Deadlifts and Back Pain

Deadlifts and Back Pain

By: Nick Soleyn, PBC and Editor in Chief

The deadlift is a back exercise that often exposes or exacerbates underlying issues, causing pain and disrupting training. Despite that, lower back pain from deadlifts causes fear disproportionate to its actual danger. Deadlifts are rarely the root cause of back pain, and it is even rarer for deadlifting to cause an acute back injury. Still, some people’s backs hurt every time they deadlift, and knowing that deadlifts probably are not the root cause of the pain and are safe (despite the pain) does not help. Pain significant enough to require modifications to training needs to be addressed.

Different types of back pain require different approaches. Chronic back pain demands smart training, modifications, and careful programming—the same way you would work around any limitation. Strength may not fix chronic, non-specific back pain, but weakness and pain avoidance almost certainly presage worsening pain with age. This article focuses on acute lower back pain that shows up in limited circumstances—with the deadlift—and the troubleshooting and changes that tend to solve the deadlift back pain problem. Mechanically, the deadlift is safe and beneficial for your lower back. In healthy backs, the deadlift does not expose the lifter to forces or movements that cause the most common back injuries. Knowing the problem—usually form, fatigue, or intensity—reveals the solution.

Common Causes of Back Pain

When a lifter experiences back pain from deadlifting, the worry is that something in the muscles or joints is either not working properly or causing pain by affecting a nerve. The following are the most common of these underlying mechanical issues:

• Sprains and strains are caused by acute damage to the soft tissues of the back. A sprain refers to overstretching or tearing of ligaments, and a strain the tearing of tendons or muscles. These may occur from twisting or lifting something awkwardly, which is rare in weight training. Lifting too heavy can cause a strain, making it a problem when lifters push to their limits in a competition or during maximum effort attempts. More commonly, hard training causes muscle weakness and may trigger spasms in back muscles, which can be lasting and painful.
• Intervertebral disc degeneration is one of the most common underlying causes of low back pain because it happens as part of the normal aging process. That is not to say that disc degeneration dooms someone to chronic or recurring pain. Many people have some kind of disc degeneration with no symptoms.
• Herniated disc. Sometimes called a slipped disc or a ruptured disc, this occurs when the outer ring of the intervertebral disc (annulus fibrosis) ruptures and some of the disc’s nucleus pushes through. A herniated disc in the lower back may cause pain, numbness, or weakness in different places. Symptoms depend on whether the herniation causes irritation or impingement of nerve roots. Radiculopathy or sciatic nerve pain are familiar symptoms of a herniated disc.

Other chronic conditions may also cause or contribute to back pain and cause problems with training:

• Spondylolisthesis. This mouthful of a condition mostly affects people over fifty, women, and people with “general joint laxity.” Spondylolisthesis is a downstream possibility from normal disc degeneration. Narrowing of the disc space leads to instability and the slipping of the disc forward (anterolisthesis) or backward (retrolisthesis). This slippage may cause pain and other symptoms depending on its severity and effect on other tissues and nerves.
• Spinal stenosis. Spinal cord nerve roots run through the spinal canal. Spinal stenosis is a general term for the narrowing of the spinal canal from several causes—sometimes genetic, but most often bone spurs, herniated discs, thickened tendons, tumors, or a spinal injury are to blame. Pressure on the spinal cord nerves can cause pain or numbness with walking that is relieved by leaning over.
• Built-in skeletal issues. Some people have a sideways (scoliosis) or inward (lordosis) curvature of the spine that may cause pain in their middle age or beyond.

The takeaway from this overview of back pain is that different underlying causes may present similarly. Without more, we cannot pinpoint the source of a person’s back pain. It is problematic to assume that proximity to the pain equals causality (“It hurts when I deadlift, ergo the deadlift is causing the pain”). Any of the above sources may be the root cause, with the deadlift only irritating it enough to cause pain. Or something may have happened outside the gym to produce extra fatigue or weakness in the back, causing normally safe training to end with a strain or spasm.

The first step in addressing lower back pain while deadlifting is not to identify the source of recurring back pain. Instead, it is more productive to eliminate the possible aggravating elements and continue training unabated.

Pain =/= Injury

Training is challenging. Done correctly, it must cause fatigue, it often causes soreness, and it sometimes causes pain. The body may rebel against uncomfortable activities, but discomfort is not the same as—or even a precursor to—injury. Some people will never accept this and will stick with exercise that involves little to no discomfort other than being sweaty. Productive physical training uses discomfort to make you stronger. Part of the lifter’s responsibility is accepting productive discomfort and distinguishing it from the pain of injury.

The most common distinction is that injury-pain is the pain of dysfunction. It will cause or lead to changes in how you move and lift, causing unsafe deviations from the basic lifting models. If pain prevents you from lifting with excellent form, it’s time to change something in your form, programming, or intensity. Injury or pain may keep you from training as you normally would. It should not be an excuse to modify your training just to avoid discomfort. If you need help learning the difference or building confidence in your routine, Barbell Logic offers free consultations or a free month of coaching.

Are Deadlifts Safe for Your Back?

Whether a lift is safe requires some brief discussion about what “safe” means in this context. By some definitions, nothing is truly safe. Getting out of bed in the morning may be the first falling domino to lead to your demise. Staying in bed, being sedentary, is equally dangerous and bad for your health.

Whether a lift is safe is a question of how likely it is to cause an injury. Safety depends on whether the deadlift risks stressing a healthy spine in ways that damage either the back’s soft tissues or the spine’s integrity. Does it require the back to do something it is not supposed to do, or is training the deadlift inherently harmful?

We can look at how the back handles compression, flexion, extension, lateral flexion (side bends), rotation, and horizontal shear to help answer those questions.

Compression. Studies have had a hard time showing disc herniation from compression alone. Early studies, using spines of the recently deceased, suggested that vertical downward compression will cause the disc to bulge slightly, but the discs handled more compression than the vertebrae, meaning a load that is not heavy enough to fracture the spine will not cause a herniation in an otherwise healthy spine. (Roaf 1960.) In another study, the authors said that a posterior herniation without some underlying degeneration required simultaneous forward bending, side bending, and violent compression. (Rannou, 2001.) In practice, we do not see compression injuries of the spine in lifting. Humans have held incredibly heavy weights in compression—the old-time strongmen and women would support thousands of pounds sometimes—without acute damage to the spine. Most normal training loads carry no inherent risk of compression fractures to the spine, let alone herniation.

Flexion, extension, lateral flexion (side bending), and rotation are all considered safe movements of this spine. Most acute spinal injuries involve some combination of safe movements combined with compression: up to two-thirds of involving trunk rotation, and awkward lifting—particularly when facing up or down an inclined surface—makes up a significant portion of the others (Ivancevic, 2008). Inherently risky movements are rotational movements combined with heavy compressive or impact forces.

Deadlifts do not involve twisting the trunk to any degree. So, why do people’s backs sometimes hurt when they deadlift? First, the issue often isn’t an acute injury but an underlying condition or something that happened outside of the gym getting aggravated. The deadlift might expose a chronic or acute underlying issue, even if the lift was not the original cause. Deadlift injuries are rare. The vast majority of those injuries are muscle strains caused by a form issue, fatigue due to training, or intensity from loading.

Form

In a correctly performed deadlift, there is no twisting motion or sudden jolts. The lift involves a gradual loading of the spine and a more or less hinge movement about the lifter’s hips, where the lifter stays square with the wall in front of them. Ideally, the spine is held in normal anatomical extension and does not flex once the back is set. Even if there is some flexion, it is not combined with any rotational force on the spine, impact forces, or anything described in the literature as likely to cause a spinal injury. The deadlift places the lifter on a flat, stable surface, the weight over the midfoot. The value of lifting in the gym should be evident: it is a place where we can set up perfect conditions for safe lifting. With proper form, the deadlift meets all the criteria of a safe lift, requiring no movements that should be considered inherently risky.

Nobody’s form is perfect all the time, however. We shouldn’t dismiss potential issues resulting from bad form because “that’s not a deadlift.” (The same way we shouldn’t assume that the slightest deviation from perfect form is courting spontaneous spinal explosion.)

Certain form issues are more likely to cause a strain, aggravate an underlying condition, or cause pain:

• Failure to set and hold the back rigid
• Allowing the bar to swing away during the lift
• Rounding of the lower back while the bar is moving

These form errors are most likely to cause issues if repeated often and habitually with regular training.

Setting the Back

Setting the back is a skill that, once learned, should be an automatic part of lifting any load, in the gym or not. The video below covers how to set your back for lifting.

Fix a Swinging Bar

There is a fight between gravity and the bar pulling the arms straight and the latissimus dorsi muscles (lats) keeping the lifter’s arms at the necessary angle to put the bar over the midfoot. If the bar swings away due to the lats’ failure to hold the bar back, then the bar is no longer over the midfoot. Not only is the lifter potentially out of balance, but the sudden changes from a moving bar also make it difficult to maintain a flat back, increasing the likelihood of a lower back strain. This cue can help:

“Taking the slack out” and “squeezing the bar off the floor” include an active contraction of the lats to help keep the bar on the legs as it breaks contact with the ground. Getting your chest up very hard also helps.

If you struggle with this still, you might also try to pause before you pull. As you pause, pay attention to your balance; you should be heavy on your midfoot. Pay attention to your grip; the bar should be heavy in your hands from squeezing all the slack out between your arms and the bar. Pay attention to the bar’s position; the bar should be touching your shins. And actively keep the bar back so it stays on your legs during the lift. This is the pulling position, which you should pass through for every single rep. A slight pause here—no more than a moment—allows you to recognize, confirm, and repeat the deadlift setup position no matter how much weight is on the bar.

Back Rounding During the Lift

Flexing the spine during the movement—seen as the lifter’s back rounding after the bar leaves the floor—causes a lengthening of the spinal erectors while under load. This tends to cause excessive muscle fatigue, making the lifter feel sore later or predisposing them to a spasm (usually later from a twisting motion). Regular or habitual flexion needs to be coached out of a lifter where possible and otherwise targeted with gradual loading and intentional supplemental work that changes the stress or the range of motion. An overall strengthening of the back with barbell rows, stiff-legged deadlifts, and Romanian deadlifts to supplement deadlift training should fix this issue. And working on paused or floating deadlifts can help train the lifter to keep the back set through the crucial first few inches of the lift.

It is also important not to confuse some back rounding when the back is held static with flexing during the movement. Sometimes a lifter will exhibit a rounded back due to proper lifting form. This should not be corrected. The telltale signs of an inappropriately flexed back are rounding during the movement (while the bar is moving) or a visible extending of the back as the lifter tries to lock the bar out at the top, sometimes called a “hitch” at the top of the lift.

Fatigue

Fatigue may lead to a muscle spasm or can cause pain that feels like a muscle strain. Fatigue is a normal part of training, but sometimes fatigue from outside the gym gets added to lower back fatigue from training, compounding and causing problems. Fatigue is properly managed with programming, managing increases in training volume and giving the lifter time to adjust to new lifts. Otherwise, the lifter must respect fatigue after training. Treating the body well after training is a part of training, and certain workouts will limit what someone can and should do later.

Finally, intelligent lifting outside of the gym can limit injuries that follow from fatigue. Stay square to the things you are trying to lift, set your back, brace, and don’t twist while holding a heavy load.

Intensity

You can strain your back with very heavy deadlifts. This happens when a person lifts too heavy or too much. What is too heavy or too much will depend entirely on the person. Even then, lifts that are too heavy usually cause untoward fatigue, not sudden injury.

A strain suffered from intensity usually requires a short-term adjustment to training or a longer-term MED change.

Rack pulls help maintain intensity by changing the range of motion. Set these to a height that allows heavy training with minimal pain and less fatigue. This is a useful adjustment for people training for competition or freak issues that started outside the gym.

An intensity-related strain is often a programming issue in which the lifter’s training fatigue had not dissipated sufficiently before a heavy training day or competition. MED changes may replace the main volume work for the lifter’s deadlift with a less stressful supplemental lift or spread out the lower back training volume with accessory work and a decrease in the main lift volume. The lifter can also work on PRs in different rep ranges to maintain measured progress in less potentially-injurious rep ranges.

On balance, deadlifts are good for back pain. They make your back stronger. They teach you to lift properly. And the train the structures that help protect your back from more common sources of injury. They also use discomfort, fatigue, and long practice to make you a more functional human being. If you can deadlift, you should. And most people can.

References

Rannou F, Corvol M, Revel M, Poiraudeau S. Disk degeneration and disk herniation: the contribution of mechanical stress. Joint Bone Spine. Dec;68(6):543-6 (2001) (Available at: 10.1016/s1297-319x(01)00325-6. PMID: 11808996).

Roaf, Robert. “A study of the mechanics of spinal injuries.” The Journal of Bone and Joint Surgery. British volume 42, no. 4 (1960): 810-823.