Squat injury
November 15, 2012 9:39 AM   Subscribe

What kind of doc or therapist should I seek about my weightlifting lower back injury?

Monday of last week, I messed up my squat, and have not lifted since. Coming up on my last rep I let my torso loosen and ended up angling my spine slightly to the right, causing the bar to tilt that way a bit on my back. The next morning, getting up out of bed, I felt strong pain around my tailbone. This happened any time I bent over at the waist, tying my shoes, getting into my car, pretty similar to this guy's description though perhaps not as severe (sitting was fine). The day after, the pain greatly subsided, and was more localized in my right butt cheek. Now it's eleven days later and the pain is nearly gone. If I hyper-extend my lower back while sitting in a chair I can feel it, but it's moderate and later in the day quite faint. So, this question is multipart:

1. What kind of doc/therapist should I see? I want to be cautious, having read scary stories on the internet of lifters being wheelchair-bound after squat injuries. Might I need xrays?
2. What strength exercises can I do while recovering? Bench presses and chin-ups ok?

Any other experiences or advice regarding squat lower back injuries welcome.

I'm a 27-year-old male, weighing 150 lb. I was squatting 167.5 lb (low-bar back squat).
posted by mnemonic to Health & Fitness (12 answers total)
Hie thee to an orthopedist. You might start with a GP, but an orthopedist will be the specialist you'll come to know and love.
posted by Ruthless Bunny at 9:41 AM on November 15, 2012

Always start with your internist/family doctor. They'll get you the referral you need, and these days the odds are good that you'll need one.

That referral will likely be to some kind of orthopedist. From there, you may wind up at any number of other practitioners, including but not limited to pain management specialists and/or physical therapists, but the orthopedist is going to be the sort of head guy for this sort of thing.
posted by valkyryn at 9:44 AM on November 15, 2012

Aim to see a sports physiotherapist. It's likely most other medical professionals will consider "Stop weightlifting!" to be valid advice. You want someone who will get you athletically functional again, not merely asymptomatic-while-sedentary.
posted by Kandarp Von Bontee at 9:46 AM on November 15, 2012 [1 favorite]

Ruthless Bunny is right, you need to see an orthopedic doctor first. They will determine what is causing the pain, take various x-rays, perhaps prescribe an anti-inflammatory and give you a list of physical therapists to see. He or she will give you a diagnosis summary to take with you to the physical therapist. From there, you can say good bye to pain.
posted by Yellow at 9:53 AM on November 15, 2012

If your weight lifting is an integral part of your life and you want a full assessment and possible preventive rehab plan I would see ( ask for a referral) to a physiatrist. In the US these are physicians who specialize in physical medicine. You might also ask for a referral to a professional specializing in sports medicine ( physical therapist, kinesiotherapist, etc.)
posted by rmhsinc at 9:57 AM on November 15, 2012

Sports med doctor!
posted by elizardbits at 10:32 AM on November 15, 2012

I would look for a sports medicine practice, perhaps specifically one with their own PT clinic. (Mine is affiliated with a university, so they have all in one place).
posted by pixiecrinkle at 10:33 AM on November 15, 2012

Re further advice - it sounds like you've just incurred a lumbar muscle strain, which is undeniably horrible but temporary (barring any postural issues predisposing you to going through it again). Rest should be your top priority, with periodic very gentle mobility work to encourage circulation and prevent seizing - here is a good run-down of basic self-rehab procedure, to which I would just add thoracic stick twist (done kneeling, and slower).

My guess would be you won't get any revelatory feedback from medical professionals on what caused the injury unless you have glaring postural issues such as anterior pelvic tilt or obliquity/functional leg-length discrepancy (which may be indicated based how you asymmetrically failed your squat). Ideally you want a trained eye to take a good in-depth assessment of your hip mobility and guide you through corrective strategies for fixing any mobility-stability deficits; a really good personal trainer is as likely as most clinicians to be able to help you with this.
posted by Kandarp Von Bontee at 4:42 PM on November 15, 2012

nice to see a fellow rippetoe fan here. Consider getting a thai massage by an RMT.
posted by spacediver at 5:26 PM on November 15, 2012

I'm not a doctor, but I've squatted 405 and I've tweaked my lower back lifting before (as will everybody who lifts weights for long enough). It sounds like you pulled an erector muscle. You're going to be fine, and a doctor is not going to do anything for you except tell you to stop lifting and take anti-inflammatories.

So take some ibuprofen if you need to and do some light, high rep movements to get blood flowing to the area. Back extensions have felt good to me in the past, or reverse hypers if you have access to one. When it stops hurting, start squatting again for high reps with light weights, and add weight and reduce the reps over a few workouts until you're back where you left off. And try to fix your squat so it doesn't happen again.
posted by ludwig_van at 5:29 PM on November 15, 2012 [1 favorite]

The answer is almost always your primary care doctor, but if you want to/are able to bypass a primary care doctor and still have your insurance cover it, sports medicine would probably care more than an orthopedist.

Because orthopedists are surgeons at heart, and this is not that likely to be a surgical problem. They'll see non-surgical issues but they're just not as excited about it.

For similar reasons, you probably don't need an x-ray, because x-rays of your spine really only show bone issues, like fractures or dislocations. Your issue is probably a muscle or ligament issue, because it did not involve any direct trauma to your spine. X-rays do not give much information about the soft tissues. IANYD and TINMA.
posted by treehorn+bunny at 10:21 PM on November 15, 2012

Assuming you're in a cage, train yourself to consider dumping the bar next time you feel your torso loosen. From experience, I know I can muscle 365 at a BW around 230 with poor form. From experience, I know it's a really bad idea. But note that "dump the bar" does not equate to "screw it, I'm letting everything go"; instead, it's "keep my form as good as possible while squatting lower than ordinary".
posted by disconnect at 8:25 AM on November 16, 2012

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