Do Weight Lifters Get More Back Pain than those Who Don’t Lift Weights?

What prompted this blog was a discussion with a patient about whether they should continue lifting weights after hurting their back in the gym. In this case the pain came on while squatting; however, another commonly reported cause of back pain is deadlifting.

Do weightlifters get more injuries by Naas Physio & Chiropractor

Firstly, I think it is important to get an overview of the overall injury rates in weightlifters in comparison to athletes in other sports. The evidence seems to suggest that injury rates in weightlifters are similar to other non-contact sports also requiring strength/power, but low compared to contact sports. The most commonly injured regions from weightlifting are the spine, shoulders & knees (Aasa et al. 2017; Siewe et al. 2011).

The next question of interest is:

  • Does weight lifting create structural changes in the spine i.e. arthritis or disc damage?
    &
  • Do these anatomical changes correlate with pain?

One study attempted to address these queries by analysing 12 adolescent weightlifters (6 boys & 6 girls) over a period of 2 years. Based on annual MRI scans, the researchers reported finding abnormal findings on MRI examinations reflective of early stage degenerative changes. All bar one of the participants demonstrated disc bulges on the scan. The authors reported that the weightlifters displayed irreversible structural changes in the spinal joints. Significantly though, these changes present on the MRI scans did no correlate in any way with actual back pain or other symptoms. (Shimozaki et al. 2018).

Of course, this phenomenon of changes on MRI scans showing very little or no correlation with pain is well recognised by the scientific community.

This is yet another example of how ineffective MRI scans of the spine are in identifying the source of back pain!

Coming back to our original case of pain after lifting weights: in this case, the patient reported that he had stopped squatting because of back pain. So the important question is this: is avoidance the best approach or should you challenge yourself to work through the offending exercise?

An analogy I often like to use in a case like this is that of an athlete who tears their hamstring while running. Should that person then avoid running in the future. After all, if they stop running, they are unlikely to tear their hamstring again!

Another common example I hear is that of someone injuring their back while performing a menial task like lifting a bag. So, should the woman who hurts their back while lifting their handbag never perform this lift again? It wouldn’t be particularly logical would it?

Should I Avoid Lifting if I Have Back Pain?

Is it different when it comes to lifting very heavy weights you might ask. Should a weight lifter avoid the exercise or start using a belt to ‘support’ their back while lifting heavy?

Research into the use of back belts shows no benefit in terms of back pain prevention. One study actually suggested an increase in back injury rate when powerlifters utilised a weight belt so we can safely rule this out as a solution to your problem.

Over the years, I have come across people who repeatedly injure themselves while lifting heavy weights; however, this is reasonably rare, and most people should be able to continue with the offending exercise without excessive risk. For some people, either due to technique issues or negative structural changes in the joints from years of lifting weights, they may choose to avoid the activity altogether. Generally speaking, however, the more we condition ourselves to an activity the lower our risk of injury when performing that activity in the future.

Does weightlifting increase the risk of back pain by Naas Physio & Chiropractor

Should I Continue Deadlifting if I Developed Back Pain?

Historically I have encountered 3 types of people who have injured their backs while deadlifting:

  • People who are new to deadlifting
  • Those setting up for a record lift, either in terms of weight or volume
  • Those who have a chronically poor lifting technique. These individuals have often trained for years and will get intermittent injuries to the back once or twice per year. Many times, this type of person is an experienced lifter who has a decent lifting technique with moderate weight but this breaks down when they ‘overreach’ on very heavy lifts which causes them pain.

Generally speaking, the first two categories should be able to continue with the offending exercise in a graduated form while paying attention to technique and avoiding significant increases in the weight being lifted.

The long-term lifter who has repeatedly hurt themselves while lifting may get to a point where the risk-to-reward ratio is no longer in their favour. In this case, I will often ask the client: do you need to do this exercise? Is it vital for your sporting performance? In most cases the answer is no, and so it is a relatively easy decision to omit the offending exercise from your routine.  

In many cases, modifying the exercise or even coming up with a similar movement but with lower load exposure, such as would happen with a single-leg or single-leg dominant lift is the answer for that athlete.

 

Does Weightlifting or Exercise Help Prevent Reoccurence of Back Pain?

Study Title: Fernández-Rodríguez R, Álvarez-Bueno C, Cavero-Redondo I, Torres-Costoso A, Pozuelo-Carrascosa DP, Reina-Gutiérrez S, Pascual-Morena C, Martínez-Vizcaíno V. Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis. J Orthop Sports Phys Ther. 2022 Aug;52(8):505-521. doi: 10.2519/jospt.2022.10671. Epub 2022 Jun 19. PMID: 35722759.

This research analysis attempted to identify the best exercise options for reducing pain & disability in adults with chronic back pain. 118 trials involving almost 9710 participants were included.

Most forms of exercise were found to be beneficial for improving pain and disability. Interestingly, stretching exercises were found to be ineffective for reducing pain.

Study Title: Owen PJ, Miller CT, Mundell NL, Verswijveren SJJM, Tagliaferri SD, Brisby H, Bowe SJ, Belavy DL. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br J Sports Med. 2020 Nov;54(21):1279-1287. doi: 10.1136/bjsports-2019-100886. Epub 2019 Oct 30. PMID: 31666220; PMCID: PMC7588406.

This research team utilised records from 89 studies involving over 5,500 patients.

From pooling the data they concluded that resistance & stabilisation exercises rated highest for physical function, pilates ranked highest for pain reduction, & resistance & aerobic exercise ranked highest for mental health; however, the quality of the synthesised evidence was low according to the authors.

 

Study Title: Nambi G, Abdelbasset WK, Alqahtani BA, Alrawaili SM, Abodonya AM, Saleh AK. Isokinetic back training is more effective than core stabilization training on pain intensity and sports performances in football players with chronic low back pain: A randomized controlled trial. Medicine (Baltimore). 2020 May 22;99(21):e20418. doi: 10.1097/MD.0000000000020418. PMID: 32481345; PMCID: PMC7249999.

Sixty university football players with chronic low back pain were divided into 3 groups who performed their respective exercise routines over a 4 week period.

  • Isokinetic group (IKT; n = 20) (Isokinetic machines apply resistance that adapt to your capacity through the movement. This would be most closely aligned to using free-weights in a real-world scenario)
  • Core stabilization group (CST; n = 20),
  • A control group (n = 20)

The clinical outcome measures used included pain intensity as well as sports performances (40 m sprint, 4 × 5 m sprint, submaximal shuttle running, counter movement jump, and squat jump) scores were measured at baseline, after 4 weeks, 8 weeks, and 3 months.

After four weeks of training the isokinetic training group showed a greater reduction in pain intensity versus the control group. The sports performance variables mentioned also showed a significant improvement in the isokinetic group when compared to the other 2 groups.

 

Study Title: Grooten WJA, Boström C, Dedering Å, Halvorsen M, Kuster RP, Nilsson-Wikmar L, Olsson CB, Rovner G, Tseli E, Rasmussen-Barr E. Summarizing the effects of different exercise types in chronic low back pain – a systematic review of systematic reviews. BMC Musculoskelet Disord. 2022 Aug 22;23(1):801. doi: 10.1186/s12891-022-05722-x. PMID: 35996124; PMCID: PMC9394044.

The findings from this research, incorporated 45 studies, shows that the effect of various exercise types, including resistance training, TCE, MCE, pilates & yoga, when used to treat pain and disability varies with no major difference between exercise types.

 

Study Title: Fischer SC, Calley DQ, Hollman JH. Effect of an Exercise Program That Includes Deadlifts on Low Back Pain. J Sport Rehabil. 2021 Feb 24;30(4):672-675. doi: 10.1123/jsr.2020-0324. PMID: 33626500.

This study investigated the effectiveness of an exercise programme that includes deadlifts on back pain.

The authors concluded that ‘Exercise programs that include deadlifts can yield improvements in both pain and function for those living with low back pain but were not found to be more beneficial than low load motor control exercises.’

Strength of Recommendation: Level B evidence exists that exercise programs that include deadlifts are a clinically effective option for the treatment of low back pain for both pain scores and functional outcome measures.

 

Study Title: Tataryn N, Simas V, Catterall T, Furness J, Keogh JWL. Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis. Sports Med Open. 2021 Mar 8;7(1):17. doi: 10.1186/s40798-021-00306-w. PMID: 33683497; PMCID: PMC7940464.

This research compared exercise programmes that emphasised the muscle groupings of the lower back, glutes & hamstrings (collectively referred to as the ‘posterior chain’).

Eight articles with a total of 408 participants were included.

The authors concluded that their results indicated that 12-16 weeks of posterior chain resistance training had a significantly greater effect than general exercise on back pain & disability.yh

No differences in the number of adverse events were reported between both groups.

 

Study Title: Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006 Mar 14;174(6):801-9. doi: 10.1503/cmaj.051351. PMID: 16534088; PMCID: PMC1402378.

This study reviewing all the available research (called a systematic review) came to the conclusion that resistance training was superior to general exercise over 12 to 16 weeks when treating individuals with chronic back pain.

References:

Aasa U, Svartholm I, Andersson F, Berglund L. Injuries among weightlifters and powerlifters: a systematic review. Br J Sports Med. 2017 Feb;51(4):211-219. doi: 10.1136/bjsports-2016-096037. Epub 2016 Oct 4. PMID: 27707741.

Fernández-Rodríguez R, Álvarez-Bueno C, Cavero-Redondo I, Torres-Costoso A, Pozuelo-Carrascosa DP, Reina-Gutiérrez S, Pascual-Morena C, Martínez-Vizcaíno V. Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis. J Orthop Sports Phys Ther. 2022 Aug;52(8):505-521. doi: 10.2519/jospt.2022.10671. Epub 2022 Jun 19. PMID: 35722759.

Grooten WJA, Boström C, Dedering Å, Halvorsen M, Kuster RP, Nilsson-Wikmar L, Olsson CB, Rovner G, Tseli E, Rasmussen-Barr E. Summarizing the effects of different exercise types in chronic low back pain – a systematic review of systematic reviews. BMC Musculoskelet Disord. 2022 Aug 22;23(1):801. doi: 10.1186/s12891-022-05722-x. PMID: 35996124; PMCID: PMC9394044.

Nambi G, Abdelbasset WK, Alqahtani BA, Alrawaili SM, Abodonya AM, Saleh AK. Isokinetic back training is more effective than core stabilization training on pain intensity and sports performances in football players with chronic low back pain: A randomized controlled trial. Medicine (Baltimore). 2020 May 22;99(21):e20418. doi: 10.1097/MD.0000000000020418. PMID: 32481345; PMCID: PMC7249999.

Owen PJ, Miller CT, Mundell NL, Verswijveren SJJM, Tagliaferri SD, Brisby H, Bowe SJ, Belavy DL. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br J Sports Med. 2020 Nov;54(21):1279-1287. doi: 10.1136/bjsports-2019-100886. Epub 2019 Oct 30. PMID: 31666220; PMCID: PMC7588406.

Shimozaki K, Nakase J, Yoshioka K, Takata Y, Asai K, Kitaoka K, Tsuchiya H. Incidence rates and characteristics of abnormal lumbar findings and low back pain in child and adolescent weightlifter: A prospective three-year cohort study. PLoS One. 2018 Oct 29;13(10):e0206125. doi: 10.1371/journal.pone.0206125. PMID: 30372456; PMCID: PMC6205614.

Siewe J, Rudat J, Röllinghoff M, Schlegel UJ, Eysel P, Michael JW. Injuries and overuse syndromes in powerlifting. Int J Sports Med. 2011 Sep;32(9):703-11. doi: 10.1055/s-0031-1277207. Epub 2011 May 17. PMID: 21590644. https://pubmed.ncbi.nlm.nih.gov/21590644/

Tataryn N, Simas V, Catterall T, Furness J, Keogh JWL. Posterior-Chain Resistance Training Compared to General Exercise and Walking Programmes for the Treatment of Chronic Low Back Pain in the General Population: A Systematic Review and Meta-Analysis. Sports Med Open. 2021 Mar 8;7(1):17. doi: 10.1186/s40798-021-00306-w. PMID: 33683497; PMCID: PMC7940464. https://pubmed.ncbi.nlm.nih.gov/33683497/

Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006 Mar 14;174(6):801-9. doi: 10.1503/cmaj.051351. PMID: 16534088; PMCID: PMC1402378. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1402378/