Dr. Austin Baraki is a medical doctor, strength coach, and competitive powerlifter. Here are his thoughts on dealing with tweaks, pains, strains, and other issues.

[During a routine barbell training session], I had programmed myself to work up to one heavy set of 5 on beltless pause squats. I worked up to 500×5 without any issues, and decent technique (other than too-short pauses).

However, after the set I began to feel significant low back pain, similar to prior “strains” and “tweaks” I’ve experienced. It persisted through the evening, overnight during sleep, and through the next day.

I didn’t panic, agonize over what could have happened, how I could have prevented it, or when I’m ever going to be able to lift again. I knew that sometimes these things just happen, maintained confidence that there wasn’t anything seriously wrong, and knew that it would improve on its own.

The next day, I began warming up for my 1.5” deficit deadlifts normally. I gradually worked up to this PR set of 5 with minimal symptoms during the set and no significant exacerbation afterwards.

Fear and Expectation have HUGE influence on symptoms and outcomes in people experiencing pain. One of the strongest predictors of who will improve the most/fastest are those who have the best expectations… NOT whether it’s your “SI” or “QL”, what type of manual therapy, stretching routine, or even what exercise program you do.

For someone experiencing pain, fear, and negative expectations (like expecting their pain to “flare up” in the gym), working them through a process like this under close guidance and reassurance shows them that they CAN, in fact, move without severe symptom exacerbation. This is known as Expectancy Violation, and is a useful tool in altering expectations and facilitating better outcomes.

Think back on your own experience: what thought processes/patterns do you have that might be influencing your symptoms and outcomes? Try to take control of them!

– Dr. Austin Baraki

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1.5” Deficit Deadlift PR: 560×5 😈 • On Thursday of this week’s training, I had programmed myself to work up to one heavy set of 5 on beltless pause squats (shown in second video). I worked up to 500×5 without any issues, and decent technique (other than too-short pauses). • However, after the set I began to feel significant low back pain, similar to prior “strains” and “tweaks” I’ve experienced. It persisted through the evening, overnight during sleep, and through the next day. • I didn’t panic, agonize over what could have happened, how I could have prevented it, or when I’m ever going to be able to lift again. I knew that sometimes these things just happen, maintained confidence that there wasn’t anything seriously wrong, and knew that it would improve on its own. • Fear and Expectation have HUGE influence on symptoms and outcomes in people experiencing pain. One of the strongest predictors of who will improve the most/fastest are those who have the best expectations … NOT whether it’s your “SI” or “QL”, what type of manual therapy, stretching routine, or even what exercise program you do. • The next day (today), I began warming up for my 1.5” deficit deadlifts normally. I gradually worked up to this PR set of 5 with minimal symptoms during the set and no significant exacerbation afterwards. • For someone experiencing pain, fear, and negative expectations (like expecting their pain to “flare up” in the gym), working them through a process like this under close guidance and reassurance shows them that they CAN, in fact, move without severe symptom exacerbation. This is known as Expectancy Violation, and is a useful tool in altering expectations and facilitating better outcomes. • Think back on your own experience: what thought processes/patterns do you have that might be influencing your symptoms and outcomes? Try to take control of them!

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I don’t know if it’s meme-based medicine, a need to always have an answer when a patient asks, or ego that says they MUST know regardless of actual knowledge that causes this.

The medical profession overall is wonderful at dealing with trauma and medication-based solutions, and god-fucking-awful at dealing with chronic conditions – including aging – that aren’t readily routed around with a pill or injection.

There are a phenomenal number of doctors who have little knowledge of either weight training or nutrition and yet authoritatively opine to their patients complete nonsense on both topics rather than using that magical phrase “I don’t know.”

– Steve Klein

Association between muscular strength and mortality in men: prospective cohort study
https://www.bmj.com/content/337/bmj.a439