Stress Fracture in Back

[Kent Williams]

Coach Rippetoe:

I bought Starting Strength so that I could be better prepared to train my 16 year old son who has recently come to me and said he wanted to start working out. I have lifted on & off for 30+ years, but as I read your book I realized that I had a lot to learn. Great book!

Now to my question. About a year and a half ago we took my 16 year old son in to see an Orthopedic Doctor for back pain. We think he most likely hurt his back in a fall while playing basketball. A MRI revealed that he has a well established bilateral stress fracture on the left and right side of the L5. As I understand it, well established just means it had been there a while and won't really heal.

The Doctor said this was very common in flexible, athletic boys who play sports. The Doc gave him some core strengthening exercises and said he could return to normal activities and play sports as long as his back wasn't bothering him. His back has been fine and he is currently playing Lacrosse without any issues.

I asked the Doctor if he could lift weights and he said "yes, but to avoid the clean and jerk". This was well before I read your book, so I didn't ask about power cleans, squats, or dead lifts. While this Doctor is a Pediatric Orthopedist, I really don't know what his level of expertise is on weight training, (as you point out on p. 312 in SS, many Doctors are uninformed on the injury potential of weight training).

Mark, I certainly understand that you are not a Doctor, and don't dispense medical advice over the internet. I am not asking for a medical opinion.

I guess my question is.......is there something unique about the clean and jerk as it relates to back stress? If "yes", then does that also apply to the power clean and should they both be avoided?

I know I could sub barbell rows for PC's, but I do buy into the benefits gained from the explosiveness of Oly lifts.

Any other concerns with other common lifts, (squats, dead lifts, etc). Obviously I have to make sure he uses proper form on all lifts.

Clearly if there are any lifts that should be avoided, I will make sure he avoids them.

Thanks for your advice,

Kent

[Mark Rippetoe]

The C&J is very ballistic, but this assumes he actually knows what they are. He may not have any idea, and may have just heard that some athletes do them. I really can't comment on this injury because I have no experience with it at all, except to say that I'd be interested in knowing why it won't heal. Is it a type of spondylolysthesis? Perhaps our resident chiropractor could address this if he has time. Travis?

[TravisRussellDC]

The most likely scenario is that it is a spondylolisthesis of L5. The bilateral fractures (in the pars interarticularis, which is posterior to the lumbar vertebral body) are statistically more common in L5 when related to trauma, and more common in L4 when related to degeneration. I see it a lot with my young gymnasts, due to the repetitive axial compression from landing and the extreme lumbar extension.

Anyway, the spondylo must be examined to determine whether it is stable or unstable. Chances are, if it was sustained a while ago then it will be stable and he should be safe to lift weights, providing that he is extra careful about maintaining perfect form. A spondylo increases stability when cartilage builds up the area between the fractured elements and essentially builds a bridge for the gap. Unfortunately, the fractured ares don't fuse due to the constant motion of the spine during activities of daily living. We're stuck with the catilagenous bridge being good enough. While "stable" it isn't as strong as bone. But more than likely, it won't cause any problems down the road as long as you're careful.

An unstable spondylo is one in which the body of the vertebra moves forward and back either under lumbar flexion and extension or compression and decompression. The method of determining a spondylo's stability is to take a simple series of xray films. Flexion/extension views are taken and the position of the body is compared to the position in the neutral lateral film. Compression/decompression views may relate a little better to the scenario of weight lifting, but they're not done that often. Basically they have the patient wear a heavy backpack for the compression film and hang from a bar for the decompression film. You can see why the flexion/extension views are more common.

Now, back to the topic at hand, as long as the core stabilizers such as the abs, obliques, multifidus and other intrinsic muscles of the spine are well conditioned, then the amount of spinal compression is actually fairly minimal during the explosive lifts. I'm not saying that there isn't some lumbar compression, but the majority of the force is absorbed by the hips and thighs with the spine staying rigid and acting as a lever. Now, if the core is sloppy and weak, then there is a higher amount of compression and more risk of injury. But that's the same as with any lifter. The key things to avoid while training a lifter with a spondylo are extreme lumbar extension and exercises which unnaturally compresss the spine such as box squats where the lifter sits all the way down a la Westside.

Basically, if he's 16 and the spondylo is stable, then he should be fine performing pretty much any lift you can throw at him as long as he's monitored closely for strict techniqe and you don't get ridiculous with the weights.

Now, all of this is said with the caveat that I haven't ever met your son, nor have I examined him. This is from my experience dealing with similar cases and you must keep in mind that every case is different. If you have any other questions I am more than happy to help in any way I can.