Bodybuilding or Body Atrophying?: A Case Study

Case Diagnosis: Professional bodybuilder with multilevel lumbar facet arthrosis, which improved after radiofrequency ablation (RFA) enabling her to appropriately train for, and win, first place in a world-renowned competition

Case Description or Program Description: 41-year-old female bodybuilder presented with progressive left low back pain since 2019. Pain was dull, exacerbated by prolonged sitting, walking, lying down, and radiated down the posterolateral leg to the calf. Patient tried acupuncture, NSAIDs, heat, ice, TPI, SIJ and piriformis injections with minimal relief. Exam was notable for positive facet loading on the left, tenderness to the paraspinals, SIJ, and iliac crest with intact strength and negative neural stretch testing.

Setting: Outpatient Sports and Spine Clinic

Assessment/Results: Patient was sent for PT and MRI Lumbar spine, which showed multilevel degenerative disease and facet arthrosis, mostly at L3-4, L4-5, and L5-S1. After failed prior treatment, patient underwent left L4-5, L5-S1 medial branch block with eventual radiofrequency ablation (RFA). Given her plans to compete in professional bodybuilding, patient was educated on risk of potential multifidi atrophy, but elected to proceed. Post-RFA provided 30% pain relief, allowing her to continue training and ultimately win first place.

Discussion (relevance): Competitive bodybuilding is a vigorous sport in which optimal muscular performance and aesthetic appearance of all musculature are sought out. Weak evidence suggests that RFA can lead to multifidi atrophy, but the clinical significance of pain relief has been shown to enable further physical activity, which is exhibited here. RFA enabled this competitor to continue to train at high intensity while not losing points in front of the judges for muscular deformity or atrophy.

Conclusions: Evidence suggests lumbar RFA may enhance athletic performance, but data on its cosmetic effects are limited. This study found RFA improved training and maintained well-defined musculature under scrutiny. Further research is needed to evaluate multifidus muscle atrophy after lumbar RFA and its impact on function and appearance.