Back and Outer Thigh Pain From Training: Load Around It, Don't Rest

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hey everyone, it's Sebastian, your host or co-host with the Restoring Human Movement podcast. Thanks for joining the show. We're going to cover one of the biggest mistakes that people make today regarding lower back pain and lateral thigh pain that they've been experiencing at the gym. I'll tell you a story of what I think would be a great scenario with this, but also like a bad scenario. Before we get on the show as well, know that if you've been looking to figure out more information about lower back, piriformis, SI joint, hip flexors, and so on, I will go on to our description for the show, which has a free webinar that we cover in pretty good detail on that, more so than we would on a show and actually has demonstrations and models.

Now, the biggest mistake that people do make with conditions like lower back pain and lateral thigh pain is that they end up taking way too much time off and too much rest. I'm going to tell you the cost benefit associated to that today and hopefully you don't make the same mistake. Now, to be clear on this, everybody should be assessed and you should make sure that you're getting a diagnosis and get an idea of what you should be doing based upon that diagnosis. But with that being said, a lot of diagnosis actually could minimize, right? You could have minimal rest and still load around the area.

I'll give you an example. I had a hamstring tear. It actually bruised. If you've been listening to the show, you realize that I've recovered pretty, pretty well back to sprinting. But for the first three weeks, I wasn't really doing much of anything with loading the hamstring. I was loading around it. I was loading the quad. I loaded the glute. I loaded the calf. But I couldn't really do anything hamstring loading too much. And the same thing goes along with low back and lateral thigh issues or outer thigh issues. If the diagnosis merits that you can't load it, such as a tear, then yeah, strategic rest is appropriate.

But usually it's not for more than you think. It's not for months and months on end. It's usually about four weeks or so is pretty common. Six weeks probably at the max. But then you would strategically start to load a little bit, especially after the third week. Now, I think the biggest concern that people end up having why they react this way with excessive rest is because they are worried that they damage something and they don't want to do more activity to make it, quote unquote, damaged more. And I think that's fair. That's a pretty reasonable thought. But let's just think of the things that actually, when you do excessive rest, what happens?

You have the tissues around the entire leg, which get a little bit weaker. You lose some of your muscular gains, possibly. You lose motivation. You distrust the limb. Now, what you can do instead is you can load around the limb, like I mentioned, or load around the tissue, which is symptomatic tissue. And I'll give you an example of this, what this may look like from a low back perspective from different diagnoses. Now, let's just say it was a low back disc injury, which can refer to the outer side of the thigh, which is super common, not down past the knee. So it's probably not going to be like a nerve root involvement.

It's not a sciatica. It's probably just more discogenic referral is since we know that the injury is more at the disc, we may choose to limit spinal movement associated to whatever lift we're doing. So for an example, if we did a split squat or a non-moving lunge, just up and down like a piston, that actually is a very leg dominant movement. And so it may actually help out with reducing the amount of symptoms a person has because they're upregulating activity of the quad and the glute and so on. What we're not doing is we're not challenging the damaged tissue in that case or the sensitized tissue.

We're not encouraging them to round their back. Now, an area where we may have a little bit more of a problem is potentially something like a deadlift or a hip hinge movement. Now, if I had someone deadlift from a lower position, if they had discogenic lower back pain, the lower down they go, especially if they can't touch their toes and they may have some issues not involving their back in the lift itself. But you can actually get the hip upregulated. You can get more activity of the hip or the glute if you do a hip hinge without doing a spinal hinge, which is what a lot of people do and end up having lower back and lateral thigh pain.

So the way we do this is we just actually, you don't change anything about the weight too much and you just decrease the range. So you put the weight up on blocks, you do something called pin pulls, or you can just grab an object that's bigger, like a backpack or a deadlift with a hex bar or a trap bar is going to be easier in regards to height than something like a barbell. So those are all fair to do. You can even change more into a horizontal position like a barbell hip thruster or some other version of a hip thruster, which may work out okay too. But if this was a discogenic symptom, then what they could do is get away, get around, or they can not rest the leg, but they can rest the spine.

So stopping from doing things like sit-ups and Russian twists and V-ups and things that require the spine to move too much, especially under load, may be the thing that we decrease the amount of for about three weeks. So you don't have to fully shut it down, but you can shut down the one that's provoking and potentially go back to it later if you want. Now, let's just take this on the full flip side and say there's nothing wrong with the spine, the back and the MRI are okay, and everyone's deemed that the back is fine until you have a muscle strain on the outer side of the thigh, which is then making your back hurt a little bit.

And so in this scenario, if the strain is from overactivity, such as the lateral quad, is working too much, we may want to make sure that the other tissues that do move the weight also are working well too. So you can do things like, usually a hip test is pretty fair with this, like a bridge test. So if you're having problems with a, let's just say a squat pattern, making your lateral thigh and your back hurt, or a lunge pattern, which is kind of the same thing about squat patterns, then maybe potentially we need to make sure that the hip is involved in this as well. Now, this is not to say this is making the squat into a hip hinge, because that would be a different exercise, and it would make sense that it would probably hurt less.

You're using less of the tissue involved. But you can actually increase activity of the glute to see if it would take some of the work off the squat or lunge pattern, which it bothers you with anyways. So the way we may do this is in bodybuilding, I think we call it, it's called pre-tensioning or pre-fatiguing. And so what you do is you would do a ton of glute hip thrusters with like a band or a ton of clamshells or a ton of other glute exercises, which can help out with up-regulating activity and stiffness of that glute. And then you would go immediately back into the squat or the lunge activity with the same weight, same coaching, same everything.

And what you may notice is that actually this decreases pain immediately after because you've increased the amount of activity another tissue does with the same exercise. Now, the long game of it is not to necessarily make it so the quad doesn't work, because the only way to get your quad to grow big and be challenged is to challenge the quad, right? But in this scenario, with something like a squat or a lunge, it can't tolerate it. So for a short period, say three weeks, we make you more hip dominant rather than quad dominant, which will take work off of that tissue, which will make it so it'll repair itself faster.

And eventually you can start programming in more squat exercises or more lunge ones to challenge that tissue and you can start to get back at it again. So there's two basic scenarios. Number one is we stop challenging the spine, which could be referring to the area. Number two is we stop challenging the quad muscle, one of the quad muscles, which is overactive, which just needs a little bit of a break. Or the third thing is we can change your program overall. Now, I spoke to someone the other day where we were talking about how diagnosis are important, but they kind of, I don't want to say they don't matter, but they kind of like, like there's some diagnosis that people just kind of glaze over and they realize, oh, you know, it's actually my lifestyle and what I'm doing, which is creating this diagnosis, right?

And then if you do the right thing, the diagnosis goes away. It doesn't follow you around forever, unless in your medical records. But let's just say you had knee pain that was creating patellofemoral pain syndrome, but you were 300 pounds overweight. Now, I think it's common sense that if you lose the weight, you'll decrease the load on the knee, the knees in this case, both of them probably heard, and then you'll start to feel better. Now, that was a diagnosis of patellofemoral pain, but the solution was not treating the knee. The solution was taking load off of the knee when this case was with just body weight.

So what we can do is we can try to decrease the amount of load on that tissue with those two forementioned versions, but also we may take some of the load off of the tissue chronically if it's not prepared for it by just changing your exercise programming. And so what that may look like is taking a hard look at your exercise programming and seeing if it's too dominant in a knee dominant pattern or exercises that challenge. It's a simple solution. I remember I saw somebody the other day that we had discussed the possibility of his shoulder pain being related to a rotator cuff tear and so on. And yeah, he had an issue with his rotator cuff, but also he had it for years.

And so if you looked at his gym programming, though, you'll see that it was just 90% pushing exercises. I said, where's the pulling ones? And he said, oh, I just haven't done that for years because it was hurting my shoulder and I just stopped. And so I gambled and said, look, let's just not do pushing for the next week. Again, strategic rest. And then let's prioritize pulling patterns. And so I gave him freeing to do whatever was he wanted to, just as long as he was putting something in. So he came back after that and said that his shoulder pain had pretty significantly gone away. I think we ended up seeing him a total of two times and he has not reported any shoulder pain since.

It was mainly because he was, quote unquote, being overweight on his push patterns. So in that case, his exercise programming was a big issue with it. So I hope this was a good podcast to give you guys some insight about how to, three ways to manage conditions like lower back pain and lateral thigh pain. If you guys want some help, we do have discovery sessions available for a very reasonable cost. Right now they're, they're about, they're $29 for 30 minutes, but I can't say it'll be happening forever. You can find our contact in the description below and we are licensed to do this in multiple different states.

So just reach out and see if your state's on the list. We'll see you next time.