Back pain and strength training…. are free weights an answer?

Back pain and free weights?

I practice spine surgery in Monterey, California, which is home to the Naval Post Graduate School and the Defense Language Institute.  In the years that I’ve been in practice I’ve seen a lot of active duty soldiers rotate through Monterey for advanced degrees or language proficiency training.  They share similar histories.  They are fit, strong, and all of them have a lot of “mileage” on their backs.  Running around the desert with a heavy rucksack on, or jumping in and out of helicopters in the middle of the night is certain to cause back pain at some point.  Most of these soldiers report that they were fine while they were with their units in Afghanistan or Iraq and their back pain was manageable.  If anything, it was made better by staying active.  However, once they are crammed into a desk learning 40+ words of a foreign language a day, their backs start to ache.

Back pain and military service

Not surprisingly, all of their MRI scans are abnormal with degenerative changes typical of someone who is used to carrying a heavy rucksack and jumping in and out of a helicopter for a living.  I’ve help enough of them rehabilitate themselves that I know they are able to return to active duty, including paratrooper and flight duty, in spite of relatively significant degenerative changes and disk bulges.  I have also performed enough microscopic decompression surgery on active duty soldiers to know that after a well done microdiscectomy they will pass their fit for duty physicals and can return to service.  However, if they have a fusion, their military careers are basically over.

Since this is a patient population that prides itself on strength, endurance, and toughness, I get asked a lot of questions about strength training for both non-operative and post-operative rehabilitation.  My response is always encouraging, with a caveat.  Just like your mother said, POSTURE is IMPORTANT.  In my opinion, the following article does a great job of summarizing the arguments in favor of strength training as a way of avoiding back pain — especially the counter-intuitive exercises like deadlifting and squatting.

https://pjmedia.com/lifestyle/2016/11/30/back-pain-and-back-strength/

back-pain-and-strength-training

I caution these patients that this is one of those times where form truly is more important than function.  It’s better to lift correctly than to lift heavily, especially if your back is already injured.  I also believe that Kelly Starrett — of mobilityWOD and Becoming a Supple Leopard fame — is probably the most articulate advocate for proper form.

Is weight lifting safe if you have back pain?

The clear answer is Yes.  As long as it is done correctly.  If you are getting back into the gym after an episode of low back pain, or if you are rehabilitating after surgery, get some help.  Find someone who is really knowledgeable, like a strength and conditioning coach or a really good physical therapist.  Make sure your form is perfect.  Start light, and work your way up.  Done properly, even deadlifts and squats can help reduce back pain.

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Sohrab Gollogly, MD is a board-certified orthopedic surgeon and Fellowship-trained spine surgeon who also performs scientific research and participates in several volunteer surgical organizations.

Dr. Gollogly completed his undergraduate education in biology at Reed College in Portland, Ore. He earned his medical degree from the University of Washington School of Medicine.

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