Milwaukee Journal Sentinel / MedPage Today—November 2, 2011
The squat lift, an exercise that has long been a standard training technique for athletes, puts inordinate stress on the spine and likely is the cause of chronic stress fractures in young athletes.
That's the conclusion of a study presented at the North American Spine Society annual meeting.
Even when young athletes have textbook form in doing squats, they are risking a hard-to-heal stress fracture of the posterior lumbar spine structure known as the pars interarticularis, researchers reported.
The most alarming finding was a change in the slope of the sacrum during a back squat, when the bar was across the upper back.
Squats significantly increase the slope of sacrum and the alignment of the spine, resulting in a "horizontalization" of the sacrum.
Doing a similar type of exercise without weight is much less likely to cause pars stress fractures.
Some people may be more predisposed to problems with the pars. Once a stress fracture occurs it can be very hard to heal.
However, changing attitudes of coaches and trainers is difficult, said Michael Reed, PhD, a physical therapist who specializes in the spine.
Part of the problem is the exercise is effective at strengthening muscles.
"The problem is, it can be very risky," said Reed, who practices at Hospital for Special Surgery Spine and Sport in Jupiter, Fla. "Even the best form will not protect you."
Reed said he doubts many parents know how risky squats are. He said they probably rely on coaches and trainers who don't fully understand the risks.
Reed said squats also pose risk for older adults, but the biggest concern is in people who are skeletally immature.
He said he has seen more than 500 kids with pars fractures and often they remember hurting themselves doing squats.
Invariably, coaches will blame the injury on bad form, he said. Now there is evidence that even good form puts the spine at risk, he said.
Once a pars fracture occurs, the chance of it healing is as low as 2%, he added.
Many of those people eventually will develop degenerative disc problems and a lifetime of low back pain, he said.
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