By Dr. Michael Gordon
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, break bricks with
your biceps — and as the plated bar bends, some people stop to watch
the steam come off your chest.
What happens next is all too common: There’s the lift, the sudden
loss of balance, the “uh-oh” moment before a “clunk,
snap, pop,” and the dropped weight, lightning bolts to the buttocks
and thighs, and the mat coming 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, sometimes even a month. Maybe
it’s the first time. Or maybe it’s the third time this year.
So what happened, and how can you avoid it?
IDENTIFY YOUR PAIN
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 percent to 80 percent of us in our lifetime, and
15 percent to 30 percent of us at any given time. During any 6-month period,
72 percent of adults in
the general population will report lower back pain and 11 percent will report disabling lower
back pain. Differentiating between the type of pain that occurs spontaneously
and that which follows a sporting 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 the 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,
These techniques I’ve mentioned include movements with the highest
degree of technical difficulty, which, if performed incorrectly, will
expose vulnerable lumbar muscles and disks 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 the clean, too. The underlying
commonality is overloading lumbar extensor muscles , the very large muscle
groups that work to stand you up from a bent forward position. These injuries
are much more likely to occur during high velocity, rapid muscle contractions,
and much less likely to occur in isometrics. The latter are low velocity
and relatively-static contractions where the joint doesn’t move
much — think of planks.
The most common scenarios include the neophyte 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 disks is, unfortunately, a stretch (no pun intended).
Regardless of the presence of perfect form and execution, loads through
a vertebral disk space when lifting over 100 percent of personal body
weight can exceed the stress-to-failure strength of disk and tendon collagen.
This leads to tears in fibrocartilage and collagen, two structural components
that are responsible for anchoring muscles to bone not unlike like tow
ropes or cables on a car.
What happened in the scenario above? The explanation is not simple but
the essential idea is that the muscles failed under excessive loads. Some
animal studies suggest that the earliest injury involves 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 ATP — the energy
molecules that run our muscles and glycogen stores.
Photo courtesy of Pixabay
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.
CHRONIC PAIN PROBLEMS
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
re-injuring,” or “This happens every time I do squats.” Some
animal studies have suggested that it takes 9 months for a disrupted knee ligament to
return to its pre-injury strength. A hypothesis of chronic back pain:
ligament sub-failure injuries lead to muscle control dysfunction. This
is to sa y injuries to ligaments that are just below rupture, as with
fraying, leads to pain in muscle contraction and then poor muscle coordination.
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 disk herniation or spinal stenosis (narrowing of the spinal
canal). True pinched nerves from a disk herniation cause numbness, tingling
and weakness, as well as radiating pain. And this type of injury is often
in combination with loss of strength, atrophy, numbness, and limb reflex
changes. It can also only be confirmed by an MRI.
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 published in the
Journal of Strength & Conditioning Research , 82 percent of strongman athletes reported a smorgasbord of injuries:
Lower back (24 percent), shoulder (21 percent), bicep (11 percent), knee
(11 percent), and strains and tears of muscle (38 percent) and tendon
(23 percent) were the most frequent. And the majority of these (68 percent)
were acute and of moderate severity (47 percent).
Strongman athletes used self-treatment (54 percent) or medical professional
treatment (41 percent) for their injuries. In fact, 41 percent of the
time, strongman athletes injured themselves enough to require medical
treatment. 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.
Weight training isn’t all bad news. 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
disk pressures are seen with these exercises as well. Isometric plank
exercises increase core strength and can also protect against injury.
And if you want to avoid severe lower back pain, prevention, as with most
things, 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. Most
importantly, do not train when injured. If you are, change to aerobics
for a week.
Simple therapies, such as initial icing, rest, subsequent heat, stretching
and over-the-counter anti-inflammatories work well for acute injuries.
Avoiding chronic pain means avoiding chronic re-injury. There is no shame
in training at 30 percent of your max for a while if in the end it means
you bounce back quicker and possibly stronger than before. That said,
if pain lasts more than a week, or if numbness, tingling, weakness occurs,
don’t hesitate to seek out a medical evaluation.
Dr. Michael L. Gordon is a spine surgeon at Newport Orthopedic Institute & Hoag Orthopedic
Institute in Irvine and Newport Beach, California. He specializes in minimally-invasive
surgery of the cervical and lumbar spine in adults. To stay fit, Dr. Gordon
tries to balance work with a minimum of 5 hours a week in the gym. He
is an avid cycler, skier and ex-runner who’s replaced the pavement
with an elliptical as an inevitable compromise with the old ACL injury.