Retired Weightlifters, Wrestlers, DDD, and Back Pain

Low back pain among retired wrestlers and heavyweight lifters. Granhed H, Morelli B. Am J Sports Med. 1988 Sep-Oct;16(5):530-3. [FREE FULL TEXT]

Abstract
The lifetime incidence and prevalence of low back pain among 32 retired wrestlers (ages 39 to 62 years) and 13 retired heavyweight lifters (ages 40 to 61 years) were evaluated and compared to the corresponding results in a cross-sectional study of 716 men (ages 40 to 47 years). The radiologic findings and the findings upon physical examination in the athletes were compared to the findings in another study of normal, active, similarly aged men who were sampled at random. The lifetime incidence and prevalence of low back pain was higher among the wrestlers (59%) compared with both the lifters (23%) and the control group (31%). The tolerance for backache seemed to be higher among the athletes than the controls. A higher frequency of old fractures was found among the wrestlers. The athletes with fractures had a higher frequency of low back pain. A significant decrease in disk height was found among the lifters.

My comments:
 
This blog is a partial answer to the question I got about axial loading of the spine from weight lifting (particularly squats and deadlifts) and if there was any evidence it would cause/accelerate any degenerative disc disease (DDD).
 
While answering the question (which you can find on my Dec 12-15 entry of this blog), I recalled the above study, which looked at retired competitive weightlifters and wrestlers 20 years after they stopped competing. Per their survey, wrestlers had increased incidence of low back pain in comparison to age matched control subjects, while weightlifters had a lesser incidence (but not significantly) of pain. It looks like wrestlers get wrenched in such a way that leaves them worse off, while the weightlifters (which isn’t clearly stated but I’m assuming are Olympic weightlifters) aren’t. The good thing about Olympic weightlifting is that almost all the lifts are done with the spine neutral.  Though given the time period, these guys probably did the Olympic press, which used to be a competitive lift but was eliminated from competition in 1972.  Depending on the technique employed, the Olympic press sometimes put the lifter in the extremes of spine extension with considerable weights.  Still, the weightlifters didn’t have an increased incidence of back pain.
 
The weightlifters did in fact have decreased disc height (at least 50%) in at least one level in 62% of their lumbar spines, while the same was found in 32% of the wrestlers, and the same for control subjects. So  there is evidence increased DDD in retired weightlifters, but it does not seem to be associated with any increase in pain or disability.  Also it is impossible to say if the DDD is because axial loading, because there was a lot of spine extension with the Olympic press. Though the Olympic lifts generally don’t have any spine flexion, (which is inordinately risky and causal for herniated discs and subsequent DDD), a lot of abdominal training that weightlifters often did was. Even so, functionally and pain wise, retired lifters’ low backs seem to do pretty well. Research has also shown squats which do cause axial compression and a neutral spine is particularly good for increasing bone mineral density for women with osteoporosis, and periodized weight training is beneficial for those with chronic low back pain. There is also evidence that free weight programs, which generally include squats and deadlifts, result in a lesser incidence of low back pain than those consisting of machine based training and stretching. In my practice, the vast majority of the physical therapy patients I see referred for low back pain progress to doing both squats and Romanian deadlifts (RDLs) and they do great. However, I am very strict to limit range of motion, insisting the spine stays neutral throughout, and having my patients stop the exercise immediately if there is any increase in pain, even if the spine is neutral. I also keep reps relatively high (15s) in my patients with pre-existing back pain.
 
Unfortunately, wrestlers didn’t hold up as well and, as such, I would expect them to do better increasing core strength and avoiding extreme spine range of motion, which is probably not the easiest task in competition.
 
As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.
 
Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.

2 thoughts on “Retired Weightlifters, Wrestlers, DDD, and Back Pain”

  1. Hi Chad,
    Following several periods of painful lower back, I had and MRI and saw an orthopedic consultant. The consultant highlighted a degenerated L5S1 cartilage, almost non existent and long story short advised me to purchase the ‘McKenzie, treat your own back’ book. Whilst the bending my back backwards idea and laying on my front gives some temporary comfort I haven’t really made any progress, and it’s been months since of getting slightly better only to return to sleepless nights.
    After reading your comments on McKenzie method I wonder whether I achieving any real help with these stretches or whether I should any extremes at all.
    Does McKenzie stretches sound appropriate for degenerated cartilage pain.
    Thanks for your time,
    John

    • Hi John,

      If I were you I wouldn’t do McKenze method for your back. To be honest, I wouldn’t do it for anyone with back pain, at least not the full system as taught, but in your case I especially wouldn’t and here’s why. The primary idea of McKenzie method, as taught in the Treat Your Own Back, and his other books is as follows. If you have too much spine flexion in your daily life (and odd are you do/did) it will result in posterior disc bulges and herniations. That much seems true. So Mckenzie would then give you extension stretches to push the disc material back forward. There is some truth to this as well, as one of my favorite spine researchers Stuart McGill did a study where they found after flexing pig spines thousands of times causing posterior disc bulging, repeated extension was able to push the disc material back forward some (but not all) of the time. The catch however, was that they needed ~60% of normal disc height for it to work. If the disc has already herniated and flattened (as you describe) the horse has left the barn already, so to speak, so there is no use shutting the door now. Plus with the L5-S1 disc being flattened, the facet joints behind the disc are going to be in especially close approximation, so a lot of spine extension is likely to hasten arthritic changes. A McKenzie practitioner might chime in saying if extension increases pain, then per McKenzie method, you should then do flexion stretches. However those flexion stretches are likely to worsen disc degeneration throughout the rest of your lumbar spine as repeated spine flexion seems to be the primary cause of posterior disc bulges, herniations, and DDD in the first place. So I think McKenzie method was innovative at the time, his materials contain a lot of truth, and certainly were an improvement over Paul Williams’ flexion stretchers which were the standard at the time, but the shortcomings I described I think explain the results of the meta-analysis that found McKenzie method no better than advice to stay active.

      If it were me, I’d try to maintain a neutral spine in sitting using lumbar supports, I’d endeavor to learn good spine motor control during exercise (which one would want to incorporate in daily activities) avoiding extremes in spine flexion/extension/twisting, rather getting more movement from your hips and knees. I would do general but pain free strength training exercises (all with a neutral spine) that increase fitness and teach good motor control. Also I can’t overstate how effective I think the right parameters of EMS can be at decreasing back pain while improving core strength and endurance. Hope that helps, if you have any other question feel free to hit me back.

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