Yet Dr. Alam does see a pattern in patients who forcibly hyperextend their backs over long periods of time—particularly gymnasts, cheerleaders, linebackers, divers, and perhaps even flip-flopping pop singers. “That repetitive trauma can cause a fracture in the lumbar spine at the lowest level, which is the L5-S1,” he explains. That joint is particularly sensitive, given that it’s the point where the lumbar spine and the sacral spine meet. When that part of the bone breaks, it’s known as a pars fracture. But those fractures don’t often happen due to a one-off backflip. “It’s that repetitive motion that causes microtrauma to those parts of the bone that are weakest, and then it eventually gets to a point where you get a complete fracture,” Dr. Alam says.
Unfortunately, these fractures don’t ever quite heal well once someone sustains them. That’s partially because the blood supply coursing to that part of the bone isn’t especially robust, and because humans constantly put force onto their spine through everyday motions like walking, sitting, and even laying down. “So these patients can have issues down the road, because that back pain may stay with them chronically,” he says. Disturbingly, Dr. Alam notes that some people may not even realize that they’ve sustained a pars fracture until they start experiencing debilitating nerve or back pain later on in their life. Most people who suffer a pars fracture, he adds, tend to be teenagers or in their early twenties. “They come see me when they’re, I don’t know, 30, 40, 50 years old,” Dr. Alam says, “And I see that the bone above has slipped, for example, a few centimeters forward compared to the pelvis, or compared to the sacrum.”
But fractures aren’t the only long-term injury that can potentially arise from years of sustained backflipping. When someone does a backflip, they rotate their lower back as well as their trunk. “You’re putting a lot of pressure on the actual spinal elements [with] that initial rotational force, and then once you do the flip, now you’re landing on both your legs,” he says. “Now that provides compressional force on that disc. So that rotational force and compressive force on the disc, when it’s done repeatedly, can definitely accelerate disc herniations or degeneration of the lumbar spine.” It can also, alarmingly, accelerate arthritis. He compares the motion to squeezing a jelly-filled doughnut too hard: “If I, like, get one hand above it and one hand below it, and rotate in different directions, you can cause that jelly to come out.”
During our conversation, Dr. Alam indulged me by reviewing a few videos of Boone backflipping. Afterwards, he determined that this limber young man seems to be in a good position to keep on flipping on, at least for the time being. “I think the advantage he has is that he’s pretty thin, and he’s pretty fit,” Dr. Alam says of Boone. On the flip side, Dr. Alam also “definitely think[s] he is accelerating his degenerative changes in his lumbar spine, and all his joints.”
Dr. Alam doesn’t advise those with even a “vague” history of lower back pain, sciatica, or any related issues to attempt backflips under any circumstances. But for those with sprightly spines who feel inspired to start jumping around like Boone, the spine doctor has some words of advice: Get a coach or expert to help with proper form, boost core strength, and try this out on softer surfaces first—no matter how strong the temptation might be to leap from piano lids. Still, Alam cautions, even the most lithe and wiry among us will eventually face the end of their backflipping career. “Like everything else, frequency matters,” he says. “So the more you do these sorts of activities that we’re not really designed to do as humans, the more likely you are to hurt yourself.”
