor for this, and luckily my doctor, Dr. Sanjay, is familiar with what we do.
After the check-up, he explained that nothing abnormal was happening. I could do imaging, to be extra sure, but the treatment will be the same.
He also mentioned that I could resume my activity. I don’t need to do anything differently or avoid any activities. I didn’t get any X-Ray.
How did I treat it? Enter the Starr Rehab
I learnt the Starr Rehab from listening to Mark Rippetoe, author of Starting Strength. This rehab protocol was first taught by Bill Starr, a legendary strength coach and a weightlifter, to remedy his own injury back in 50s and 60s. More about this rehab can be found in this article.
This is the summary of how to do it:
When to start?
0-4 days after the injury, depending on the injury. For a normal back tweak, it’s sooner as compared to a muscle belly tear
Do the exercises that cause the pain. Most likely squat or deadlift.
Very light weight, you can even start with an empty bar. Make sure to use the perfect form. You can add the weight incrementally, such as 5-10 kg jumps if the sensation doesn’t increase. In the beginning, be super conservative! I have a couple of experiences where I reinjured my back by being too aggressive with the weight jumps.
A lot of reps, 25 repetitions times 3 sets is what Rip prescribed. I have tried 8-12 reps for my clients and it works as well.
You can do this every other day with increasing weight each time. The number of reps can continue to drop as the weight gets heavier.
Note that we are expecting the sensation to be better or at least the same throughout the set. If it gets worse, stop! Wait for another day!
Do you take any medication?
This is not a prescription. Please consult with your doctor for advice on medication!
Yes! During the first 3 days, some anti-inflammatory can be useful to reduce the pain and inflammation at the injured area.
I took ibuprofen and paracetamol based on the dosage on the packaging.
Besides the oral medication, I also use some topical creams to help (such as Voltaren, Tiger Balm, or Counterpain).
Is it cream effective? Not at healing the strain, but it gives extra comfort by overwhelming the receptors in the region. So, I believe the cream’s main benefit is to distract you from overthinking about the pain.
Short term training consideration (Recovery)
During the recovery period, the main rule is to be more conservative until everything clears out of the system. Assuming that you will have the 4 main movements, here are things that I usually encounter while recovering.
Due to the stiffness, it’s common to have our back angle a little bit more vertical than normal. While this is okay, remember that the goal is to get back to the regular form as soon as possible. If it feels better after a few reps or set, you can try to mimic back the regular form.
If the weight is too heavy on that day, you will feel some pinching during the unracking process. You don’t have any business doing that weight that day. Lower it again! Save it for another day.
If setting up a deadlift off the floor is “too scary” or hard, you can start with an empty bar Romanian Deadlift. I will assume that the full range of motion is too uncomfortable for now. So, stop the bar where you feel very tight, and repeat for a few repetitions up to that height. After a few reps, you might feel better and more range of motion is available.
If you are able to do a full range of motion, start doing a normal deadlift with small increments.
Back tweak can cause some discomfort when you try to extend/arch your back. The action of putting the feet down and doing the leg drive exaggerate that arch and can be uncomfortable. Placing a few bumper plates under your feet could be the way to go at this point. If it doesn’t help, the last resort is to do a feet-up bench press.
The press normally is the least affected by the back tweak. However, I’ve seen people with less shoulder flexibility feel discomfort in their lower back during this period. Their lack of ability to straighten the arms up will require their hip to be more extended (imagine laying back while standing) to maintain the bar above midfoot.
You can do a strict press if Press 2.0 (with hip bounce) gives you any sensation.
For those of you that are curious about my rehab process, here’s my rehab training log.
*The weights, reps and sets used here are specific to me on that particular back tweak. DO NOT FOLLOW THESE NUMBERS FOR YOUR REHAB – YOUR WEIGHTS, REPS, SETS AND RECOVERY PROCESS WILL BE DIFFERENT.
Day 1 – Tuesday:
Tweaked my back
Day 2 – Wednesday:
Bodyweight to 5kg squat – 5 rep x many sets. Unable to deadlift.
Day 3 – Thursday:
Squat with belt:
20kg x 5 reps x 2 sets, 30×5, 40×5, 50×5, 60×5, 70×0 (too painful to support the weight), 60×5.
My back angle was slightly more upright than my usual back angle – no problem!
70x5x3. I couldn’t arch during the bench and sometimes put feet on the bench to make it tolerable. Unfortunately, getting up from the bench was also painful.
20x5x2, 30x5x2, 40×5, 50x3x2. 60×1 x3 (decided to stop, hurt too much)
Day 4 – Friday:
Felt better in the morning, and then I carried the safety squat bar and loads of plates during coaching. I took a nap afterwards and realised that there was some swelling; decided to visit a doctor. This day was the peak of the discomfort.
Day 5/6 – Saturday/Sunday
I continued the medication. I didn’t have time to lift due to work.
Day 7 – Monday:
20×5, 25×5, 30×5, 40×5, 45x5x3
The warm-up felt horrible, then I tried using a belt, and surprisingly it felt worse. So I decided to continue without a belt. Everything felt more comfortable starting from the 40×5 set. Still, I felt some sensation holding the lockout, thus using soft lockout for the rest of the workout.
20×5, 30×5, 40×5, 50×5, 60×5, 70×5, 75×5
I can immediately walk without limping after the squat.
Day 8 – Tuesday:
60x5x3. Easy, with a low arch.
40×5, 50×5, 60×5, 70×5, 80×5.
Felt a minor sensation on my right glutes during ascend and when sticking my arse back during setup. But, as always, after training, it felt terrific; it reduced stiffness around the lower back and hip area.
I included some of my training clips here. You can see that the first “real” training on Day 3 was not comfortable. You can see that I was in pain; however, it indeed got better afterwards!
I can resume a typical day’s activity after the eighth day.
You might also notice that I used sets of 5 across to do my rehab. While this is okay, I prefer to use a higher number of repetitions as how Rip described now. I came to understand that the high reps automatically limit the weight on the bar. Thus, preventing myself from getting overly aggressive while recovering.
Long term training consideration (Post-injury)
I mentioned that form and stress are the major causes of the tweak. After the injury, it will be good to see why things happened on that day.
If there were a form breakdown on the day, assess how to improve it. For example, if the issue only comes when the weight gets heavier, it’s worth trying to do more specific “practice” at the weight where form starts to break down.
Another idea is to do targeted accessory works. For example, I had a lot of success doing paused squats if the form breakdown happens at the bottom of the squat.
In general, our best friends for this are tempo and paused work at the concerned portion of the movements.
Stress and recovery go hand in hand.
Before assessing what we can do better with the programming or managing training load, ask this question. Have you been managing your recovery components?
Are your sleep and food enough? (Quantity)
Are your sleep and food good? (Quality)
If it’s not optimal, can you do anything to fix it?
If you can fix it, fix it.
Now, what if it’s something outside your control?
This is where programming needs to be tuned to be more precise.
I can’t give an exact answer on how to modify your training program here, but this will be my process as a coach.
Check the overall training template
- Ensure that the stress on each day of the week is well distributed.
Imagine having a very long 3-hour workout day and another short 45 minutes workout on the other day. Then, probably one exercise can be moved to a longer – more stressful day.
- I like to provide a sufficient gap between stressful squat days and deadlift days.
Imagine having 5-8 heavy sets of squats on Monday. Then, I wouldn’t put another 5-8 heavy sets of deadlifts on Tuesday.
- Ensure sufficient total weekly stress of each lift, but don’t go crazy.
Imagine having to squat 3 times a week. If all squat days are equally hard, we might as well do a novice linear progression.
Of course, some days will need to be lighter than the others. But, most commonly, people can follow a variation of the Heavy-Light-Medium combo for each lift.
Playing around with the length of the block:
The method I am about to describe will resonate more for the intermediate to advanced lifter versus the novice lifters.
By training, we are inducing stress to our body, hoping that it will also increase performance (weight on the bar). Unfortunately, the further you are in the program, the more stress you will carry. With this carry-over stress, there will come the point that will hinder you from progressing.
When your performance starts to dip, it’s crucial to decide if a temporary decrease in stress is necessary. It can be in the form of a “deload,” or I have also seen coaches who cycle lighter stress week by removing a few sets from the main program.
The concept of “time to peak” is where the program length is decided on how many exposures (usually in the number of weeks) you can stay in the program before the performance dip. For instance, if your performance showed signs of declining every 6th week, your peak time is 5 weeks.
In this case, you can set a 5-week training program, followed by a deload for 1-2 weeks. Then, again, try to restart another 5-week training program, and the cycle continues.
For those of you who are still terrified
It might be your first time experiencing this, or you had an awful experience having a back tweak before that it bothers you until now. You might still feel apprehensive about picking the barbell up again. If that’s the case, I am sorry that it happened to you. I hope it doesn’t happen to anyone.
Let me tell you that back tweak is one of the most common complaints reported in the A&E. It really can happen anywhere. But, unfortunately, it happens when you are trying to be stronger.
From the words of my wise wife. “If you fall while walking or running, will you stop walking or running for the rest of your life?”
If I try to be sassy, I’d answer not for running and walking, but maybe yes for lifting weights.
However, for me, why stop because of an injury that will heal within a week or two? I think the benefit will far surpass the 2-weeks of discomfort.