The Masters Lifter Whose Back Catches at Lockout
A 47-year-old masters powerlifter (4 sessions/week, conventional deadlift 1RM 205 kg, competing in 5 weeks) reports 6 weeks of right-sided low back "catch" that appears only at terminal hip extension. No radiating symptoms, no night pain, no unremitting pain, no change in bladder or bowel function; it settles within a minute of stopping. Screen: cervical flexion FN; cervical rotation right DN; upper extremity pattern 2 DP (left shoulder, familiar pinch at end range); multi-segmental flexion FN; multi-segmental extension DP, with pain reproduced at L4-L5 on the right, and he stops well short of what you judge to be true end range; single leg stance right DN with a hip drop, left FN; overhead deep squat DN with heels rising and loss of thoraco-lumbar extension. He wants to know whether he can keep pulling heavy this week.
1. Assign the score for each pattern and state what each score obliges you to do next, including the two painful patterns.
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FN (cervical flexion, multi-segmental flexion): cleared patterns. Nothing further. They are not treatment targets and should not be "prehabbed" to fill time.
DN (cervical rotation right, single leg stance right, overhead deep squat): non-painful dysfunction. The score tells you the pattern is limited, not why. Each obliges a breakout into the contributing segments. Overhead deep squat is the exception in practice: it is a composite, so it is your re-test rather than a treatment target.
DP (multi-segmental extension, upper extremity pattern 2): pain changes the decision rule. A DP is not a stretch target and not evidence that the tissue is short. You first screen referral criteria; by history he is clear (mechanical, reproducible, brief, no night or neuropathic features). You then manage pain first and use only pain-free breakouts to hunt the driver.
Priority: multi-segmental extension drives his sport goal, is painful, and is fed by the right single leg stance dysfunction. Upper extremity pattern 2 is painful but irrelevant to lockout, so protect it and defer. Count of DNs is not a treatment plan.
2. Sequence the first two sessions. What do you do first, what do you deliberately leave alone, and why?
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Session 1 - information and pain control. Do not repeatedly provoke multi-segmental extension to end range; each repetition feeds the DP and degrades the reliability of what you find. Instead run pain-free extension breakouts: prone hip extension with control, thoracic extension over a bolster, lumbar extension dissociation. The question is whether the limitation is hip-driven (supported by the right hip drop in single leg stance and by his deadlift lockout) or thoracic-driven. Leave upper extremity pattern 2 alone except to confirm it stays pain-free. Leave multi-segmental flexion alone, it is FN.
Session 2 - dose the driver. Begin low-irritability motor control and mobility at whichever segment limited the breakout, 2 x 10, pain-free, with an immediate re-test of multi-segmental extension. If the re-test improves within session, you have found the driver. If nothing changes the pattern, question whether the pain is still the dominant variable.
Rationale: pain trumps dysfunction in the SFMA model; a painful pattern produces unreliable breakouts, and stretching into pain in a 5-week competition window is how you create the flare that ends the block.
3. What is your week-1 loading advice for the deadlift, and what would make you change course?
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Loading: not "stop pulling." Keep him pulling in ranges and at loads that do not reproduce the lockout catch - block or rack pulls stopping short of terminal extension, tempo work, and reduced intensity with full technique. Avoid maximal terminal hip and lumbar extension under load until multi-segmental extension is no longer painful.
Change course if: the pain stops being mechanical (night pain, unremitting pain, radiating or neuropathic symptoms, bladder or bowel change) - refer; the extension pain does not settle within 2-3 weeks of pain-free work - refer rather than persist; or the pattern becomes non-painful but stays dysfunctional - that is the signal to push the restriction hard with breakouts, because you can now work into range.
Documentation: baseline scores with symptom response, the decision to defer upper extremity pattern 2 and why, the load restriction given, and the re-test date. Record the competition date as a constraint in the plan so the next clinician understands the trade-offs you made.