I read Should You Fear Lumbar Flexion by Sam Spinelli so you don’t have to. In the blog following I will outline his article and give you my thoughts on it. So, Lets Dive in….
First a general overview of the article
The first thing that catches your eye when you see this article is the cover photo and headline. It grabs your attention and pulls you in, well done. The next thing you notice is the length of this article. Its not your classic blog that takes 5 minutes to read. It’s well thought out and supported by multiple backlinks to the articles he cites.
Setting the Stage:
The first half of the article is set up. The writer talks about general anatomy of the lumbar spine and disc, types of pathologies of low back injury, explaining risk vs hazard and trying to define neutral spine. Even though it is longer than the regular gym goer would want to read, the author does a great job of setting back story.
The sciency stuff:
The author gets into the science of flexion (bending over) vs neutral spine and which position puts you at more risk for injury. He cites great articles by Callaghan & Mcgill, Gooyers et al 2015, and Wade et al 2014. The author uses these articles to explain that discs can be injured in both neutral and in flexion. He explains how disc are more likely to be injured by compression forces than by spinal position. He then uses the articles to explain how it’s more likely for someone to suffer an endplate fracture than a disc injury.
The authors biggest point comes when he references the study from Veres et al 2010. This study concludes that neutral spine discs failed at a higher rate than flexed spine discs. He uses this article to understand the mechanism of injury most closely related to a sporting injury where people are compressed quickly like falling on your butt, tripping or putting a heavy barbell on your back.
Then he finishes up by pointing out some of the inherent problems in the previous studies such as all studies were done on animal spines and discs, or that in vivo the disc has the ability to adapt to stress.
Article in closing
Lastly the author answers his question of Should I Fear Lumbar Flexion, to which he answered, “it depends”. He says a flexed lumbar spine is necessary for some sports such as cycling, jiujitsu, and wrestling. However, he states that heavy weight lifting athletes should train a neutral spine for volume, but may benefit from training and improving lumbar flexion tolerance.
I thought I would absolutely hate this article, but I do have to admit the author took some time with it. The number of hyperlinks in this makes it one of the best sited articles I have read in years.
I think the main goal of this article is to challenge the status quo that the medical field has set condemning flexed spine movement and grab some reposts in the process. He does this with the incredibly click-baitey picture that is the cover photo for this article. All to sum up the question with it depends. Yes there are some interesting findings within the articles surrounding the mechanisms of low back injuries, but they do not out weight the overwhelming evidence that shows flexion movements do increase your risk for low back injuries.
I also disagree with how he correlates the findings from Veres et al 2010. If these findings are similar to quick compression forces like a fall or a sporting injury, then this injury is traumatic. Traumatic injuries are vastly different than the flexion-based overuse injuries that are discussed in the Callaghan & Mcgill, and Gooyers et al 2015 articles.
My take away:
Is moving in a flexed lumbar spine a death sentence? No, but is it the best practice…..? Also no. Being able to have full pain free flexion of the Lumbar spine is part of having a healthy spine. Of course, there are some activities you have to do with a flexed lumbar spine. That does not mean we should start changing the way we cue our patients and athletes. This article in no way supports anything more than to say, “hey some spinal flexion isn’t always bad, and you shouldn’t fear it. However, the cover photo endorses weight lifting like an idiot. If you are going to deadlift like the cover photo you should fear flexion, and I’ll see you in my office.
Yours in health,
Dr. Jordan Krause
Tags: dead lift, flexion, low back pain, low bakc, pain, weight lifting