Powerlifting is a popular sport around the world. It consists of the Big 3: bench press, squat, and deadlift. This sport relies on the athlete to produce the maximal amount of strength to move the heaviest amount of weight in one repetition. Due to the nature of powerlifting, it is a great way to build strength in functional muscle groups when performed correctly.
Although the physical demands of the sport are extremely high, the injury rate for a powerlifting athlete is relatively low. A systematic review conducted by Aasa et al. (2016) reported that for every 1000 hours of powerlifting training, an athlete would experience around 4.4 injuries. The low back was reported to be one of the three most common areas to be injured in powerlifting, with close to 40% of these presenting with lumbar discogenic pain.
What is lumbar discogenic pain?
Lumbar discogenic pain is a chemical or mechanical irritation of the nerves within the discs of the spine in the lower back, without injury to the adjacent nerve root or spinal instability. A common mechanism of injury is a sprain to the disc due to an overload of pressure when lifting heavy loads especially in sustained bent-over postures. Due to the structures that are involved, it is often mistaken for a disc herniation (slipped disc, bulging disc, etc…).
Anatomy involved in the injury
In a healthy spine, between each bone (vertebra) is a disc (intervertebral disc) made up of a thick ring of fibrous tissue (annulus fibrosus) with free nerve endings. Within this ring there is a gel-like centre (nucleus pulposus) and on the top and bottom of the disc are two smooth plates of cartilage. The purpose of these discs is to absorb pressure that is distributed through the spine when we walk, run, jump, lift, or bend. When we do these activities, our core muscles activate to maintain the correct amount of pressure that is distributed through the discs by limiting excessive forward or side bending of the spine.
For example, whenever we bend forward at the spine, the two adjacent vertebral bodies squeeze the front of the disc and push the gel towards the back of the disc. Normally, the fibrous ring is able to resist the pressure exerted by the gel while the extensor muscles of our core prevent excessive forward bending. However, if the extensor muscles of the core are weak or not properly activated, then the pressure exerted by the gel overcomes the strength of the fibrous tissue, resulting in a disc sprain.
Why do I feel pain?
Similar to a light ankle sprain, the disc sprain is sensed by the free nerve endings within the fibrous ring and relay the sensation of pain back to the brain. Typically, pain is reported in the middle of the muscle bulk on either side of the spine, with occasional referred pain to the sides of the trunk or buttocks. This pain is made worse with long periods of sitting, bending at the spine, lifting heavy loads, or sudden jolts of pressure when we land after a jump.
Unfortunately, there is no definitive test to make a clear diagnosis of a disc sprain. However, the current gold standard for evaluating a disc injury is MRI’s combined with an understanding of the mechanism of injury, aggravating, and easing factors for the pain.
At Breathe, we provide you with a clear and individualised Roadmap to Recovery to improve and limit future episodes of your low back pain. We have provided a rough guide of the Roadmap, but it will be tailored to each individual as required.
Stage 1: Pain reduction
Here are three ways that you can reduce your immediate back pain.
Manual therapy
Passive positions of ease
Gentle movements.
As mentioned in our previous blog, the 2021 clinical practice guidelines highly recommend spinal manipulation (both thrusting and gentler mobilisation techniques) for people with any type of acute or chronic low back pain. It is also recommended to apply soft tissue massage and mobilisations for short-term pain relief. Hot and cold packs can also be beneficial as part of these treatments as they are easy and readily available.
Other options that can help reduce your pain is with sustained postures and gentle movements. The aim is for the movement to decrease pain intensity, pain location, or increase range of motion. Yoga poses like the 'Cobra pose' and ‘Cat pose’ help de-load the front of the disc and help relocate the gel when performed repeatedly. Here is how to do them:
Cobra
Begin by laying face down on the floor (or yoga mat)
Gently push your upper body up off the floor with your hands, but keeping your hips in contact with the floor
Repeat as necessary
Cat pose
Begin in 4 point kneeling position
Slowly and gently let your lower back arch down as you “stick your butt out” and look to the ceiling
Stage 2: Activation
As your pain reduces to a tolerable amount, you can begin to focus on activation of your core, to help prevent overloading your spine while performing deadlifts and squats. As mentioned in our previous blog, "McGill's Big 3" will help you know how to activate the muscles of your core to keep your pelvis level and to keep your lumbar spine in its natural curve while lifting.
Additional activation exercises for your lower back are standing pelvic tilts and core activation.
Pelvic tilts
Begin in standing with hands on your hips
Perform an anterior pelvic tilt by thinking “Sticking your butt out” or “Lifting your tailbone”
Bracing your core
Begin in an upright position, with hands slightly pushing in on your waist
Using only your breath, push your hands out.
Hold that breath and really tighten your core ('brace for a punch').
Hold for 3-5 seconds
Stage 3: Movement
As you come closer to the end of the roadmap, an important step is retraining your movement pattern. As mentioned earlier, an overload of the spine can cause disc sprain. In this step, you will retrain your deadlift with the conscious effort to activate your core to prevent overloading of the front of your spine. To achieve this, we can do a 3-exercise progression:
Rack pulls
This beginner level exercise begins with a shorter range of motion but still mimics most of the deadlift movement.
By decreasing the lifting range, you are able to focus more on the activation of your core.
Gradually increase the range of the movement, by lowering the height of the rack.
Low weighted deadlift
Do a normal deadlift with a very low weight to allow your body to know how to maintain your core activation through the movement.
Remember to brace your core.
Progress this movement by increasing the weight, but only if you can maintain your core activation throughout the movement.
Deficit deadlift
The last exercise in this progression aims to get you to activate your core before you get into the normal range of a deadlift
Begin by assuming your stance on a step or a bumper plate
Brace your core, and lift
The purpose of a deficit deadlift is to allow your core to activate correctly before you get to the usual range of motion for a deadlift.
Stage 4: Strength building
After mastering the movement pattern with core activation, you can return to loaded deadlifts and squats. However, it is important to continually check your core activation at different weight levels to see if you are maintaining core activation during every movement.
In summary, powerlifting is a popular sport with a relatively low injury rate. However, lumbar discogenic pain can prevent athletes from competing and training. Joint mobilisation and manipulation are highly recommended, but gentle movements and positions can also reduce pain. It is important to have the correct core activation during lifts to continue to strengthen and participate in powerlifting.
References
Aasa, U., Svartholm, I., Andersson, F., Berglund, L. (2016). Injuries among weightlifters and powerlifters: A systematic review. British Journal of Sports Medicine, 51. P211-219
Patton, A. (2016, April 15). What I learned about injury rates from surveying 1,900 powerlifters. Stronger by science: https://www.strongerbyscience.com/powerlifting-injuries/
Pathak, S., Conermann, T. (2022). Lumbosacral Discogenic Syndrome. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK560537/
Jmarchin, 2020. Intervertebral disk. Wikipedia commons. https://commons.wikimedia.org/wiki/File:716_Intervertebral_Disk.svg (last accessed: 27/07/2023)
Yang, G., Liao, W., Shen, M., & Mei, H. (2018). Insight into neural mechanisms underlying discogenic back pain. The Journal of international medical research, 46(11), 4427–4436. https://doi.org/10.1177/0300060518799902
George, S., Fritz, J., Silfies, S., Schneider, M., Beneciuk, J., Lentz, T., Gilliam, J., Hendren, S., Norman, K., (2021) Interventions for the management of acute and chronic low back pain: revision 2021. Journal of orthopaedic and sports physical therapy 51(11). P1-60 https://doi.org/10.2519/jospt.2021.0304a