Welcome back to the SpineIQ Back Blog! This week, we are summarizing and discussing the clinically relevant findings of a novel study of powerlifting for chronic low back pain.1 Powerlifting and lifting heavy objects in general are an oft-debated topic in low back pain. The evidence of positive health benefits from exercise and resistance training has been well documented for a long time leading to WHO and CDC guidelines recommending exercise and resistance training for health.2 However, whether heavy lifting recreationally is helpful or even harmful for low back pain is understudied. While powerlifting, Olympic weightlifting, and CrossFit injury rates for back pain are low and comparable to other sports, there is still a prevailing fear of heavy lifting impact on low back pain.3,4 Therefore, Gibbs et al. the effectiveness and harm of a powerlifting style resistance training compared to core-specific bodyweight training for people with low back pain.
Methods and programs
Gibbs et al. randomized 64 patients with chronic low back pain to one of the two exercise groups. Both groups received pain neuroscience education along with their respective exercise group. The exercise program was delivered for 8-weeks with a once weekly hour-long session.
The power lifting group performed squats, deadlifts, and pin Pendalay rows starting at their respective exercise tolerance. The exercises were individualized to be able to change the range of motion (full to half range of motion) depending on patient symptoms and preferences. In order to find a baseline for how much weight each exercise should be, a 5-rep maximum test was performed. For those that are unfamiliar with that test, a patient performs the exercise five times and continues to add more weight until it is heavy enough where the patient can only lift the weight for 5 repetitions. This 5-rep maximum weight is then decreased so the lifter can perform numerous sets and reps as % less than their 5-rep maximum. For example, if your 5-rep maximum weight is 100 lbs for a squat then you can use 80% of that weight (80lbs) and perform 3 sets of 5 repetitions as training. In the powerlifting group, the patients performed 5 repetitions of each exercise (squat, deadlift, and pin-pendlay row) for 3 sets at 80% of their 5-rep max weight with ~2 minute of rest in between each set.
The core-specific bodyweight training group was given similar individualized options in terms of range of motion for each exercise. This group performed bridges, lunges, squats, and hip hinges for 3 sets each with ~2 minutes of break in between sets.
The outcomes of pain intensity (0-10 visual analog scale) and disability (oswestry disability index) were assessed at baseline, 8-weeks, 3-months, and 6-months.
There was no significant differences found between the powerlifting or bodyweight group on pain or disability at any of the time points (8 weeks, 3 months, 6 months). Additionally, both groups significantly improved from baseline in pain and disability at all of the time points (8 weeks, 3 months, 6 months). These improvements in pain and disability were an a priori clinically meaningful amount of change from baseline for both groups.
This study intended to evaluate the effectiveness and safety of powerlifting compared to bodyweight exercises. As the majority of the studies have concluded, there appears to be no superior exercise and exercise appears to be safe for people with low back pain.5 This allows clinicians to discuss with their patients and choose through a shared-decision making process the exercises that are most meaningful to the patient. These exercises can range just as much as they did in this study going from a 5-repeptition maximum powerlifting exercise to bodyweight exercises. This study shows that conservative spine clinicians have numerous guideline concordant treatment options at their disposal to help patients with low back pain. Above all, while the evidence for exercise is incontrovertible the issue is rarely about the exercise but rather about the desire, expectations, motivation, and readiness of the patient. This is the opportunity to sit down with your patient and really find out what THEIR goals are and then arrive at a common understanding which is the only way compliance will be achieved.
- Gibbs MT, Morrison NM, Raftry S, Jones MD, Marshall PW. Does a powerlifting inspired exercise programme better compliment pain education compared to bodyweight exercise for people with chronic low back pain? A multicentre, single-blind, randomised controlled trial. Clin Rehabil. Published online April 24, 2022:02692155221095484. doi:10.1177/02692155221095484
- Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462. doi:10.1136/bjsports-2020-102955
- Klimek C, Ashbeck C, Brook AJ, Durall C. Are Injuries More Common With CrossFit Training Than Other Forms of Exercise? J Sport Rehabil. 2018;27(3):295-299. doi:10.1123/jsr.2016-0040
- Aasa U, Svartholm I, Andersson F, Berglund L. Injuries among weightlifters and powerlifters: a systematic review. Br J Sports Med. 2017;51(4):211-219. doi:10.1136/bjsports-2016-096037
- Hayden JA, Ellis J, Ogilvie R, Malmivaara A, Tulder MW van. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;(9). doi:10.1002/14651858.CD009790.pub2