Deadlifting After Back Pain
Low back pain is the most common type of pain reported by patients and is the leading global cause of disability. It is likely that almost everyone will experience an episode of acute back pain at some point in their life.
Acute low back pain can be effectively treated with activity modification, cryo/ thermotherapy, mobility, and strength training. If not managed appropriately, acute back pain can develop into chronic back pain (pain lasting roughly more than 6 months). We now know that effective management of chronic low back pain is multifactorial encompassing physiological, psychological, and behavioral therapies.
Evidence suggests that deadlift training is an effective tool in treating mechanical low back pain. Mechanical low back pain arises from musculoskeletal structures including muscles, bones, ligaments, discs, vertebral joints, and nerves. Common diagnoses you may hear that are classified as mechanical back pain include myofascial pain, muscle strain, spinal stenosis, disc herniations, discogenic pain, bulging disc, vertebral fractures, sciatica, and sacroiliac joint pain.
In our previous blog post “Is deadlifting good for your back,” I cited a study that suggests deadlift training is most effective in treating mechanical back pain when the patients have manageable pain levels, minimal disability, and moderate back and hip extensor strength. There are various interventions and techniques we use in the clinic when first treating back pain to decrease pain levels, restore mobility, and increase isolated hip and back strength/ endurance.
The purpose of this post is to illustrate how deadlifting can be safely implemented into rehab programs in patients with back pain.
Hip hinge with dowel
We strongly promote learning how to perform a movement correctly before loading the movement. Placing a dowel along your spine maintaining all 3 points of contact, is a tool we use to teach hip hinging with a neutral spine. Keeping the spine in a neutral position will allow you to deadlift more with your legs and less with your back, reducing the stress on your spine and lower back muscles.
Once the patient demonstrates good motor control performing the hip hinge, the movement is progressed to using a light to moderate kettlebell. Pulling the kettlebell from an elevated step allows the patient to replicate the hip hinge pattern they just practiced with the dowel. This exercise can be progressed by increasing resistance and removing the step to transition to a movement that better represents a deadlift.
Barbell rack pulls
A rack pull is an excellent way to introduce the barbell through a limited range of motion. I typically add in the barbell rack pull once the patient has progressed to a moderate kettlebell weight through full range of motion. The rack pull allows the patient to get comfortable hinging with a barbell and begin to load the upper range targeting glute strength.
Full range barbell deadlifting is the final progression. Not only does the deadlift have the ability to maximize low back strength, but it also has positive psychological effects. Pulling large amounts of weight from the floor without apprehension or pain gives patients confidence to return to their prior activities without fear of re-injury. The intensity and volume of training is strategically progressed to safely challenge the patient increasing strength without re-injury.
⊗This is not medical advice for anyone with back pain to start deadlifting. A physical therapist can determine if your pain is of musculoskeletal origin and will design an appropriate and individualized program to safely get you back to activity.
Written by Hannah Sweitzer, DPT, OCS, CSCS
- Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020;8(6):299. doi:10.21037/atm.2020.02.175
- Chien JJ, Bajwa ZH. What is mechanical back pain and how best to treat it? Curr Pain Headache Rep. 2008 Dec;12(6):406-11. doi: 10.1007/s11916-008-0069-3. PMID: 18973732.