Deadlifting with Back Pain

Fewer debates have swept the fitness community quite like the one surrounding the safety and efficacy of deadlifts, specifically in the context of lower back pain.

On one hand, deadlifting is labelled as dangerous or risky due to the associated forces encountered at the lumbar spine. On the other, it’s regarded as one of the most effective exercises for developing lower back strength and trunk stability.

So, is deadlifting safe?

If you have back pain, should you be avoiding deadlifts, or prioritizing them?

Let’s get into it.

Firstly, what is a deadlift?
In a resistance training context, a deadlift is a compound lift involving a hip hinge. While there are several variations (sumo deadlifts, RDLs, rack pulls, trapbar deadlifts), deadlifts in general target your posterior chain muscles (namely: the erector spinae, glutes, and hamstrings).
More than just a common gym exercise, however, the deadlift is an integral part of daily life. Essentially, a ‘deadlift’ refers to picking something up off the ground, then setting it down again. It’s an incredibly functional movement; one you almost certainly do several times a day without even thinking about it.

Is deadlifting dangerous?
There’s nothing inherently dangerous about a deadlift. In fact, several studies have found deadlifting can be effectively utilized in the management of lower back pain.

As with any other exercise in the gym, it’s important to ensure the volume and intensity of your deadlifts don’t exceed the tolerance of your tissues, or your ability to maintain a good level of stability while performing this lift. Simply put: your body has the capacity to handle a given amount of force and, if this is exceeded, injury and/or pain may occur. With progressive overload and resultant training adaptations, however, this capacity can be increased so your system can safely handle more load.

To translate the above into more practical terms: when deadlifting, you should start light and focus on developing a technique/form that is right for you. From here, you need to gradually build up. This way, as the volume and intensity of your deadlifts increases, so too does your body’s ability to handle it.

Should I avoid deadlifting if I have back pain?
As previously mentioned, deadlifting is something you do every day. If you’ve squatted down to pick up your kids, you’ve deadlifted. If you’ve rearranged furniture in your house, you’ve deadlifted. If you’ve brought in a package from Amazon, you’ve deadlifted!

So, if you want to be unrestricted in your activities of daily living, deadlifting with back pain is likely going to be a part of getting there.

In fact, not only can deadlifting be incorporated into your rehab- there are many arguments to say it should.

Deadlifting helps to create a stronger, more resilient back: it improves lifting mechanics, increases trunk stability, and develops the muscles that surround, brace and offload the spine.

To understand why deadlifting might be provocative when experiencing an acute episode of lower back pain, it’s important to know a bit about the forces that go through the spine during this lift.

Compressive and Shear Forces
There are three directions in which forces are applied to human tissues: compression, shear, and tension. For this discussion on lumbar mechanics, only compressive and shearing forces are relevant.

Figure 1. Terminology for Directions of Force

Firstly, a group of muscles known as your erector spinae run alongside and attach to your spine. When active, these muscles pull the vertebrae together, creating a compressive force.

Secondly, the weight lifted in a deadlift is situated a relatively long way from the lumbar vertebrae, creating a large torque (moment of force). Due to the downward pull of gravity on the weight and upper body, a component of this force acts as shear on the lumbar spine.

During a lower back pain flare, your system is in a kind of heightened/sensitized state. As a result of this, certain movements and/or forces that would otherwise be well tolerated can elicit a pain response. This may include shearing forces, compressive forces, or both.

Deadlifting with Back Pain
When experiencing back pain with a given force/movement, the common response is to avoid these altogether. Unfortunately, this lends itself to a cycle of ongoing pain and sedentariness: you move less, so your system becomes even more neurally wound and sensitive, which leads to greater pain with activity, meaning you move even less…

So, what’s the solution?

Generally speaking, move!

While there are certain rare exceptions to this rule (see the comment on ‘Red Flags’ below), when dealing with back pain, it’s important to find ways to keep moving. As your tolerance to activity increases and your pain decreases, you can gradually build up your movement until you’re back to doing the things that matter most to you! This is known as ‘graded exposure’. Initially, focus on finding a comfortable range of motion and practice moving through this. Then, when it comes to movements that aren’t pain-free, gradually re-introduce these to your day with the knowledge that it’s safe (and sometimes necessary!) to move with pain.

How can we apply this to deadlifting?

If you’re experiencing pain with shearing forces, a loaded deadlift will likely be quite provocative to begin with. Instead, practice hip hingeing with just a dowel. Focus on the movement itself rather than the pain you experience with the movement, and perform ‘little bits, lots of times throughout the day’. You can also get some good muscle activation happening with exercises such as deadbugs, bird dogs, crab walks, palloff press, or planks: these exercises promote bracing and trunk stability, which will have a great carry-over to compound lifts like deadlifts.

Once things are a little less sensitive and hingeing is better-tolerated, you can begin to practice deadlifting through a shortened range of motion. Start light, and try exercises such as rack pulls, RDLs, and/or trapbar deadlifts. From here, you’ll be in a great position to progress to full range deadlifts- and reap the full benefits of this fantastic exercise!

Red Flags
A note on safety: in rare cases, low back pain/injury can be accompanied by bowel and bladder changes, saddle anaesthesia, or significant changes in lower limb strength, sensation or reflexes. If experiencing any of the above, it’s important to seek medical attention.