When you have low bck pain, the last thing you want to do are probably deadlifts. And I get it, I understand where you come from. We all have been told that deadlifts can cause back pain, not help it. So what do we see in Physical Therapy clinics? Clamshells, bird dogs and leg lifts with 2#. While there is a place for these exercises and I often prescrobe them myself, we should not stop there!
What if I told you that deadlifts might actually be your best choice to treat low bck pain? –
Welch et al., published a study
looking at the effects of a 16-week free-weight resistance training routine on patients with lower back pain for greater than 3 months in duration. They included a lot of exercises we would traditionally see in strength & conditioning programs, such as deadlifts, goblet squats, lunges, planks, and step ups.They also had individuals lifting loads between their 6 and 10 rep maxes. This not something we typically see or do in Physical Therapy clinics…..
Any psychological beliefs around pain were also addressed in this study. This last part might be quite important: Pain science education is key. Many people in pain have a fear of movement and unless that is resolved, any exercise might be doomed to offer relief.
So what did they see?
Significant improvements in fatty infiltrate of the lumbar muscles, a 72% decrease in pain scoring, 76% improves in disability measurements, and increases in quality of life assessments!
When performed well, deadlifts are one of the greatest exercises to strengthen your back muscles. –Dr. Pieter de Smidt, PT, DPT
Another study conducted by Dr. Stuart McGill at the University of Waterloo set out to determine how much low-back flexion deadlifting caused, and thus how much strain it put on the vertebrae and lumbar ligament (as there were many claims that the lift put these things under tremendous strain, which could lead to injury).
Researchers used real-time x-ray imaging (fluoroscopy) to watch the spines of elite powerlifters while they fully flexed their spines with no weights, and while they deadlifted over 400 pounds. With the exception of one trial of one subject, all men completed their deadlifts within the normal range of motion they displayed during full flexion. Ligament lengths were unaffected, indicating that they don’t help support the load (since muscles are responsible for it), but instead limit range of motion.
While bad deadlifts are BAD, proper deadlifts SHOULD be included when treating lower back pain.Dr. Pieter de Smidt, PT, DPT
Notes From the research:
- Athletes with mechanical low back pain least likely to benefit from deadlift training have a Sørensen <60 seconds and a VAS of >60mm (6/10)
- Men that train at 65% to 85% 1 RM reduce lumbar spine stress and increase vastus lateralis EMG activity, greater peak force, peak power, and peak velocity with Hex bar deadlift.
- Use straight bar deadlift to emphasize activation of the lumbar region and hamstrings.
So what is the right treatment for low back pain
“It depends”. I use exercises like clams, bird dogs and cobra all the time. Its a great way to get moving and then after that we load them up with deadlifts, squats, etc. It depends on what the patient can comfortably do. It depends on what the patient has done in the past. It depends on the patient’s goals. So sometimes we start with light deadlifts right away: focussing on technique, form, mechanics and more than anything the eccentric loading portion of the lift to gain mobility, confidence and resilience. Then we add more load, but I firmly believe that without loading we can not achieve long term, succesful, outcomes!
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