Olympic weightlifting can play an important role in the rehabilitation of disc prolapses, either on its own or as an adjunct to exercise modalities such as Pilates.

When thinking of rehabilitation exercise for back injuries, Pilates is often the first thing that comes to mind, so when my osteopath advised me to take up Olympic weightlifting to help with my multiple back conditions – disc bulge, facet joint inflammation and sacroiliac joint dysfunction – my jaw dropped. After all, I had been a Pilates teacher for many years and was working my own rehabilitation program. Progress was slow though, hence the visit to the osteo to help things along a bit.

Disc bulges are almost always posterior – the bulge is backwards - and usually caused by bending your back while lifting heavy things. It is never that one stupid thing that causes the disc to slip out the backdoor; usually it has already been sitting there in readiness from doing repetitive stupid things--sometimes over years. The straw that finally breaks the camel's back can be a minor movement or even just a coughing fit or sneeze. A mild disc bulge can be present for a long time without causing any symptoms until that fateful day...



Pilates focuses on the internal core muscles; transverse abdominis, multifidus, oblique abdominal and pelvic floor muscles are recruited while maintaining neutral alignment of the spine, thus stabilizing it. Flexion (bending) is contraindicated in the initial rehabilitation stages. The effort part of a movement is performed on exhalation. This aids contraction of the transverse abdominis which in turn switches on the multifidus muscles along the spine. Contraction of the pelvic floor muscles – where the legs meet in the dark - complete the stabilizing function of the core.

Back injuries, especially long-term ones, often result in insufficient recruitment of these internal stabilizing muscles, while "bracing" with the external core muscles rectus abdominis, spine extensors, and often gluteus maximus as well, is perceived as a protective armour for the injured back. Our bodies have to relearn the correct sequence of muscle recruitment in the core area while performing controlled, safe movements such as bent-leg raises, upper back and arm movements to allow injuries to heal and prevent recurrence. Gentle mobilization of the spine with minimal deviation from the neutral position allows muscles in spasm to gradually relax.

As a weightlifter you can probably already see the crucial differences but also the similarities between weightlifting and Pilates. Both modalities maintain neutral spine during movement, both recruit core muscles. However, Pilates discourages the use of the larger core muscles rectus abdominis, spine extensors and glutes as stabilizers. They are only switched on as soon as they are required to perform a certain movement. In Olympic weightlifting, when your coach sings out 'everything tight,' you recruit the hell out of all the muscles you can think of in the general core area, hopefully including all the internal ones.

The main difference is the way breathing is used during movement. Pilates uses breathing out during movement to recruit transverse abdominis, pelvic floor and multifidus to create intra-abdominal pressure that acts like a corset around the spine. This works really well for movements up to a certain level of resistance. On its own, though, it would not be sufficient to stabilize the spine while using the heavy resistance used in Olympic weightlifting. Here the larger muscles need to provide extra stabilization, and the deep inhalation before tightening all core muscles, internal and external, brings the diaphragm into play to seal off the intra-abdominal area which, due to the involvement of the larger, external muscles, creates a stronger corset-like effect. The lift is then performed while holding your breath, maintaining intra-abdominal pressure until the weight is safely released.

How then can these two different types of exercise be married to help in back injury rehabilitation? Specifically we are talking disc bulges, one of the more common back injuries that occur due to flexing the spine with heavy resistance – bending over while lugging heavy stuff. Pilates has always been the initial exercise prescription preferred by many physios, osteos and chiros. Learning to switch on those internal spine stabilizers is essential before progressing to more loaded movements, and once you are cleared to move there has to be movement, movement and more movement, in a controlled manner. Loaded flexion of the spine is contraindicated; neutral alignment of the spine must be maintained. Enter Olympic weightlifting with its focus on good form, i.e. having a straight back throughout the lifts.

Little did I know what Olympic weightlifting could do for this middle-aged former Pilates teacher. Fortunately, I gave my osteo the benefit of the doubt and had a crack. Once I got past the counter-intuitive use of my breath and larger core muscles, I really started to love the challenges that the Olympic lifts presented. Here is what I found:

• Despite years of Pilates, I was not as flexible as I needed to be for lifting. I had to increase my ankle, hip, upper back and shoulder mobility and the ability of especially my shoulders to move comfortably behind my neck.
• My posterior chain and my hamstrings were not as strong as I thought. Beyond a certain resistance in the deadlifts or squats, for example, my spine wanted to flex. Back strength needed time to catch up with the legs.
• My coordination was challenged a lot and often. As a 5' 11" Gumby with long limbs, I needed a lot of repetition to "get it".
• My upper body strength in general required a lot of work. Pilates and my other sport of choice, mountain biking, did not prepare me for the presses, push-presses and pulls. Many a time I left the gym with sore arms and shoulders.

Almost a year down the track, my back has never been better. From the start, every lifting session I had brought a little bit of improvement, largely due to a great coach who would never let me use heavier weights than my back could handle. Initially that meant many lifts were performed using only the bar. With the increase in overall core muscle strength, I could lift weights I had never dreamed of, especially after developing a "bad back." The lifting technique carries across into day-to-day activities, enabling me to do things that I thought were of the past. Just moved 30 heavy railway sleepers for a garden bed from the bottom of the garden to an area near the house by using a power clean movement to bring one side of the sleeper to shoulder height and then pressing it up to tip it over lengthwise. Piece of cake!

How does Olympic weightlifting compare to other resistance training in terms of functionality of movement? With the heavy focus on ab work and single joint movements – e.g. biceps curls, triceps extensions, legs extensions and the like, and usually only a token back exercise and squats thrown in here and there in general exercise programs, it’s fair to say that Olympic weightlifting is a much more efficient way of using exercise time. And since functional movements can easily transfer to many activities in daily life, it has an important role to play in general preventative exercise programming. For the purpose of rehabilitation, there is no need to take lifting to competitive level. Many benefits will be derived when working comfortably within limitations and gradually and carefully pushing the envelope. Not many daily living activities strengthen our upper and lower backs or focus our minds on correct posture. Olympic weightlifting challenges all muscles of the body with every lift and puts our bodies in a much better position to deal with all those occasional activities that overload our bodies and potentially cause injuries because it has such a great overall strengthening and muscle balancing effect.