It always amazes me that 80% of people in the world have had low back pain at least once in their life! That statistic is huge. I mean, come on now, 80% of people in the world! That stat isn’t just saying people who sit on the couch all day or people who workout five times per week. Back pain is one of the biggest epidemics in the healthcare world, and it’s also true the mechanism of injury for the strength athlete and for someone who may work a desk job 10-11 hours per day can be very different.
I recently heard world renowned spinal injury and low back pain expert Dr. Stu McGill on the Kabuki Strength Lab Podcast discussing low back pain and injury. He had mentioned that there are five different reasons why strength athletes hurt their backs. With Dr. McGill’s wealth of knowledge, these 5 major mechanisms of back injuries are worth a more in depth review. So without further ado, here they are; the 5 of the most effective ways to minimize spine injuries based on the mechanism of training injury.
#5 Poor Technique & Movement Execution
Exercise technique and how someone performs a certain movement is important. Not only does it optimize performance and force transmission through the body, but having proper technique is going to minimize the potential for injury at the spine and chronic low back pain.
When we mention technique, this can apply to any movement whether it be the squat, deadlift, or any other strength movement. For this post, it will be in relation to the spine. Common technique errors we see with either the squat or the deadlift are:
Lumbar Spine Flexion
Lumbar Spine Extension
Now, when we have the discussion about technique, good technique is a range. Meaning, there is no cookie cutter way everyone should squat or deadlift. There will be variations in how people move.
For example, elite level strength athletes and powerlifters will sometimes flex through their lumbar spine during a heavy max effort lift and they didn’t get hurt doing that.
First off, they are elite! They have trained their bodies over years and years, rep after rep, pound after pound. Their body is more resilient that someone who has only been lifting for 5 years. Their body can handle flexion better than someone else due to their body’s resiliency.
Second, to piggyback on the first point, from years of training and experience, they know how much flexion they can get away with. What that means is that they are not fully flexing through the lumbar spine. They have trained and learned over the years what their body can handle and stay within that acceptable range for them.
For the purpose of this post, we are going to suggest using relatively strict technique for the squat and deadlift.
So, with the squat and deadlift, make sure you are maintaining a neutral spine during all portions of the lift. Does it mean that if you don’t maintain a neutral spine on one single rep you will get injured? No.
We want to make sure we are training with good technique. No one is perfect and if one rep is not the best technique wise, not the end of the world. The key is to make sure you are training with good technique for almost all of the time.
#4 Progressive Overload At All Costs
Progressive overload is key to improvements in strength and power. If we don’t challenge our bodies, then our progress with plateau and stagnate. The problem arises when we want to be further ahead in our progress than we currently are. When we speak about overloading, we are speaking about non-progressive overloading.
There has been a lot of work done on work capacity and how someone should progress through a strength program. Whether it be someone coming back from an injury or someone who is moving/feeling good, we need to be cognizant of how fast and how heavy to progress.
If you don’t progress enough, your improvements will not be sufficient. You progress too fast, you can get hurt.
The key is to find that middle ground. If you have ever read Tim Gabbett’s work, he speaks about using the 10% rule. This means in order to progress and overload, we want to increase the workload by 10%.
This can mean increasing the weight by 10%, the reps by 10%, sets by 10%, etc. Gradual progressive overload is key.
It can be detrimental if you go too hard, too fast and keep getting hurt. Not only are you gradually progressing your programming, but you are also building up your body’s resiliency to accept heavier and heavier loads.
#3 Too Little Rest & Recovery
There is a mindset in the strength training world that you need to go hard all the time. Intensity is key to make improvements and training hard can create strength gains, build physical and mental fortitude, as well as provide a feeling of accomplishment after a hard training session.
The problem arises if someone is training hard all the time. Day in and day out, their intensity of their training session is always at the max. Constantly doing this can cause the body to have a difficult time recovering and in turn affect future training sessions.
You can still receive a great training effect without going at 100%. Using percentage based training where you train at 60-90% of your 1-rep max in weight can be a great way to dial back the intensity while still receiving a great training effect.
For example, if your 1-rep max deadlift is 500 pounds. You don’t have to keep trying to hit heavy singles training session after training session to try and get to 505.
Instead, try training at 60-90% of that. What that means, lifting with weights ranging from 300-450. By training submaximally, you are allowing your body to rest, decrease your risk for injury, and building a broader training base to allow your body to withstand heavier loads for the long term.
#2 Squat Depth
Depth on the squat is a hot topic. One school of thought says that everyone should squat “Ass to Grass” while others believe in quarter or half squats. As with most things in life… It depends!
If someone has the proper mobility, position, and stability prerequisites to squat deep with good technique, then squat deep!
If someone does not, then training above parallel or “ass to grass” is perfectly fine. By performing squats to a depth that is not appropriate for that particular client or athlete, places them at increased risk for injury due to compensations by the spine to attain a deeper depth. Monitor and optimize depth using these squat variations:
Not everyone is made to back squat, deadlift from the floor, etc. We are all created somewhat the same, but have very different dimensions. Whether it be:
Various angulations and rotations at the femoral neck
Various angulations of the acetabulum in relation to the body
Shallow/deep acetabuli (hip sockets)
Not everyone is made to back squat, squat deep, or deadlift from the floor. Structural adaptations prevent that! If you try to push through your anatomy and do things your body physically won’t allow, you will get hurt.
So, there are two options.
Either try to push through your anatomy and increase your risk for spinal injury or…
Find an exercise that is made for your body type.
For the squat, adjusting your squat stance and/or width can help. Externally rotating your feet and/or increasing or decreasing the width of your stance can help.
If you’ve tried that, try performing different strength movements that you can perform with proper technique.
These are 5 major reasons why someone can get hurt when training and lifting. If you want to minimize your risk for low back pain and spine injury with training, it’s imperative that you train, coach and live by these 5 recommendations:
Dial in Your Technique
Train at the Proper Depth
Choose the Right Exercise for Your Body Type
If you can take care of business on these foundational principles of pain-free training and injury prevention, you’ll mitigate the risk of otherwise preventable training and movement related injuries.
Andrew Millett MSPT, SFMA, CSCS is a sports orthopedic physical therapist with a background in strength and conditioning. He is the owner of Move Strong Physical Therapy, LLC outside of Boston, Massachusetts. His practice uses a combination of manual therapy (dry needling, IASTM, etc.), exercise, and strength training to help athletes of all ages move and feel better. He has worked with athletes ranging from middle school age up to the professional and Olympic ranks. To find out more info, he can be found on social media and on his website at MoveStrongPhysicalTherapy.com