T Nation

Degenerative Disc Disease and Lifting?

I was recently diagnosed with degenerative disc disease in both the L5/S1 disc and the L4/L5 disc. According to the doctor I don’t have a herniated disc, but they are both bulging to the sides and the back. I am already seeing a PT and she’s got me doing mobility and flexibility work, and added more ab work to my routine because of weak lower abs.

I’m trying to understand two things: 1) the risk involved in lifting and 2) if I should place limits on the weights I lift (or drop certain exercises altogether).

So I’m 36 years old about 6’ tall and I weight about 98 kg (about 79 kg fat free mass). The cause of the DDD is not lifting - seven years ago my wife sat on my back while I was reading in bed on my belly. In the year after that I had some significant back pain, which at some point got better.

Now I normally have no pain at all, my back just sometimes feels stiff, like I need to crack it. I generally have no pain or discomfort at all while lifting, however I do feel a bit of a twinge when doing speed work with dead lifts/squats/power cleans.

According to the PT my form is quite good, but due to the weak lower abs my hips are slightly in the wrong position sometimes (my butt sticks out a bit too much, so my back is slightly extended).

About two months ago I started doing Wendler’s 5/3/1 with the BBB assistance work. So this (with the rep scheme as recommended by the program):

Low bar squat / Abs
Bench / BB bent over row
Conventional dead lift /Abs
Overhead press / Chins

After about a month of this I started feeling a lot of pressure (like I had to crack my back) in my lower back, so I switched from low bar squat to high bar squat, from conventional dead lift to sumo dead lift and from BB bent over row to Kroc rows. Alone this change lead to by back feeling normal again. Since then I’ve also switched away from BBB to a version of the triumvirate to further reduce stress on the lower back and address some weak points and I feel great. My 5/3/1 routing now looks like this:

High bar squat / crunches / Bulgarian split squat / hip thrusts
Bench press / Kroc rows / sulpinated grip face pulls
Sumo dead lift / wipers / GHR / oblique work
Over head press / chins / dips

My weights are not super high, but climbing steadily with the 5/3/1 program. Right now my 1RMs are about S 150 kg / BP 130 kg / DL 170 kg / OHP 75 kg. So my questions are:

  1. am I putting myself at significantly increased risk of a herniated disc by doing squats or dead lifts? If yes, can you quantify this somehow?

  2. should place limits on the weights I lift - in particular with respect to squats and dead lifts? My plan was to work up to squating around 170 - 180 kg and dead lift around 200 - 210 kg and then stop increasing weight and go for reps.

The doc I saw just gave me the typical “don’t lift heavy things” line. The PT made a very good impression and has said to continue with this program, but stop once the weights get very high. If I were to just “listen to my body” I’d say keep lifting and keep increasing weight… I feel great. I’m going to see another doc (sports medicine/orthopedist), who apparently has experience with weight lifters, to get a second opinion.

Thanks in advance, I’d really appreciate any tips!

[quote]canucknje wrote:
I was recently diagnosed with degenerative disc disease in both the L5/S1 disc and the L4/L5 disc. According to the doctor I don’t have a herniated disc, but they are both bulging to the sides and the back. I am already seeing a PT and she’s got me doing mobility and flexibility work, and added more ab work to my routine because of weak lower abs.

I’m trying to understand two things: 1) the risk involved in lifting and 2) if I should place limits on the weights I lift (or drop certain exercises altogether).

So I’m 36 years old about 6’ tall and I weight about 98 kg (about 79 kg fat free mass). The cause of the DDD is not lifting - seven years ago my wife sat on my back while I was reading in bed on my belly. In the year after that I had some significant back pain, which at some point got better.

Now I normally have no pain at all, my back just sometimes feels stiff, like I need to crack it. I generally have no pain or discomfort at all while lifting, however I do feel a bit of a twinge when doing speed work with dead lifts/squats/power cleans.

According to the PT my form is quite good, but due to the weak lower abs my hips are slightly in the wrong position sometimes (my butt sticks out a bit too much, so my back is slightly extended).

About two months ago I started doing Wendler’s 5/3/1 with the BBB assistance work. So this (with the rep scheme as recommended by the program):

Low bar squat / Abs
Bench / BB bent over row
Conventional dead lift /Abs
Overhead press / Chins

After about a month of this I started feeling a lot of pressure (like I had to crack my back) in my lower back, so I switched from low bar squat to high bar squat, from conventional dead lift to sumo dead lift and from BB bent over row to Kroc rows. Alone this change lead to by back feeling normal again. Since then I’ve also switched away from BBB to a version of the triumvirate to further reduce stress on the lower back and address some weak points and I feel great. My 5/3/1 routing now looks like this:

Low bar squat / crunches / Bulgarian split squat / hip thrusts
Bench press / Kroc rows / sulpinated grip face pulls
Sumo dead lift / wipers / GHR / oblique work
Over head press / chins / dips

My weights are not super high, but climbing steadily with the 5/3/1 program. Right now my 1RMs are about S 150 kg / BP 130 kg / DL 170 kg / OHP 75 kg. So my questions are:

  1. am I putting myself at significantly increased risk of a herniated disc by doing squats or dead lifts? If yes, can you quantify this somehow?

  2. should place limits on the weights I lift - in particular with respect to squats and dead lifts? My plan was to work up to squating around 170 - 180 kg and dead lift around 200 - 210 kg and then stop increasing weight and go for reps.

The doc I saw just gave me the typical “don’t lift heavy things” line. The PT made a very good impression and has said to continue with this program, but stop once the weights get very high. If I were to just “listen to my body” I’d say keep lifting and keep increasing weight… I feel great. I’m going to see another doc (sports medicine/orthopedist), who apparently has experience with weight lifters, to get a second opinion.

Thanks in advance, I’d really appreciate any tips!
[/quote]

To answer your question, clinically there are more disc herniations with deadlifting then any other exercise I have seen. The nature of the lift itself and the mechanism of failure leads to disc herniations if there is any breakdown in form. The risk of herniation is less with squatting but it may flare up your DDD.

My tip would be to NOT try and increase the reps at those weights, as you fatigue the greater the chance of your form breaking down, I would instead prefer to see you do less reps and maybe try to lift the weight at greater speed resulting in more force F-ma. You can’t live in a bubble but at the same time your 36 and unless your trying to compete in powerlifting im not sure I see the point of striving for 5-600 pound lifts.

http://www.nejm.org/doi/full/10.1056/NEJM199407143310201

Read the above.

[quote]BHOLL wrote:
To answer your question, clinically there are more disc herniations with deadlifting then any other exercise I have seen. The nature of the lift itself and the mechanism of failure leads to disc herniations if there is any breakdown in form. The risk of herniation is less with squatting but it may flare up your DDD. [/quote]

Yeah, I’ve read that about dead lifts. I googled a bit, found a few forums and read through them. It seemed to me that most people ended up messing up their back when two things were happening 1) lifting over 400 lbs and 2) bad form. That’s one of the reasons I was considering setting a weight cap on certain lifts - let’s say no high than about 180 kg (396 lbs) for deads - and working on increasing reps.

That it’s possible to mess up your back with dead lifts is clear. I think my question is rather how much higher is the risk of a herniated disk with DDD?

[quote]BHOLL wrote:
My tip would be to NOT try and increase the reps at those weights, as you fatigue the greater the chance of your form breaking down, I would instead prefer to see you do less reps and maybe try to lift the weight at greater speed resulting in more force F-ma. You can’t live in a bubble but at the same time your 36 and unless your trying to compete in powerlifting im not sure I see the point of striving for 5-600 pound lifts. [/quote]
Speed is an interesting tip… something to consider. I’m not trying to compete in power lifting… just want to be strong and get my fat free mass up to about 85 kg. And if I can’t maintain good back position, I drop the weight with deads. I’m not really into heavy singles and if I can’t do 3 reps, I do a reset.

[quote]beefcakemdphd wrote:
http://www.nejm.org/doi/full/10.1056/NEJM199407143310201

Read the above. [/quote]

Very interesting, thanks! Maybe the reason my doc was out the door in less time that my question about the risks of lifting took.

I have a degenerated disc in my low back from wrestling and I had a fear for a long time of reinjurying it also. My best advice would be to figure out what keeps you able to lift, for me it was a lot of hip and hamstring mobility, and to not stop doing whatever helps. I had the problem of thinking I had worked so much on my mobility that I could back off a bit which was a huge mistake. It’s unfortunate but prehab work takes on a new meaning when you’re always on the verge of disc or potentially spine injury.

As said before certain lifts carry a risk of disc herniation you have to ask if the benefits outweigh the potential risks. Not squatting and deadlifting will leave you with a degenerated spine that can’t handle compression well, which is a pretty strong indicator that you will end up with back pain in the future. Degeneration of the spine happens as we age.

This is why Xrays and MRIs in the low back aren’t really the best option until you’ve gone through conservative treatment options because they can often be confounding or lead you to believe something is causing you pain when it isn’t.

What are you doing to strengthen your “lower abs”? In cases where someone is at an increased risk for disc pathology increasing flexion based ab training is essentially the worst thing you can do.

[quote]CroatianRage wrote:
What are you doing to strengthen your “lower abs”? In cases where someone is at an increased risk for disc pathology increasing flexion based ab training is essentially the worst thing you can do.[/quote]

The PT has me doing two new excercises. I’m not totally sure what they’re called, so I’ll describe them:

  1. I lay on my back, with my legs pointing up perpendicular to the floor and try to push my feet higher to get my hips off the floor
  2. I lay on my back, with my thigh pointing up perpendicular to the floor my shin parallel to the floor. I lift my hips a bit off the floor and alternate between flexing the left and right obliques.

Sounds like you’re describing glute bridges and dead bugs–both of which are good choices in developing core stability while sparing the lumbar spine. My concern was you were doing things like leg raises in an attempt to train the “lower abs.” I would recommend you avoid all flexion based ab exercises.

I think you’ve made some great decisions already in changing your squat and deadlift variations to those which produce less discomfort. I am similar to you where when I do a lot of back work I experience pain/discomfort instead of normal muscle soreness. Addressing weak spots should go a long way in increasing your longevity in lifting.

[quote]CroatianRage wrote:
Sounds like you’re describing glute bridges and dead bugs[/quote]

Not sure about that… the first one is like this:

[quote]CroatianRage wrote:
I think you’ve made some great decisions already in changing your squat and deadlift variations to those which produce less discomfort. I am similar to you where when I do a lot of back work I experience pain/discomfort instead of normal muscle soreness. Addressing weak spots should go a long way in increasing your longevity in lifting.[/quote]

Thanks! Nice to hear you think I’m on the right track.

Probably the best material on this are Stuart McGill’s books (e.g., on Amazon). There is one that is more for rehabilitation of acute conditions and another that is more for athletes. Both are great but if you can’t afford both get the one for athletes.

So I found articles about degenerated discs and risk of herniation and thought I would post them. Apparently degenerated discs loose height under load which adversely impacts stress distribution in the disc. This has been shown to cause pain, at least in some people. It is assumed that because of the changed mechanical behavior of the disc that there is a higher risk of injury, but there is no reference for this claim.

I also read that the force required to a herniate a healthy disc often causes a vertibae to fail before the disc, meaning that some degeneration is necessary before a disc can herniate. Here is the link to this article:
http://www.biomedcentral.com/content/pdf/ar629.pdf

However, this article shows that lack of sports is a risk factor for degeneration:

And this one shows that use of free weights is not correlated with risk of lumbar herniation, and weakly correlated with cervical herniation:
http://ajs.sagepub.com/content/21/6/854.short

So to sum up, with a degenerated disc there is a higher risk of herniation, but sports reduces the risk of herniation, and lifting free weights is either not or only weakly associated with risk of herniation. So… I think I’ll keep lifting and just cap the weight.

The vertebrae fail before the disc because the vertebral body is responsible for handling compressive loads, not the disc. You can’t compress a healthy disc, it’s full of fluid. Excessive compression in a healthy spine will cause the vertebral end plates to fracture.

A mixture of compression, flexion, and rotation cause damage to the annular fibers of the disc which allow the nucleus to migrate posterior and lateral. The effects of this are worse when loaded. This is why it is important to intelligently program to spare the spine (and not end up with disc derangement like yours truly).

Not moving any joint puts you at risk for degeneration. The body’s response to a non-mobile joint is to ossify the structure.

The use of free weights and risk of lumbar herniation is a risk/reward proposition. I don’t have the full text of that article but I suspect they were monitoring symptomatic disc herniations as opposed to just disc herniations. I could be wrong, but I don’t imagine they gave 250+ athletes MRIs to confirm the presence of disc issues.

Great discussion. I was diagnosed with degenerated L3-4-5 and told “don’t lift anything heavy”. After a year of doing things to improve core strength and recover from strained right hip stabilizers, which led to the discovery of back issues, I’ll be trying to work on some of these DL and squat variations.

I’ll tell you my story,

I degenerated/ slightly bulged L5/S1 during deficit deadlifts and here’s what i did;

  1. When the initial pain subsided, i really worked on my core and lower back. Not heavy lifting but higher reps (12-50) & higher duration. Planks, palloff press, Hyperextensions etc. Check out the RKC planks by Brett Contreras, all this time i was planking wrong.

  2. But what did work like a magic was the reverse hyper. After being the MRI diagnosis, i worked high volume & high frequency band reverse hypers and after 20 days, i was back on the field playing middle linebacker. Check how Louie Simmons got his back fixed after breaking it twice.

  3. Incase you have anterior pelvic tilt, that makes everything much worse, try to sort it, i’m still struggling.

  4. Lots of stretching glutes, hip flexors, hamstrings and rolling everywhere pretty much

After 6-7 months i was front squatting and trap bar deadlifting quite heavy. Haven’t tried back squats/ conventional dead’s. Key thing is keep core and lower back strong and dont listen to doctors/people that dont know shit about lifting. You will get back to heavy lifting

Good Luck!