The first 72 hours
The lock-up you get in the first day is protective. Muscles around one segment stiffen to stop you moving it, which is why getting out of a chair or off the Central line seat feels worse than the set that caused it. That guarding is doing a job for about 48 hours, and after that it starts costing you.
The target for the first three days is short, frequent movement at a level that does not spike the pain. Ten minutes of walking every couple of hours beats one long walk, and beats lying flat for a day by a wide margin.
Day by day
- Day 1. Walk ten minutes every two hours. Change position roughly every twenty minutes. Heat over the area for comfort. Keep training anything that does not load the spine.
- Day 2. Usually the stiffest day. Same walking pattern, and add gentle hip and knee movement: supported squats to a box, hip hinges with no weight, cat-cow. Expect it to feel tight rather than sharp.
- Day 3. Start loading. Goblet squat with something light, a hip hinge to a dowel, a farmer carry for twenty metres. Mild discomfort that settles within an hour afterwards is the green light to continue.
- Day 4 to 7. Add weight in steps you would call boring. Roughly half of what you were pulling, then 60 per cent, then 70, one step per session.
People who keep moving in the first week get back to their pre-injury lifts faster than people who wait for the pain to reach zero first. Complete rest lets the guarding set, and the sensitivity that follows a week of stillness feels exactly like fresh damage, which is what sends most people back to square one.
What you can still train
Stopping everything for a fortnight costs you conditioning you then have to rebuild, and it makes the return harder than the injury did. The rule is simple: train what does not load the lumbar spine under compression, and train it properly rather than going through the motions.
Usually fine inside the first week
- Upper body pressing and pulling with your chest supported. Chest-supported rows, incline press, cable work seated.
- Single-leg work with light load: split squats, step-ups, calf raises.
- Anything on a bike or a cross-trainer at conversational effort.
- Carries. A suitcase carry with a moderate weight is a genuine trunk exercise and most people tolerate it early.
Leave the barbell deadlift, heavy back squat, bent-over row and loaded rotation alone until you can hinge with a dowel and feel nothing sharp. Those come back in the second week for most people.
Getting back under the bar
Reload by pattern first and weight second. The hinge is the pattern that went, so it gets rebuilt before the number goes back on the bar.
A workable progression across two weeks: dowel hinge, then a kettlebell deadlift from a raised block, then a trap bar or a rack pull at knee height, then the full-range pull. Move up when the previous step produces no next-morning flare, which usually means one step every two or three sessions.
The numbers that keep this honest
- Stay at or below a 4 out of 10 during the set.
- Whatever you feel should settle back to baseline within an hour of finishing.
- No worse the next morning. A stiff first ten minutes is normal, and a stiff whole day means you moved up too fast.
- Expect 70 to 80 per cent of your old working weight by week three, and the rest over the month after.
When it is more than a strain
Most lifting-related back pain sits in muscle, fascia and the joints between segments, and it behaves the way described above. A smaller group involves a nerve root, and that one changes the plan rather than the timeline.
The tell is where the pain travels and what comes with it. Pain that runs below the knee in a defined line, with pins and needles, numbness or genuine weakness in the foot, needs assessing rather than loading. Same for pain that wakes you every night regardless of position, or pain that is worse after two weeks than it was on day three.
Stop and get seen if
- Numbness around the groin, the saddle area or the inner thighs.
- Any change in bladder or bowel control.
- Weakness in both legs, or a foot that drags or slaps when you walk.
- Fever, unexplained weight loss, or a history of cancer alongside new back pain.
- Pain that followed a genuine fall or crash rather than a lift.
Straight answers
Should I get a scan?
For a back that went during a lift and behaves like a strain, a scan almost never changes what you do next. Disc bulges and degeneration show up in large numbers of people with no symptoms at all, so a finding on a report is difficult to pin to your pain.
Imaging earns its place when there is a clear nerve pattern that has not improved over six weeks, or when any of the red flags above are present.
How long until I can deadlift heavy again?
Most people are pulling a moderate weight in week two and back near their old working sets between weeks four and six. The variable that moves that date is whether you loaded gradually from day three or rested for a week and then tested it.
Is it worth getting hands-on treatment, or will it settle anyway?
Most of these settle either way. Soft tissue work, dry needling and mobilisation are useful for opening a window where you can move and load more comfortably, which brings the loading phase forward by days. The loading is what builds the capacity that stops it happening again.
The other reason to be assessed is to confirm which of the two patterns above you have, because they get handled differently and guessing wrong costs weeks.