SHOULD THE DEADLIFT BE FEARED AS AN INJURY RISK? OR EMBRACED AS AN IMPORTANT REHABILITATION TOOL?
One thing I’ve heard a lot, during my time as a physiotherapist, is how bad deadlifts are. Usually those complaining have come to see me for their back pain after they had hurt themselves deadlifting in the gym. Now of course people can get a sore back from deadlifts, but the cause is usually a breakdown of technique, the use of excessive load or poor programming. But doesn’t the same go for any exercise?
The deadlift is a basic functional movement where you are picking something off the ground. So why do so may people fear it when we do it all the time during daily function? Why do many health practitioners, including physiotherapists, turn away from the deadlift? Is the deadlift good or bad for your back when performed properly?
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Proof is in the powerlifter
A study by McGill et al (1992) looked at highly trained elite powerlifters and what sort of flexion forces were applied to their spines by deadlifting when compared to just standing and bending forwards. The idea was that in a flexed position the load would put excessive strain on the vertebrae and ligaments, possibly leading to injury.
A real time x-ray was used to assess the participant bending and the deadlift of 400 pounds. With the exception of one subject in one lift, all lifters completed their deadlift within normal range. They were completed without excessive force applied to the wrong tissues when compared to just bending forwards. As a result, good technique and the use of an appropriate weight, the deadlift is not dangerous for a well functioning back. Please note the importance of correct technique to avoid back pain from deadlifting.
Practice makes perfect: use correct technique
I often tell patients that if they want to be good at something, practice it. Think of it this way; If you’re not usually a runner, but decided to run for hours one day, it should be no surprise to became very sore and possibly sustain an injury. However if you’re conditioned to run for hours, a different result would be expected. Therefore, it makes sense that if you want to become better at lifting and bending during daily function, you practise these tasks in order to condition your back for them.
The paraspinal muscles are big cable like muscles running up each side of the spine. 80% of people with lower back pain have poor paraspinal muscle strength. Strong paraspinal muscles reduce the sheer force occurring in the spine, meaning strong back muscles, put less force onto the discs of the lower back. A study by Colado et al. (2011) demonstrates that the deadlift is the most effective exercise at recruiting the paraspinal musculature compared to other exercises. It is also extremely functional and has great application for progression given the compound nature of the exercise. Essentially, the deadlift is an effective method to build the muscles that are very important for supporting the spine.
Another study by Welch et al. (2015) showed that over a 16 week free-weight-resistance based program 30 participants with over 3 months of lower back pain reduced their pain by 72%, their disability by 76%, greatly improved their back strength endurance and paravertebral size. There was also a decreased presence of fat infiltration in the spine, which is a common finding in MRI of people with longstanding lower back pain. Interestingly, a maximum weight intensity of 6-10 repetitions was used in the study. Therefore the intention was getting the participants strong using relatively heavy weights, not shying away from them.
Deadlifts proven to reduce back pain
A study by Aasa et al. (2015) showed a group of participants with over 3 months of lower back pain improved greatly with exercise. Participants were broken up into high-level lifting loads, including the deadlift, and low-load motor control exercises, such as Pilates. After eight weeks both groups showed similar improved results with pain, strength and endurance. The only difference between the groups was that the low-load motor control group showed better results with movement control. Given this is what they were training this makes sense. So what would happen if these two methods were combined? Should they be combined, or should we just get stronger given the improvements were similar across the board?
Later Aasa et al. published the paper Which Patients With Low Back Pain Benefit From Deadlift Training? (2015). The paper broke the study down further to assess what participants did better, with deadlifts as their prescribed form of treatment. It was found that patients that did better with the implementation of the deadlift generally had better back endurance during the Biering-Sorensen Test, and less pre-exisiting pain (VAS <60mm) prior to commencement of the study.
Consequently, deadlifts are a very valuable tool in the rehabilitation process for someone with lower back pain. When performed with proper form and appropriate load, deadlifts are not dangerous. Aasa et al. (2015) study results demonstrate it’s advised to undertake low-load exercise to improve back endurance and pain, prior to commencing functional strength work such as the deadlift. Importantly, all study participants were instructed with correct lifting form. If unsure of the proper technique, or having trouble in the gym – seek the advice of a trained professional.
Berglund L, Aasa B, Hellqvist J, Michaelson P, Aasa U. Which Patients With Low Back Pain Benefit From Deadlift Training? J Strength Cond Res. 2015 Jul;29(7):1803-11. doi: 10.1519/JSC.0000000000000837.
Burton AK, et al. Chapter 2. European guidelines for prevention in low back pain: Eur Spine J, 2006.15 Suppl 2: p. S136-68.
Colado JC, Pablos C, Chulvi-Medrano I, Garcia-Masso X, Flandez J, Behm DG. The progression of paraspinal muscle recruitment intensity in localized and global strength training exercises is not based on instability alone. Arch Phys Med Rehabil. 2011
Welch N, Moran K, Antony J, et al. The effects of a free-weight-based resistance training intervention on pain, squat biomechanics and MRI- defined lumbar fat infiltration and functional cross- sectional area in those with chronic low back. BMJ Open Sport Exerc Med 2015;1:000050. doi:10.1136/ bmjsem-2015-000050