Rebuttal of the mainstream interpretation of Anderson and Chaffin 1986?

Pain & Rehab Forum [Moderated]
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I’m sure that BBM is familiar with this study: https://deepblue.lib.umich.edu/bitstream/handle/2027.42/26237/0000317.pdf?sequence=1&isAllowed=y

The argument from the “good form reduces injury risk” camp seems to be:

  1. Injuries are much more likely to occur in discs on the lower back rather than the upper back.

  2. It is likely that some/most/all of this discontinuity in injury risk between lower vertebral discs vs higher vertebral discs is explained by the fact that the lower discs are subjected to higher compressive forces during lifting.

  3. Lifting with a neutral back decreases injury risk by reducing strain on ligaments and compressive forces on the discs of the lower back (which is the authors’ interpretation of this data set).

So what exactly is BBMs objection to the above?

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Okay, let’s see if I can be thorough enough here to finally bury this argument once and for all. First, out of the gate “good form” is subject to interpretation. No one in the BBM camp is saying technique does not matter. If one looks at any of the programming and information we put out you’ll see a nuanced discussion of technique including errors to avoid, and cues for set up. If this is the case, there is obviously a concession on our part that technique does in fact matter.

Now, there is no evidence to my knowledge of “poor form” increasing the risk of injury. The problem with modeling studies such as this as they automatically assume increased strain=injury. Strain does not have a good/bad assigned to it and general programming rules follow a progressive overload principle a.k.a. increasing strain. We know that high magnitude loading increases bone mineral density and has positive adaptation processes on tendon development. My question would be, if it’s good for tendons and bones, why is it apparently Michael Bay explosion bad for discs?

What the other camp seems to forget is that lifting has a relatively low injury rate in general (1.0-4.4 per 1000 training hours). I would also say that the average squat performed by the average lifter is not a technical thing of beauty. Somehow injuries rates have managed to stay low in spite of this. This is also for ALL injuries, not just the low back. Once again, no one in the BBM camp is advocating for squatting and deadlifting with a rounded back out of the gate. We are just saying that if this happens from time to time it DOES NOT significantly increase the risk of injury.

Let’s break down point 3…

“Lifting with a neutral back decreases risk of injury”…does it though? Can that statement by supported with any literature whatsoever? If that statement is unsubstantiated, the rest of the sentence is moot. Strongmen athletes who have an even predicated on lifting with a rounded back have a reported injury rate of 4.5-6.1 per 1000 hours. While that is higher than that reported for powerlifting I don’t know it really supports the stance.

“by reducing strain on ligaments and compressive forces on the discs”…once again this is an assumption that stress is inherently bad. This gets back to adaptation to stress, either positive or negative, being dose dependent. Enter Steele et al 2015. Their results from the abstract.

Research from animal model studies suggests the existence of a dose-response relationship between loading and regenerative processes. Although high loading at high volumes and frequencies might accelerate degeneration or produce disc injury, high loading, yet of low volume and at low frequency appears to induce potentially regenerative mechanisms, including improvements in disc proteoglycan content, matrix gene expression, rate of cell apoptosis, and improved fluid flow and solute transport.

So high load at high volume and frequency likely has a detrimental effect so don’t max every day adage likely holds no matter how perfect your form is. However, high loading low volume and frequency seems to have a regenerative effect. Once again, it is not the rounding. It is how often an individual is going beyond what they are capable of. If I take from the discussion of the paper that you cited

Adoption of these guidelines appears, in general, to minimise the stresses on the disc, vertebra, muscles and ligaments of the low back and thus reduce the risk of injury

Here would be my question, if the disc, vertebra, muscles and ligaments of the low back are not stressed, how do they adapt? If they’re not adapting, wouldn’t this make them the rate limiting step for performing a task and possibly increase the risk of injury? If I have my choice, I want my discs, vertebrae, muscles, and ligaments of my low back stressed so that they can adapt and become more resilient. Is rounding on a squat going to hurt my back, highly unlikely. Is not using sufficient load to elicit adaptation because I’m hooked on some arbitrary definition of ideal going to make me more resilient, highly unlikely. Rounding is okay, technique matters but it is something we all need to continually work on while accepting errors will occur, stress is stress and the dosage makes the poison or the cure.

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So essentially, you see the risk of lower-disc injury as the price of doing business with regards to training the lower back?

Stressing these discs is better than not, despite the apparent reality that stressing the lower back via BB training results in injuries at a higher rate than stressing the thoracic discs via BB training.

Is your position that the lower discs are just inherently more vulnerable based on human anatomy, and there is no way to adjust training to make the risk to lower discs closer more like the risk the discs towards the top of the spine take on?

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sure but also, in life, do you really have the option of never using your lower back?

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No, that is not what I said at all. Discs adapt to stress in the same way other tissue in the body adapts to stress. It doesn’t make you more or less prone to injury. Rounding does not make you more or less prone to injury. Across the spectrum of life the lumbar spine shows radiographic changes at a much higher rate than the thoracic spine. That is not unique to barbell training. It just is.

I want to be explicitly clear here. Your lumbar discs are not “more vulnerable” based on human anatomy. There is a higher rate of changes in the lumbar spine compared to the thoracic spine for life in general but that does not make them vulnerable. I couldn’t find a primary source that I trust but the common trope is that thoracic disc herniation represents less than 3% of all cases. This does not have anything to do with barbell training. Once again, changes do not necessarily imply good or bad as everything is a spectrum. If you want to see this in the general population Brijinki et al is the most cited paper. If 96% of the general asymptomatic population demonstrated disc changes at 80 years old this is something that happens as a result of living. None of us at 80 years old hopefully expect to have the skin of a 20 year old and expecting for any part of our anatomy to stay in pristine condition as we age is not ideal.

You are conflating injury and radiographic change. Just because something changes on imaging does not necessarily mean that you are symptomatic or injured. The risk of radiographic changes in the lumbar spine is the price of doing business with life. One thing that has been shown to protect against symptoms and all-cause mortality though is resistance training so if anything training the lower back should be seen as a savings plan for health and not as a debt paid as a result of training.

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got it, thanks.