For years, an argument has taken place between coaches, trainers and healthcare providers alike. Some argue that the deadlift is purely the opposite motion of a squat; similar to how a biceps curl is the opposite of a triceps extension or a leg extension is the opposite of a hamstring curl.
The deadlift and the squat are two totally different animals.
And while both require appropriate levels of spinal rigidity, hip mobility and recruitment of ALL the muscles;
the physiologic patterning and body control demands differ.
Both movements are excellent methods of total body strengthening but often the deadlift gets a bad reputation as a means for injuring your back rather than being a tool for managing and resolving back pain. This poor reputation tends to stem from the medical community’s advice of “avoid any heavy lifting” when a patient is experiencing low back pain.
Can the deadlift hurt your back? If performed incorrectly, absolutely. But so can running or stretching or swimming or…you get the point.
Form is key.
A deadlift is a hip hinge. Well, what the heck is a hip hinge? The hip hinge occurs by flexing at the hips (bringing your belly button closer to the front of your thighs) while maintaining a stiff (rigid) spine.
Hinging is different than simply bending over or squatting. Unfortunately, a great many coaches and providers alike, cue and coach the deadlift poorly. The deadlift is a HIP DOMINANT movement not a back dominant movement. Is the back involved? It better be. Hoever, the back's role is to provide a rigid, stable platform to leverage from while the legs do most of the work. Should the back be strong? Hell yes. But to deadlift well your back, glutes, quads and hamstrings must all be strong and it makes sense because all of them are shown to have high levels of activation during this particular lift.
This is the beauty behind this type of lift is that for general strength training or lift specific, competitive powerlifting it hits everything.
And for treating low back pain...it hits everything (with a slight adjustment in purpose and focus of the lift)
Should someone with low back pain deadlift?
The answer that gets thrown around a lot in the PT world is that it depends.
Context is key. While research shows that the deadlift is outstanding for strengthening the entire body, decreasing low back pain and improving general performance/function; some patients are not receptive to idea of deadlifting. The clarifying point that must be made is that you don’t have to lift ALL THE WEIGHT. If that's a goal of yours, awesome, but that's for another discussion. Mastering the hip hinge movement, improving body awareness and spinal control will still offer the same benefits to the arms, back, core, hips and legs as performing it with heavy weights. Simply being able to control your body through a full range of motion while countering gravity can be input enough to recruit the same muscles.
How To Progress The Deadlift
The following is a list of methods I often use for teaching, scaling and/or progressing the hip hinge and teaching the deadlift. There are many other ways of regressing or progressing these movements and positions but those are best left to be prescribed following a full Physical Therapy assessment.
Hip Hinge Wall Touch
Hip Hinge with PVC
Golfer Pick Up with PVC
Plate Hold Hip Hinge
Trap Bar Deadlift
If you can't bend over or lift objects off the floor you’re lacking full, general functional ability.
At Southeast Physical Therapy, we frequently teach people how to lift properly and diving right to the conventional deadlift is not always the best option. Regressing slightly to identify a comfortable, scaled version of the deadlift is better starting point for people with low back pain. If you're unsure if this is a good starting point for you come in for a Full Musculoskeletal Assessment; this examination, manual treatment, careful exercise selection and exercise dosing is the best method of getting out of pain and back to doing what you love as quickly as possible.
If you would like our help in resolving any pain please contact us or call/text us directly at 678-640-4606.