Rethink Fitness. Prevent Back Pain. Stop Swinging. Stop Deadlifting.
Fitness is not Health
Do you care about your spine? Maybe its time to rethink those kettlebell swings and deadlifts?
I wanted to become a world cup ski racer when I was young, and so I trained hard to make it happen - when I retired at the age of 26, I was surprised to learn that I had the spine of an 80 year old man and I needed 2 back operations. A few years later, I was to learn that I also had grade 4 osteoarthritis of my knees. At first I thought I was just unlucky; after all, I had been doing all the right things my entire life by working out hard, watching my diet, and following what many of the experts in fitness were advocating at the time. Years later I am no longer telling myself I was unlucky; much of the 'wear and tear' on my body was not bad luck, and was likely related to my sport as well as bad training methods. Being an athlete may have enhanced my health and my overall quality of life in many ways, but I also think that it damaged my health in other ways.
There was a time in my life that I believed that being an athlete and being healthy were one in the same - in fact, I actually thought that training to be an athlete was perhaps the best way to reach your optimum state of health. In many ways this may be true, but when it comes to fitness, I think this thinking is problematic. Training to be an athlete requires that you ready your body for the demands of your sport, which often involves putting the joints of your body under high amounts of stress. In the context of sport, stressing your joints to the point where there could be increased rates of tissue damage is worth it because you are more likely to accomplish your sporting goals; however, in the context of fitness, where the goal is to promote health, putting your joints under the same stresses doesn't have the same benefit. Or in other words, the risk of certain exercises might be worth it for athletes, but not worth it for individuals who's primary goal is health.
Every day around the world, people are performing exercises like Deadlifts, Kettlebell Swings, Olympic Lifts, and other weightlifting moves that involve the lifting of heavy weights off of the floor, often quickly and with high levels of fatigue, all in the name of becoming healthier. I think this is misguided, and that fitness professionals that are advertising them as healthy should stop saying that. I will outline below some reasons why they might be risky, but I would also suggest that a little common sense might be enough, and perhaps I don't have to drag through a bunch of weak science to suggest that a certain exercise is harmful. Ask anyone who doesn't do fitness and they will tell you that a kettlebell swing looks dangerous. Why do all exercises have to be proven harmful in order to stop advocating them? We may never have good enough science to fully understand the risks of every different physical activity out there, we simply don't have resources to do that. Conversely, we also don't have resources to prove that every exercise is completely safe, and so we are stuck in this zone where we are armed only with some weak science and our wits. We need to be mature when considering exercises, and ask ourselves what we are potentially gaining by performing a seemingly riskier exercise over another.
Reasons that Kettebell Swings and Barbell Deadlifts are Potentially Harmful to your back:
- 90% of people will at some time get back pain in their lives. 50% of these people will suffer from recurrent or chronic pain that affects their quality of life and income. (Okay, I know that's not a reason, but at least it puts back pain in perspective first!)
- Forward bending is likely the number one mechanical determinant of injury in the spine. It is accompanied by sheer forces, compression, and other mechanics that stress the spine adversely.
- Lifting heavy loads greatly increases the already existing stresses to the spine, and increases the likelihood that a weak link in the spine could be exposed. Working with high levels of fatigue/ repetitions and also higher speeds of motion will also have the same effect.
- Fitness instructors will argue that these exercises are safe when performed correctly. That's the same as saying that I won't get into a car accident because I pay really close attention when I drive. What they mean to say is that the exercise may be safer when performed properly.
- Even when a spine is held in a more visually neutral position, most experts agree that you cannot predict when motor control errors will occur, leading to small segmental changes in the positions of your spine. The spine gets injured one individual joint at a time, and 2-3 degrees at time - the eye cannot see this in most situations. These motor control errors are probably more likely to occur while lifting heavy weights, fatigue, or high speeds, commonly seen with kettle bell swings for instance.
- Most people don't have a neutral spine when performing these lifts, and most trainees are simply trying to progress toward the more complicated lifts way too soon. Being able to show someone how to keep a neutral back is extremely challenging and takes a lot of skill and expertise to teach. I would argue that most people don't have a level of fitness that is adequate even attempt to do these activities in the 'safer' way that their trainers talk about. For instance, ask anyone to drop down to the bottom of their deadlift or squat, and hold themselves there for 90 seconds with perfect form, without any resistance other than their body weight. Most people will not be able to maintain their ideal posture, which means that as they get tired during an activity (for instance with some of these high volume sets you see in a bootcamp or crossfit session) they are at greater risk of injury.
- When lifting anything from the floor, such as in a deadlift, the hip joints rarely have the flexibility and coordination to prevent the lowest part of the back from bending. Trainers 'talk the talk' and say their clients 'hing at the hip' but when I actually watch their client's doing these activities its a different story. Moreover, when a barbell is being forced to pass in front of the knees, it forces even more loading into the hips and lower back, rather than the legs.
- In a kettlebell swing, the individual takes a heavy weight, and swings it with speed into the air, before allowing it to swing down between the legs, having to decelerate it at the point where there is the most potential for flexion and sheer in the lumbar spine. Moments of declaration are very often the moments when injuries occur. Should a motor control error happen at this high speed, with all of the compression from the resistance as well as forces from bending and decelerating, an injury to the spine could be much more likely.
These are just a few of the reasons I don't advocate these exercises for most people. If what I say is true, then why are these exercises so common? I think its because of the common held belief that sports and athletics go hand in hand with health, and these exercises are commonly used in sports and athletics. In schools, the 'jocks' often become the PE teachers and in universities the health and fitness departments go hand in hand with Sports Medicine. Most of the training certifications for fitness are heavily sport related - even the one most respected by medical doctors in the USA, still bears the name, American College of Sports Medicine. Health, Fitness and Sport are joined at the hip.
In my own experience with my patients, I have found that there is actually much intimidation about getting into fitness because it is largely viewed as something for sporty people. Not only do I think that the fitness world is causing too much injury, but I also think it is doing harm by not providing a brand of fitness that is more relevant to health as opposed to sport. Perhaps if fitness were more geared toward health, and we weren't trying to get every person to lift olympic barbells, then more people would feel like fitness is for them. I can't tell you how many times I have heard the story about a client that didn't want to do deadlifts, but their trainer loves them and so they had to do deadlifts - only to subsequently hurt their lower back. These stories should not be happening.
So if lifting heavy weight with a bar and swinging weights to the floor are potentially harmful, then what exercises do I recommend? I think the following are acceptable alternatives:
- Squats with light weights in the hands (no barbells on the back, no lifting a bar from the floor).
- Teach people to lift with proper form, with an emphasis first on flexibility, then on stability, and finally (months later) on lifting heavier objects.
- Squats in which the weight is between the legs, not in front like with barbell.
- Jumps with body weight, or onto a padded surface
- This is something fast that can replace the speed of motion in the kettlebell swing. Jumping up onto something is a great way for advanced trainees train powerfully, but without the stress of landing on their body.
- Single Leg Deadlifts
- These allow your spine to say more protected and usually involve much lighter loads and slower speeds. Also, balancing causes your body to 'switch on' stabilizing muscles, which could likely decrease the risk for motor control errors.
- Single Leg Squats
- Putting all of your body weight into one limb is a great way to strengthen your legs without having to lift any heavy weights. Just make sure its done without excess twisting, flexion or side bending in the spine, which is easier said than done.
I also don't think we need alternatives. For some people, the risk of lifting heavy off of the floor in the fitness setting may never be worth it, or they may get enough of that movement during their job. Simply teaching people how to do those things in their day to day lives are arguably more powerful than having them repeat it over and over again for the sake of getting fitter.
I think trainers should spend less time trying to 'be the best' or have the 'best workouts' and spend more time helping their clients figure out the movements that are 'best for them' or 'best for that person's health'.
Thanks for reading. Yours in Health,
Dr Ryan Oughtred, ND