Deadlift: Harmful or Helpful for Low Back Pain?

The deadlift is essentially a hip hinge with weight.  The hinge occurs by flexing at the hips while maintaining a flat low back.  The deadlift also involves some knee flexion but the majority of the movement occurs by hinging at the hips.  Hinging differs from stooping and squatting.  Stooping involves bending at the low back more than the hips.  Squatting involves bending at the knees more than the hips.   The deadlift is an exercise which resembles a safe technique for lifting.

The deadlift is a great exercise to strengthen your backside.  The gluteus maximus, one of the largest and strongest muscles of the body, is the prime mover when performing the deadlift.  The quadriceps, hamstrings, and low back muscles are also activated at high levels.  Adequate strength in these large muscle groups is necessary for every day function and performing sports at high levels.  The deadlift also activates smaller stabilizing muscles of the spine to a greater extent than low load exercises lying on the floor or a ball.

The deadlift sometimes gets a “bad rap”.  This is because many in the medical community have cautioned patients with low back pain from performing any heavy lifting.  It is true that improper execution of the deadlift can result in low back injury.  However, when performed properly, the deadlift is an excellent exercise to strengthen the hips and low back.  Proper instruction and coaching of the exercise should always occur for individuals with low back pain.   Most people require the help of a physical therapist or coach to learn the exercise correctly.

Should People with Low Back Pain Deadlift?

The safe answer is it depends.  However, research does show the deadlift can be very effective for strengthening the low back muscles, decreasing back pain, and improving function.  Therefore, most people with low back pain can, and should, be instructed on how to hip hinge and perform some variation of the deadlift.  This does not mean everyone with low back pain should attempt to pick up as much weight as possible from the floor.  There must be proper instruction, safe practice, and appropriate progression.

A 2015 study in the Journal of Orthopedic and Sports Physical Therapy showed both low load exercises and deadlift training resulted in similar improvements in low back pain, back muscle strength, and disability.  It was later found that people with better low back muscle endurance and lower pain levels were more likely to benefit from deadlift training.  Therefore, a wise approach is to begin with low load exercises on the floor or a table.  Once pain levels decrease and muscle function improves, progressing to deadlift training can be started.

Deadlift Progressions

It can be challenging for some individuals to learn how to properly hinge at the hips without bending at the spine.  Physical therapists use different corrective exercise approaches to teach the proper movement pattern.  Only after mastering the movement pattern is weight added.  The basics of the set up for the deadlift include a hip-width stance, soft slightly bent knees, shoulder blades back, and a chest-up position.  Your chest should be above your hips, and your hips above your knees.  The movement is initiated by extending the hips with a flat back.

Below are 5 exercise progressions for the deadlift.  There are many others which are considered when designing an individualized program.  The specific exercises prescribed depend on the individual’s current levels of strength, mobility, function, and their goals.



Closing Thoughts

 People with low back pain cannot fully function in everyday life without lifting objects from the floor.   Physical therapists can teach people how to properly lift.  Deadlift variations are ideal for this purpose.  Research shows people with low back pain can safely and effectively perform the deadlift.  For many people with low back pain, the conventional deadlift is not the best choice.  Most people require modifications.  Your physical therapist can perform a physical examination and then prescribe the exercise which is best for you and your goals.

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