Narre Warren Osteo Explains The Link Between High Rep Deadlifts and Lumbar End Plate Fractures
When it comes to back injuries whilst performing exercises, such as the deadlift, the most common cause of pain and disability is a lumbar disc bulge. However, an injury that is not as common, yet may pose a problem for Crossfitters who frequently perform high repetition sets of deadlifts are "end plate fractures". This blog post will discuss the link between loaded flexion exercises and lumbar end plate fractures, as well as the common symptoms and recovery timeline. Our focus for this post are Crossfit athletes, not the osteoporotic population who are at particular risk for not only end plate fractures, but fractures in general.
What is a Lumbar End Plate Fracture?
The lumbar spine consists of five vertebrae (L1-L5) that are separated by intervertebral discs. Each disc is composed of a gel-like nucleus pulposus surrounded by a fibrous annulus fibrosus. The end plates are thin layers of cartilage that cover the top and bottom of each intervertebral disc, connecting the disc to the adjacent vertebrae (1).
A lumbar end plate fracture occurs when there is a break or crack in one of these cartilaginous end plates. This type of fracture is often caused by excessive loading on the spine, such as that experienced during high repetition deadlifts and loaded flexion exercises. In severe cases, an end plate fracture can lead to disc herniation, where the nucleus pulposus leaks out of the annulus fibrosus and compresses nearby nerves (2).
Link Between High Repetition Deadlifts and Lumbar End Plate Fractures in CrossFit Athletes
CrossFit athletes frequently perform high repetition deadlifts and loaded flexion exercises, which involve lifting heavy weights and flexing the spine under load. These exercises place significant stress on the lumbar spine, particularly the end plates, which can increase the risk of fractures (3).
Deadlifts, when performed with proper form and technique, can be a highly effective exercise for developing overall strength and power. However, the high repetition nature of CrossFit workouts can increase the likelihood of poor form and technique, resulting in excessive spinal loading and end plate fractures (4).
Loaded flexion exercises, such as kettlebell swings and medicine ball slams, also involve repeated spinal flexion under load, which can place significant stress on the end plates. As a result, athletes who frequently perform these exercises may be at a higher risk of developing lumbar end plate fractures (5).
Common Symptoms of Lumbar End Plate Fractures
The symptoms of a lumbar end plate fracture can vary depending on the severity and location of the injury. Some common symptoms include (6):
Localised lower back pain, which may increase with movement or weight-bearing activities (especially dynamic movements such as running, skipping and jumping)
Muscle spasms in the lower back.
Limited range of motion in the lumbar spine.
Numbness, tingling, or weakness in the legs (in cases of disc herniation and nerve compression).
Recovery Timeline for Lumbar End Plate Fractures
The recovery timeline for lumbar end plate fractures can vary depending on the severity of the injury and the individual's overall health. In general, conservative treatment methods, such as rest, pain management, and physical therapy, are recommended for most athletes (7). The typical recovery timeline includes:
Acute Phase (1-2 weeks): Rest and pain management, avoiding activities that exacerbate symptoms.
Subacute Phase (2-6 weeks): Gradual introduction of gentle range of motion exercises and core strengthening under the guidance of an osteopath/physiotherapist. (The lock 5 core and glute exercises are a great starting point for this stage).
Progressive Rehabilitation Phase (6-12 weeks): Continued progression of exercises, focusing on functional movements and sport-specific training.
Return to Sport (12+ weeks): Athletes may begin to reintegrate into their sport or training program, with a focus on proper form and technique to minimise the risk of reinjury.
It is important to note that each athlete's recovery timeline will be unique, and returning to sport should be based on individual progress and the guidance of their therapist.
Preventing Lumbar End Plate Fractures in CrossFit Athletes
To reduce the risk of lumbar end plate fractures, CrossFit athletes should focus on proper form and technique when performing high repetition deadlifts and loaded flexion exercises. Some key prevention strategies include (8):
Prioritising form and technique over lifting heavy weights or achieving high repetitions. (You don't need to Rx every workout, everyday)
Strengthening glute and core muscles to provide additional support to the lumbar spine.
Ensuring adequate rest and recovery between workouts to avoid overloading the spine.
Incorporating mobility and flexibility exercises into the training program to improve range of motion and reduce stress on the spine.
Lumbar end plate fractures can be a serious concern for CrossFit athletes who frequently perform high repetition deadlifts and loaded flexion exercises. Understanding the link between these exercises and end plate fractures, as well as the common symptoms and recovery timeline, can help athletes and coaches make informed decisions about training and injury prevention. By prioritising proper form and technique, incorporating core strengthening, and allowing adequate rest and recovery, athletes can reduce their risk of lumbar end plate fractures and maintain a healthy, active lifestyle.
Rajasekaran, S., & Kanna, R. M. (2015). The importance of endplate in disc degeneration. European Spine Journal, 24(Suppl 4), 449-454.
Alpantaki, K., Kampouroglou, A., & Koutserimpas, C. (2019). Lumbar end plate fractures. Journal of Clinical Neuroscience, 65, 34-36.
Cholewicki, J., McGill, S. M., & Norman, R. W. (1991). Lumbar spine loads during the lifting of extremely heavy weights. Medicine & Science in Sports & Exercise, 23(10), 1179-1186.
Hamlyn, N., Behm, D. G., & Young, W. B. (2007). Trunk muscle activation during dynamic weight-training exercises and isometric instability activities. Journal of Strength and Conditioning Research, 21(4), 1108-1112.
McGill, S. M., & Marshall, L. W. (2012). Kettlebell swing, snatch, and bottoms-up carry: back and hip muscle activation, motion, and low back loads. Journal of Strength and Conditioning Research, 26(1), 16-27.
Smith, J. A., & Hu, S. S. (2011). Management of lumbar stress reactions in athletes: a review. Clinical Journal of Sport Medicine, 21(2), 97-104.
Roberts, J. M., & Wilson, K. (2015). Lumbar spine disorders. Current Sports Medicine Reports, 14(1), 41-46.
McGill, S. M. (2016). Ultimate back fitness and performance. Backfitpro Inc.