Weight Training and Lower Back Pain

Mind the Weights, Mind Your Form, and Prevent Injury

Okay, I know you: the gym is where you live between work and your bed. You pride yourself on ripped abs, thrashed glutes and cut quads. You could strum your serratus, pound nails with your pecs, and break bricks with your biceps. You know the drill: 6 plates and the bar is bending, steam comes off your chest, and maybe some people stop to watch. Okay, you know the rest: there’s the lift, the sudden loss of balance, the “uh-oh” moment, then “clunk, snap, pop,” the dropped weight, the lightning bolts to the buttocks and thighs, and the mat comes up to meet you. This follows with the writhing spasm, the crawl to the sauna, the stretch, the ice and the Advil. Maybe you borrow someone’s Vicodin, or maybe you had some left over from the last injury. This lasts a day, a week or a month. Maybe it’s the first time, maybe the third time this year. What happened, and how can you avoid it?

Low back pain is one of the most common health problems in society and causes considerable disability, work absenteeism, and use of health services. It is said to affect 50% to 80% of us in our lifetime and 15% to 30% of us at any given time. During any 6-month period, 72% of adults in the general population will report lower back pain and 11% will report disabling lower back pain. Differentiating between the type of pain that occurs spontaneously and that which follows a sports injury is sometimes difficult, as not all patients recall a specific event that caused pain.

With the general and extremely common nature of lower back pain, consider that, among patients who frequent the gym, and particularly weight training sports, certain patterns of complaints emerge. In my practice, as a spine surgeon accepting referrals from the community, there are certain weight training maneuvers that generate the majority of injury: deadlifts, squats, and the clean-and-jerk.

These techniques I’ve mentioned include movements with the highest degree of technical difficulty, which, if performed incorrectly, will expose vulnerable lumbar muscles and discs to high strain, shear and axial loading. “I hurt my back trying for personal best on the deadlift” is a comment I hear weekly. I hear similar comments about squats and cleans too. The underlying commonality is overloading lumbar extensor muscles. These injuries are much more-likely during high velocity, rapid muscle contractions, and much less-likely in isometric and static contractions.

The most common scenarios include the new weightlifter with poor form, the over-confident lifter taking on too big a weight, and the seasoned pro suffering from overuse training injuries.
Even with the best coaching and form, the notion that “avoiding a rounded back” or “lifting straight on the rack” will prevent loading of discs is, unfortunately, a stretch (no pun). Regardless of the presence of perfect form and execution, loads through a vertebral disc space when lifting over 100% of personal body weight can exceed the stress-to-failure strength of disc and tendon collagen. This results in tearing of cartilage and collagen.

What happened in the scenario above? The explanation is not simple but the basics are as follows – muscles failed because loads were excessive. Some animal studies suggest the earliest injury is tearing of the sarcomere (muscle unit) cell-wall. Some studies suggest that, contrary to perception, injury is more likely to occur when a muscle is lengthening under load (an eccentric contraction).

Perhaps the muscle is over-taxed resulting in buildup of lactic acid and depletion of adenosine triphosphate (ATP) and glycogen stores. At the larger scale, muscle loading combined with injury, a tetanic contraction occurs (the muscle cannot relax) and this results in severe pain all along the muscle fibers and attachments. The muscle injury ranges from a micro cellular disruption at the low end to tendon avulsion injuries or muscle tears at the high end. Inflammation ensues, muscles and tendons become sore, swollen or sometimes bruised. Pain radiates from the lower back to the legs – muscles cannot hold up body weight and the reflex action of the body is to fall to the ground. This is the acute or sudden muscular injury.

In the athlete with recurring pains, it is thought that chronic disruption of collagen attachments to bone can result in further susceptibility to injury. It may also be that recurring bad habits in training can result in recurring injury. This is the familiar, “I’ve got a muscle that I keep reinjuring,” or “this happens every-time I do squats.” It might be useful to remember that in some animal studies, a disrupted knee ligament did not reach pre-injury strength for 9 months.

Although many people will refer to this severe lower back pain as “sciatica” or a “pinched nerve,” this is rarely the case. It’s important to note, as an aside, that the sciatic nerve is rarely compressed in these types of injuries, and pinched nerves occur only when there is documented disc herniation or spinal stenosis (narrowing of the spinal canal). True pinched nerves from a disc herniation cause numbness, tingling and weakness as well as radiating pain. Only an MRI can confirm this and is most predictive of injury when combined with corroborating physical findings of loss of strength, atrophy, numbness and limb reflex changes.

Injuries with weight training can occur whether you are a pro in a strongman competition or just an enthusiast (if there is such a thing.) As an example, in an article in Journal of Strength & Conditioning Research¹, it was reported that Eighty-two percent of strongman athletes reported injuries (1.6 ± 1.5 training injuries per lifter per year, 0.4 ± 0.7 competition injuries per lifter per year, and 5.5 ± 6.5 training injuries per 1,000-hour training). Lower back (24%), shoulder (21%), bicep (11%), knee (11%), and strains and tears of muscle (38%) and tendon (23%) were frequent. The majority of injuries (68%) were acute and were of moderate severity (47%).

Strongman athletes used self-treatment (54%) or medical professional treatment (41%) for their injuries. Although 54% injuries resulted from traditional training, strongman athletes were 1.9 times more likely to sustain injury when performing strongman implement training when exposure to type of training was considered. Interestingly, stretching regularly and being in shape and training consistently were not necessarily protective. Monitoring form and adherence to a careful training regime was preventative.

What exercises are least likely to produce injury? I’ve rarely seen a chronic injury from performing leg lifts, crunches or planks (unless the supports gave way). Abdominal muscle injury can occur with overzealous or excessive weights. These exercises are safer because they are lower velocity, shorter lever arm and concentric contractions (excepting crunches). Lower lumbar disc pressures are seen with these exercises as well. Isometric plank exercises increase core strength and are protective against lower back injury.

What’s the treatment for severe lower back pain? Prevention of injury is the best medicine. Maintain an appropriate body weight. Lift weights within reason and within prior ability. Advance slowly and methodically. Use excellent form, which can only come from excellent coaching. Do not train when injured. For the acute injury, the basics always help. Simple therapies such as initial icing, rest, subsequent heat, stretching and over the counter anti-inflammatories work well. Do not weight-train when hurt, change to aerobics for a week. Avoid chronic pain by avoiding chronic re-injury. There is no shame in training at 30% of your max for a while. Seek medical evaluation from a board-certified spine surgeon if back pain lasts more than a week, or if numbness, tingling, or weakness occurs.

About Michael L. Gordon, M.D.

Dr. Michel L. Gordon is a board-certified orthopedic spine surgeon at Hoag Orthopedic Institute in Irvine. Dr. Gordon specializes in a range of spine surgeries from minimally invasive spine surgery to complex spinal deformities of the cervical and lumbar spine.

Sources:

¹ Journal of Strength & Conditioning Research: January 2014 - Volume 28 - Issue 1 - p 28–42