By Marisa A. Colston, Ph.D., ATC
The benefits of weight lifting are numerous and range from burning fat to the improvement of mental health, heart health and bone health. Weight lifting can also minimize back pain, especially the pain and stiffness resulting from sitting at a desk all day. However, protecting your back while lifting weights is important, particularly if you have a history of back pain. Previous low back injury presents a 3-6 times greater risk of future injury. Guidelines for the management of back pain consistently recommend staying physically active and avoiding bed rest. But how do you do so, without further aggravating the back pain?
Many back problems are worsened by poor training programs, where the cause of injury is unknowingly incorporated into the lifting technique. The most frequent contributing factors to back injury in lifting weights include extreme flexion (hyperflexion), extreme extension (hyperextension), and rotation (torsion). Hyperflexion occurs when the low back is allowed to round, and then the weight is jerked up; e.g., rows, dead-lifts, and bent barbell rows. Hyperextension places excessive compression on the posterior aspects of the vertebrae. Thus, exercises such as the bench press, unsupported overhead press, power clean, ballistic back extensions, prone leg curls, and squats must be used with caution and supervised closely. Rotational or twisting-type activities frequently occur in combination with flexion or extension, which places the spine in an extremely vulnerable position.
Numerous exercise programs emphasize training the core. The core is comprised of the low back, pelvis, and hips. Muscles around the core function differently than arm and leg muscles, and therefore should be trained differently. Core muscles function to brace the trunk during motion, acting more as stabilizers, than movement generators. Initial exercise can be done with just your body weight and then resistance can be added to increase the challenge. Planking exercises are an excellent way to work multiple muscle groups without high loads to the spine. A forward plank requires weight bearing through the forearms and toes, with the body maintained in a horizontal position elevated above the ground. A side plank is performed with legs extended and feet and hips resting on the ground and stacked on top of each other. The elbow is placed under the shoulder to prop up the torso. Then the core is contracted and the hips and knees are lifted off the floor (perform on both sides). Plank exercises can be held for 10-30 seconds, gradually working up to a minute.
For dynamic (movement) exercise, power should be generated through the hips which is transmitted through a contracted core. This is quite different from challenging the core muscles, such as the abdominal muscles, through repeated spine flexion or rotation, which is not a good way to train the core. Activities that emphasize a push, pull, lift or carry enhance hip power generation through a stiffened core. Programs should incorporate exercises that fulfill these tasks, rather than isolating specific muscles of the abdomen or back which create ‘energy leaks’ through bending. More motion in the back may increase injury risk. Strength without control increases the risk for injury, as well as a lack of endurance to repeatedly execute movements with perfect form.
An important point to remember is that the intervertebral disc, and the spine in general, has only a limited number of bends before damage occurs. These bends should not be used up in exercise programs. This requires creative exercise design to challenge the trunk and core, without excessive flexion, extension, or rotation. Unfortunately, there are currently no validated guidelines for lifting volume. We simply do not know ‘how much weight is too heavy’ or’ how many lifts are too many’. What is known, however, is that the risk of lifting-related back injury increases as the demands (load and frequency) of the task increase. Increases in load elevates spine and intervertebral disc compression forces. In the work setting, the load is one of the strongest risk factors for low back injury. This risk increases substantially when movement mechanics are not optimal.
Finally, the presence of muscles imbalances should be addressed before jumping into a weight training program. For example, an individual who has tight hip flexor muscles will frequently have weak hip extensor (gluteal) muscles. This is a concern because if the gluteal muscles are weak and inhibited, the likelihood to overcompensate by using the hamstring muscles to extend the hip increase, thereby increasing the possibility of a hamstring injury. When muscle imbalances exist, it is important to first stretch the muscles that are tight before strengthening the muscles that are weak. Obtaining full motion of tight muscles ensures that the strength aspect of the program will not occur in a limited range of motion.
Weight lifting and strengthening exercises can help reduce back pain, but avoid focusing on just the muscles of the back. Resistance exercises that include the core, arm and leg muscles will lead to overall body strength which will help to reduce back pain and reduce the risk of back injury.
Sources:
Almoallim H, Alwafi S, Albazli K, et al. A simple approach of low back pain. Intern J Clin Med. 2014;5:1087-1098.
Bouwmeester W, van Enst A, van Tulder M. 2009; Goertz M, Thorson D, Bonsell J, et al. 2012).
Dugan S. The role of exercise in the prevention and management of acute low back pain. Clin Occup Environ Med. 2006;5(3):615-32.
Goertz M, Thorson D, Bonsell J, et al. Adult acute and subacute low back pain. Bloomington, MN: Institute for Clinical Systems Improvement. 2012:1-91.
McGill S. Core Training: Evidence Translating to Better Performance and Injury Prevention. Strength Cond J. 2010. 32(3): 33-46
Marisa Colston Contact
Marisa Colston is the interim Department Head and Athletic Training faculty in the Department of Health and Human Performance and Athletic Training Faculty at the University of Tennessee at Chattanooga. Marisa’s research focuses on low back biomechanics, injury prevention and management, as well as legal, ethical, and regulatory issues in sports medicine. Marisa enjoys outdoor activities such as running, hiking and biking with her husband and son.