AANS Neurosurgeon | Volume 29, Number 2, 2020


Competitive Weightlifting and the Spine

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When done correctly, weightlifting can help build muscle mass and strength, which can help stabilize the spine, improve posture and reduce back pain. When done incorrectly, it can worsen or cause back injuries. There is a clear correlation with spinal biomechanics and injury patterns.

Read more on deadlifts in the 5th installment of Wellness Outside the OR.

There are two types of competitive weightlifting: powerlifting and Olympic weightlifting. Powerlifting consists of three lifting techniques: squat, deadlift and bench press. Olympic weightlifting includes two: snatch and the clean & jerk. With the exception of the bench press, all of these techniques place significant stress on the spine:  

  • During the snatch, the peak of the extension moment happens with the peak of compression forces, generating unusually high contact forces at facet joints.
  • In squatting, greater lumbar flexion and forward lean have been associated with higher lumbar shear forces, especially during repetitive squatting at faster speeds, and faster lifting speed has been associated with higher compression forces.
  • For deadlifts, studies have shown compression forces may exceed 17,000 newtons in elite powerlifters, with distribution of forces depending on the lifting technique used.

Lumbar injuries have been found to be one of most common type of injury encountered by competitive weightlifters, with an average rate of 0.45 per 1,000 hours for weightlifters and 0.42 per 1,000 hours for powerlifters. A retrospective study of injuries among powerlifters revealed that 24.5% of reported injuries occurred in the cervical spine, 18% in the thoracic spine and 40.8% in the lumbar spine. Another interesting study of spine MRIs of athletes participating in the 2016 Summer Olympics found that weightlifting had the second highest incidence of spinal disease (67%, 1.5 per 100 weightlifter) primarily localized to the lumbar spine.

A Predictive Marker for Lumbar Deformation on Elite Weightlifters

The center of gravity is located anterior to the S2 vertebra, which shifts forward when weightlifters lift heavy weights. To restore the center of gravity and maintain a proper balance, weightlifters arch backwards, flex their hips and knees and tilt their pelvis back. This results in an increased lumbar lordosis and a decrease in pelvic tilt angle. Studies have shown that elite weightlifters had increased lumbar lordosis and decreased pelvic tilt angles compared to a control group. Additionally, the ratio of upper lumbar lordosis (ULL) to total lumbar lordosis (TLL) was increased in athletes with spondylolysis or spondylolisthesis, suggesting that an increase in ULL is an adaptation of the sagittal lumbar alignment. Therefore, changes in ULL/TLL >40% may be a sign of adaptation exhaustion that can be used as a predictive marker for lumbar deformation in elite weightlifters.

Common Techniques to Reduce Injury Rate

Weightlifting shoes: They are thought to assist in maintaining an upright posture, promote a less forward lean when squatting and reduce shear forces on the lumbar spine. A recent study reported a greater forward lean when squatting barefoot, compared to weightlifting shoes and running shoes, but found no difference in the compressive or shear forces on the lumbar spine between all three when squatting.

Lifting belts: The effectiveness of lifting belts continues to be controversial. An in vivo study on weightlifters reported a 10% decrease in compressive forces when wearing a tight and stiff back belt, but only when inhaling before lifting. Wearing a lift belt during squatting has been shown to increase intraabdominal pressure, generate extension moments and decrease EMG levels of spinal muscles. However, another analysis found a higher incidence of spinal injury in athletes who use lifting belts for squats and deadlifts, possibly due to non-physiological loading.

Reduce speed during squatting: Studies have shown a greater forward lean and increased compressive forces with greater squatting speeds.

Keep the barbell close to your body during a deadlift: It has been shown to decrease hip and spinal moment arms, reducing the risk of injury and improving performance.

Avoid a “stiff-leg” deadlift: This occurs when the lifter extends their knees prematurely or excessively, decreasing their quadricep effort, making their hamstrings and erector spinae muscles work harder, leading to a less upright torso position.

Use the Sumo style deadlift: Not only is it easier to maintain a more upright torso using this lifting style, but it has been shown to decrease the L4/L5 moment and shear forces.

Perform the most demanding lifts early in your workout: Fatigue has been reported to alter the lifting technique, which may increase the risk of injury.


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