Hey, everyone. Welcome back to this Pr1me Time episode. Thank you so much again for tuning in. Again, my name is Dr. Chad Kuntz, the founder and owner of Pr1me Movement and Pr1me Time. And today we're gonna really dive in the topic "Is It Safe To Return Back To Squatting And Deadlifting After A Back Injury?" Big topic, and I know as a sports therapist, this is a topic that comes up quite often. And even having worked with a lot of different clients who "tried physical therapy" elsewhere, have tried to see a chiropractor, whoever else, I would say 90% of the time or so, people are unable to get back to working out with traditional care. And I think a lot of times even health professionals can get a little bit nervous about sending people back into the gym, doing squats, doing deadlifts after back injury.
Certainly, and not to throw all the orthopedic physicians underneath the bus here, but I can't say personally that a lot of times orthopedic physicians seem stoked to allow their clients to go back underneath the bar for a squat or deadlift. And so we find ourselves in this conundrum. I know if it were me, if I wasn't a therapist and I was just everyday Joe Schmo and getting tossed around the healthcare system, and I would be distraught if I couldn't get back in the gym, especially with confidence in doing some deadlifts, doing some squats. Those are just not only great exercises but every day functional movements. I don't care how you wanna break it down. If you need to sit down when you go to the bathroom, you are doing a squat. If you need to pick up a heavy gallon of water or something off the ground, you are technically doing a deadlift. So, that will come to haunt you no matter what.
So, guys, is it safe to get back to squatting and deadlifting after a back injury? Well, first, a few different things. We could probably spend a lot of time on this but we have to know what the back injury was, how bad was it? What was actually the problem there? So, from a pathoanatomical perspective, was it a disc bulge? Was it a disc herniation? Did we have a more severe case like with a disc extrusion or the outer annulus is torn and now you've got some nerve problems? From a statistical standpoint, that's gonna be much more severe having a disc extrusion, right, where the outer annulus, is torn versus a disc bulge or let's just say disc degeneration. These are really common things that asymptomatics or those who don't have pain. So, you're not gonna very easily convince me that you can't get back to squatting or deadlifting just because you've got a disc bulge or disc herniation. There's just too many people with no pain who present with that.
Maybe you've got a spondylolysis, which is a small fracture in your lower back, or spondylolisthesis, where you've got some slippage of the vertebrae in the back, where do all these things come into play in terms of your ability to get back into squatting and deadlifting? But what if it was just a strained muscle or what if the facet got irritated? You see, I'm just making a point here. We'd really have to understand and respect the fact that what has happened from a pathoanatomical perspective. Now, just to give you the CliffsNotes review version there, if you have an extrusion where the outer annulus is torn and that is pressing on the nerve root, most likely you're gonna have to probably get that debrided or cleaned out. That's where it's okay to let the guys with the surgical scopes get in there and probably clean that up because sometimes if you've got just a bulge or a part of the disc, I should say, sitting on the nerve root and it's just...it's moved locations, it's deep and lodged in the intervertebral foramen, yeah, there are times when you're gonna need to go in there and get that cleaned out.
So, that even leads us to potentially returning back to squatting or deadlifting after surgery. So, let's say you had a disc where you had an extrusion of the disc and it was torn and it was just really bad scenario, let's say you had to go in and get surgery. Surgery opens up a whole other can of worms, whether it's just a debridement, a laminectomy, do they fuse it? What was the surgery done in there? So, we've got to take all those things into consideration as well before I get you back underneath the bar. A lot of times more people than not are terrified to get back into doing some of those motions after they've had surgery, and I don't blame them. I actually do think it's possible to get them back at some level doing some squatting or deadlifting because a lot of times people have really significantly limited hips or they've overcompensated by trying to use their back to doing squats or deadlifts.
The reality is a lot of times these people who overuse their back doing a squat or deadlift, when they fuse that, they're told to not move that as much or they're told to stabilize and they're like, "Well, I can't do a squat now because I used to overuse my back." So, I do think with people who even have had surgery, they're thinking back to doing squats or deadlifts, there has to be a lot of relearning that has to occur in there. And I think that sometimes just the barrier is that we have to, form a root perspective, reteach the subconscious brain how you can actually do a squat or a deadlift because you haven't moved like that maybe ever. Now, you've got that rod in the case of surgery or fused disc, your body has got a lot of guarding around that space anyways so now you really got to get great hip mobility. So, then you've got to relearn and redo maybe, I don't know, 20 years worth of compensations in your hips. You've got to loosen those up before you can get back to even squatting or deadlifting.
By the way, just to close loop on the spondylolysis or spondylolisthesis that I mentioned earlier, you can absolutely get back to doing deadlifts with a small fracture in your back. Of course, this is gonna be a long time, it's gonna have to heal, reteach you how to stabilize a spine. But I hope people get back to deadlifting or squatting after something like that. The slippage or the spondylolisthesis question, so, can I get back to squatting or deadlifting after that? Well, to some extended degrees, how much slippage there is. So, it's, I believe, a grade four scale. So, grade four would be it's completely slipped off, that would probably not be good. You would probably need to go in there and get that aligned, which would maybe potentially get you back in that surgical question again. But yes, you can get back to squatting or deadlifting with nearly anything I've said so far. Some roads are more traveled than others, some are difficult, some are longer. In most cases, surgery, if you end up having to go through surgery, I think that's gonna be a much longer road in order to get back to deadlifting.
And there are certain levels of continuum in terms of the degree that you're able to get back to doing deadlifts and squats like you used to. So, maybe you're not that 400-pound deadlift behemoth again. And let's say you've had a couple of low back surgeries and fusions and all kinds of nasty stuff, well, then heck, let's just see if we can get you back to 200-pound deadlift. So, let's see if we can do that, cut that in half. Does that make sense? So, all that is underneath just the pathoanatomical standpoint. Then we have to approach this from a psychological perspective. The back is just an interesting area because it's not like the rest of the hand, for example, I can look at my wrist, I can fully identify it, I can turn it around, toss it, move it. I feel pretty comfortable because I can see it and that helps me from some level of fear. But with the back, you don't ever really get to reach around with your neck and look at your back and examine it and get that personal relationship with it. It's this big broad area, we don't have very good neurological sensation built into that area. So, meaning, we just don't feel really well in that back, and it just has a certain level of fear tied into it when you hurt it.
So, I'd say with a lot of my clients when I'm trying to get them back to squatting or deadlifting, there is a huge component of fear and sensitization when I start to help people move again. So, what that means is that the sensation they should feel is not always equivalent to the perception that they'll feel. Usually, their perception is much, much higher because their fear is really high, they're in the fight or flight or sympathetic stage. Like, if you're getting chased down by a bear, you would feel and notice everything, and that's what happens to us from a sympathetic perspective. We start to really narrow in and zoom in on the area of pain because we're nervous. There's analogy like you've got a lot of motion detector headlights right in your low back, the ones that are sitting outside your garage or whatever, and even if someone just steps outside, the lights will pop up. That's what happens to us when we start to get back to working out in general, but more specifically, with squats or deadlifts. And I use the analogy like those motion detectors would even pick up the slightest little leaf that goes by in your back. Your body will pick that up because it is on high intense alert.
So, a lot of times when I help get people back to squatting or deadlifting after a back injury, we need to really build a lot of confidence. We need to accentuate that. A lot of that starts with just getting a lot of repetitions in. If your body is on alert, so if it's on guard and it's looking for anyone it needs to attack, we wanna give it a lot of repetition. So, overtimes, your body's ability to be on guard slowly relaxes. It's like, "Do I have to be on guard if nothing bad has happened for quite some time? This guy has done 50 repetitions with maybe not a full range of motion deadlift, but let's say even 50 or 75%, nothing bad has happened." That'll eventually tell the brain, "We don't need to worry as much." We can finally decrease the level of perception and make it somewhat equivocal to the sensation which it should be.
So, that's all on the first block of this. We really need to figure out what the pathoanatomical problem was, we need to see how they're presenting clinically, we need to see how they're handling it psychologically, we should say, and, of course, the person's ability to do deadlifts in the first place. So, have they been doing this for one year? Have they been deadlifting for 5 years, 10 years? What level of an expert are they? So, you got to take that into consideration. What's their overall just health and fitness lifestyle? Are they eating good? So, you can see there's a lot of other systems that go into it. But let's just put that on pause for a second.
The next step regardless of all that is to help to teach people to properly deadlift again. A lot of times people who are deadlifting or squatting with poor form, so not only are we trying to reteach them how to move, but we're also trying to correct usually years and years worth of compensation at the same time. Most people are over-utilizing their back and they're getting too much range of motion from their back, both, I could say arguably, in squats and deadlifts.
For me, I'm usually trying to stabilize like hell the low back during squats or deadlifts, which means, most oftentimes, we've got to get a little bit more range of motion than they might expect or for what they're accustomed to from their ankle, their knees, and especially their hips. A lot of people are really tight in their hips, and if we can mobilize the hip and loosen that up, all of a sudden, they're probably doing the deadlift or a squat the way that they used to. But just so many people are so tight in their hips, they try making up for it in their back. So, what I like to do is to just start to slowly introduce these motions, squatting or deadlifting.
I like to start with just half the range of motion with, of course, no weight, and just start to give them a lot of repetitions on that the very early acute stage when they might be really nervous about this, they're psychologically nervous about this. I'll send people home doing 500 deadlifts or squats, depending which one we're attacking, and I'll just have them go through half the range motion. A nice, slow, good control and heck even doing that, I'll give them a little bit of a workout just because their reps are so obscenely high. But I'm also trying to reingrain this new type of form or technique. So, from there I just slowly increase their strength, I slowly increase the intensity. And there is no rush. And I know a lot of us wanna get back to it like yesterday, but really at the end of day, we wanna make sure we do this the right way because the worst thing that can happen is a recurrent injury that keeps setting them back and probably starts to defeat them more mentally than anything else. So, if you get recurrent, strong back pains after you've tried and tried and tried again over the course of a few years, you're eventually gonna just give up. There's gonna be a type of fatigue that sets in, where your body is just gonna be unable to keep trying to come back from this injury. So, I really take that with a lot of respect. I do not want my clients to come back from recurrent injuries.
Now, with the spine, particularly, our younger generation, but it can be a little bit older too, if you have a very flexible body and a very flexible spine, that type of person is more so predisposed to recurrent injuries. So, it's all the more reason to continue to focus on stabilizing spine like hell and getting great mobility from the ankles, from the knees, and especially from the hips and maybe even upper spine so that we're continuing to get the mobility there while we can stabilize the spine to help them get back to working out. Now, I do also have to say just a couple of musculoskeletal components, definitely a weak core can be a huge component to this. I do have to say just a shout out, if you're anthropometrically built, where you've got a long torso, it depends on the movement squat or deadlift, but I generally have to say that's increasing their lever arm for their core to have to stabilize a lot more work. So, you might find that that type of client will need to do a little bit more accessory work to stabilize their core under load so that they don't go into an excessive extension moment but that rather they can keep a neutral spine.
A neutral spine, I think that's something that almost everyone has to work with with a professional to figure out what that neutral spine looks like. But a neutral spine is incredibly important for both deadlifts and squats to make sure that we're not asking, for example, our lower spine to do all the work, which is usually what I see. We wanna make sure that each segment in that spine is doing its job and it's got a great linear and straight position to it rather than overarching or, at times too, over flexing or over rounding. And then just a couple of other thought processes on this. The hamstrings, those are a muscle group that can get tight, especially if you're everyday weight lifter and you're working out your legs and hamstrings, those muscles get tight. It wants to pull your lumbar spine into flexion or rounding. That means you're gonna have to work even harder to get your spine into extension.
So, you might find that loosening up hamstrings, heck even loosening up your calves can help improve your ability to get back to doing both of these. And these are such big topics because you've got to think about how many stinking joints and muscles, tendons, and ligaments, and bones are all involved for a successful movement, whether it be the squats or the deadlifts. So, you've got to just take that into thought how ridiculously complex these movements are. And rehab, in general, can be complex because it throws a monkey wrench in your body's ability to do its normal motions, you've got to relearn how to do things anyways. So, when you're thinking about relearning how to do a squat or a deadlift, you're talking about some of the most complex movements out there. So yes, it does take time.
At the end of the day, I do absolutely think it's possible to get you back to squatting or deadlifting after a pretty severe or even minorly insignificant low back injury. I think the psychological component is often very underrated, undernourished, and missed in the health and fitness world because so many people forget the ability... Well, I should say so many people just lose the ability to be confident in movement. And that's something here with the Pr1me Movement that we are ridiculously passionate about, it's making sure that people can get back to doing the things that they love with confidence. Otherwise, it doesn't feel right, it doesn't feel like you're who you really are, and it doesn't provide the same level of reward.
All right. So, yes, I think you can get back. There are certain cases that are tougher than others. Like I started with this podcast today, some journeys are longer and more difficult to travel than others. The more tougher cases would be maybe severe spondylolysis, a severe spondylolisthesis where you've got huge slippage. If you're dealing with severe neural tension, we don't really talk about it much today, but even sciatica can be a tougher one but it doesn't always have to be. But the fusions too tend to be the tougher cases, but it doesn't mean you guys can't get back to doing this.
There are success stories all the time with people getting back, having come back from a really nasty back injury. The best thing I can say is to continue to try to stay ahead of the curve, try to stay away from surgery as best as possible. There are, like I said, a few times when you just have a mechanical thing going on, like maybe a serious fracture or maybe you're in a car accident. There are times, of course, when surgeries may occur. So, I understand if you have to go through with that, but try to fight the good fight, not get into surgery. If you do, know that the war is not over. You can most likely still get back to squatting or deadlifting. You're gonna have to just really be patient and work hard and understand that you're gonna have to really relearn how to move from top to bottom to do both of these very complex movements.
So, from Dr. Kuntz over here at Pr1me Time, thank you guys so much for tuning in. With any other questions or comments or anything else, please feel free to reach out to me. And thank you so much. Have a great rest of your day.
Pineville Physical Therapy, Pr1me Movement. www.pr1memovement.com