Posted on Apr 16, 2020
A Heavy Subject: The Impact of Weightlifting on Young Spines
By Tim Bertelsman, DC
Is weightlifting safe for adolescents?
No, well yes, okay maybe…in the right situations. That is about as clear as it gets concerning the growing epidemic of adolescent injuries via weightlifting and competitive sports.
There is no disputing the facts that plague childhood athletics. A September 2018 systematic review1 found that injuries increase in proportion to sports specialization. However, few studies have linked the detrimental effects that any single sport has on the progression of spinal degeneration—until now.
Is adolescent weightlifting harmful?
Parents and coaches are always looking for a competitive edge, and strength gains can help fill that role. So, what are the risks and benefits of youth resistance training? Many studies highlight the detrimental effects of improper weight training. Incorrect lifting technique, lack of proper training, and advancing weights too quickly are commonplace. Faulty training methods coupled with open-growth plates may lead to an increased incidence of injury and long-term damage.
A new study by Shimozaki2 relays real-world data to help us provide evidence-based recommendations. Although this study consisted only of a dozen adolescent competitive powerlifters, the conclusions were dramatic:
“At the start of this study, there were no positive findings of LBP, and abnormal lumbar findings on MRI were observed in only 2 participants. At the 2-year follow-up, 8 of 12 participants had abnormal lumbar findings. In the final year, 3 participants had LBP; however, abnormal lumbar findings were observed on MRI in 11 participants. Among these, lumbar spondylolysis was observed in 4 participants, lumbar disc protrusion or extrusion in 2 participants, and lumbar disc degeneration in 9 participants.”
In a three-year cohort study of child and adolescent weightlifters, 11 of 12 participants revealed abnormal lumbar findings upon MRI examination! These findings leave very little room for dispute. Results confirm that competitive weightlifting in the prepubescent population leads to degenerative changes in the lumbar spine. It would be difficult to appreciate any potential benefit compared to the long-term risk. The results of this small, very specific study are hard to extrapolate to other youth sports, but clinically, we see similar scenarios on a daily basis. Young athletes are affecting their long-term structure due to repetitive movements and lack of rest. Baseball players with “little league” elbow, dancers with hallux valgus, runners with shin splints and basketball players with patellar tendinosis are pervasive. Year-round, sport-specific competitive athletes live in a physiologic environment void of rest and rebuilding.
How much activity is too much?
There is no clear answer to that question, and it probably depends on the sport, but the 12 weightlifters in the Shimozaki study trained extensively; approximately two hours per day for an average of five days per week, and 500 hours per year. Clearly, from the results of this study, that amount of weightlifting was too much for a developing spine. There is no stopping the sports specialization craze that has permeated youth sports, but one realistic intervention is simply—REST.
Sports participation and resistance training are designed to stress musculoskeletal structures and therapeutically damage tissue. Rest allows rebuilding of the tissue, promoting more resilient tissue with improved capacity. Without rest, an athlete’s body is continually breaking down tissue without the ability to rebuild.
As providers, we are only one cog in the wheel of recovery. Our treatment success is often more largely dependent on our patient’s understanding of their problem and willingness to take appropriate steps to correct their problem. Patient education is one of the most critical aspects of care. If overtraining is hampering your ability to treat a patient, this becomes an essential conversation between you, the athlete and their parents.
Sometimes it is difficult for young athletes to appreciate the long-term ramifications of sports. Talk to your patients and parents about the importance of rest and avoiding back-to-back training days.
Follow the link for the complete blog post and a list of article references.