The debate about whether or not to do lumbar flexion exercises (sit ups, knee ins, bicycles, v-ups, etc) is a heated one. To tell you the truth, it probably wont ever end as professionals will always reside on one side of the fence (lumbar flexion isn’t that bad!) or the other (stabilize, stabilize, stabilize!).
Dr. Stuart McGill has done a great job conducting research on the topic and lecturing around the world regarding appropriate training strategies for strength coaches, fitness professionals, and rehabilitation specialists. However, one of the common debates that often comes up is, “Competitive fighting athletes go through lumbar flexion (sometimes very aggressive lumbar flexion) in their sport and thus we must train that movement to ensure that they are adequately prepared for competition.”
Sounds good, right? After all, the role of the strength coach is to prepare the athlete for their competitive endeavors!
The only problem I see with this argument is that as the strength coach, we need to ensure that the athletes are healthy and injury free. If we know that the mechanism of disc injury is repeated flexion, and we know that the athletes go through this movement in their sports training and competition, is this a movement that we really need to do more of in the gym? To me, that sounds like the same as doing a high volume plyometric program for an inseason basketball or volleyball athlete. They are already getting a lot of contacts in practice and games, why do we need to load that up more? In fact, we should unload that and do something with less impact that sufficiently addresses the strength needs of those athletes. Speaking of basketball, when taking a jump shot, athletes will typically go into knee valgus. With this same mentality, shouldn’t we train that movement it so that they are prepared for it when it happens in a dynamic environment like competition? Obviously I don’t expect anyone to answer“yes” to that question.
The next point that is always brought up is “Athletes who fight competitively all over the world train using lumbar flexion exercises and then go and practice and compete and do more lumbar flexion and don’t seem to have problems. Maybe it isn’t such a big deal.”
One of the things science does is helps us to remove our assumptions of what we think is going on based on our observations. Our assumptions are brought about by several factors including the sample size of people we are working with and our own personal bias towards what we are doing. Basically, we put it in the hands of a neutral third party who tests these assumptions and then comes back to us an either says, “Yep, you were right! It looks like that is happening”, or “Actually, we tested your assumption and we found the opposite to be true.” This of course leads to more research and more questions and eventually theories are developed to help give us a larger explanation of what is taking place.
While the idea that, “Training these movements is essential because they happen in sport” may sound good on paper, are the programs being created really helping these athletes compete without incident?
A 2007 study conducted by Okada et al, looked at the prevalence of nonspecific low back pain and lumbar radicular abnormalities in 82 male judo athletes in three different weight classes – light, middle, and heavyweight.
Back pain:
- 10 out of 29 lightweight athletes had nonspecfic low back pain (34.5%)
- 10 out of 31 middleweight athletes had nonspecific low back pain (32.3%)
- 9 out of 22 heavyweight athletes had nonspecific low back pain (40.9%)
Lumbar radicular abnormalities:
- 19 out of 29 lightweight athletes exhibited lumbar radicular abnormalities (65.5%)
- 28 out 31 middleweight athletes exhibited lumbar radicular abnormalities (90.3%)
- 20 out of 22 heavyweight athletes exhibited lumbar radicular abnormalities (90.9%)
With lumbar radicular abnormalities and WITH low back pain:
- 50% in the lightweight group
- 100% in the middle weight group
- 88.9% in the heavy weight group
With lumbar radicular abnormalities and WITHOUT low back pain:
- 73.7% in the lightweight group
- 85.7% in the middleweight group
- 92.3% in the heavyweight group
The researchers concluded that the prevalence of low back pain in this group ranged from 30-40% and that the prevalence of lumbar radicular abnormalities with nonspecific low back pain (79.3%) and without nonspecific low back pain (83%) suggest a lack of association between back pain and imaging (this should come as no surprise since it has been indicated in previous research). While medical imaging didn’t give us the full picture as some athletes had pain without positive imaging and others with positive imaging did not have pain, low back pain appears to be a problem in this group of athletes and Okada et al state, “Because nonspecific low back pain is a common complaint among athletes, it is important that the athletes and their coaches work towards prevention so that athletes can continue their sports activities.”
In the wrestling community, reports of low back pain have been shown to be as high as 69%. Wrestlers are a group who spend a lot of time on the mat getting into and (hopefully) out of a variety of positions. Iwai and colleagues (2004) evaluated trunk muscle strength and functional disability of chronic low back pain in 53 college wrestlers. The wrestlers were evaluated for radiological abnormalities and isokinetic trunk muscle strength. They found that 14 of the subjects with radiological abnormalities had low back pain (40%) and 8 of the subjects without radiological abnormalities had low back pain (44%). Similar to the study by Okada et al, we see that the percentage of those with low back pain and with or without radiological findings is relatively close. Iwai et al, concluded that low trunk extensor strength may be a potential factor in chronic nonspecific low back pain in this population of athletes. Which would be in contrast to those supporting more lumbar flexion training for these types of athletes.
Just looking at these two studies, we see that maybe the assumptions being made regarding lumbar flexion training and competitive fighting athletes is not a good one. Perhaps the anecdotal information that we get from other coaches is not valid? In other parts of the world, how much pain/injury goes undocumented or maybe the athletes don’t even bring it to the coach’s attention? How well is the record keeping of these coaches? Everyone seems to remember the “hits”, “This is how we’ve have always done it and we have had 10 world champions.” However, they failed to remember the 30 other athletes that were sidelined with injury. Are we missing people?
Conclusions
Low back pain is common in sports and the training program should be comprehensive and well thought out in a manner that helps to prevent or reduce the incidence of injury. While some potentially injurious movements happen in sport that doesn’t necessarily mean that we need to further train those movements in the gym. Rather, it may be more advantageous to prepare athletes to handle the loads and forces placed upon them in competition with a strength and conditioning program that teaches healthy movement and does not seek to overtrain/overuse patterns that are commonly performed in both sports preparation and competition.
References
Okada T., Nakazato K. Iwai K., Tanabe M., Irie K., Nakajima H. Body Mass, Nonspecific Low Back Pain, and Anatomical Changes in the Lumbar Spine in Judo Athletes. JSOPT 2007;37(11):688-693.
Iwai K., Nakazato K., Irie K., Fujimoto H., Nakajima H., Trunk muscle strength and disability level of low back pain in collegiate wrestlers. Med Sci Sport Exer 2004;36(8):1296-1300.