I have Low Back Pain. Should I Avoid the Deadlift?
Prevention of lower back pain should be a goal for everyone, especially people who are very active. As the popularity of weight-lifting increases, gym-based exercise programs like Crossfit, powerlifting, and Olympic lifting (which all seem to be quite popular in the Ottawa region) are encouraging more and more people to perform the deadlift. There are many different versions of the deadlift, and many ways to instruct this maneuver. For the purposes of this conversation, we are going to define the deadlift and lifting a barbell (often with weights), from the ground to mid-thigh height, while bending both the hip and the knee. For many who are in the business of treating or preventing low back pain, this exercise can become quite controversial. There are many who work in lumbar pain care who recommend avoiding this exercise because it may increase the load on the back and may make pain worse. Recently there has been some research on the topic of the use of a deadlift as a treatment for low back pain. Today, we are going to talk about that research, and what it might mean anyone who is thinking about exercising with low back pain.
If you have back pain but wish to exercise safely and effectively, then…
Comparing two exercise programs
In 2016, Michaelson and colleagues conducted a randomized control trial that compared the use of two different exercise programs to treat patients with low back pain. 35 patients (70 total) were each assigned to a group to do either, deadlift exercises, or motor control (core training) exercises. The groups were compared at two, 12, and 24-month follow-up and there was no difference between the outcomes at either group for either intervention. This study tells us that, in this study, deadlift exercises did not make people worse, but demonstrated a similar efficacy to conventional core exercises when treating low back pain.
To whom the deadlift?
Earlier, in 2015, Berglund and colleagues examined which characteristics may indicate who might feel better from doing a deadlift exercise program when suffering from low back pain. The characteristics that increased favorability to respond well to a deadlift program were a lower intensity in low back pain (as reported by the patient), and better endurance of the lumbar extensor musculature (as tested by a Biering-Sorensen test). This study tells us who might be best suited to a deadlift exercise program when dealing with low back pain.
Key points to take away
Now that we have an understanding of what the research has discovered when looking at deadlifting and low back pain, let’s think of what this might mean in the world of exercise and pain. Here are a couple of key points I have taken from this research:
- The deadlift may be most effective if it is implemented later in the course of recovery from back pain, or in very mild cases of active or fit individuals. You may fit the criteria for positive outcomes once you have spent some time building your core (especially back and hip extension) endurance and using other forms of treatment to reduce pain.
- Deadlift exercise for low back pain does not require high volume or frequency. The exercises in the studies took place over 8 weeks, twice over the first 4 weeks, and then once a week for last 4 weeks. The subjects were asked to perform between 2 and 5 repetitions with each session. We are free to speculate about what other programmings might produce for outcomes, but in the first study, we see effective results (at least compared to other types of exercise) with the frequency discussed above.
- In early stages of the exercise, the technique should be prioritized over the load. The advice given to subjects in studies above was:
- to begin with lifting very low weights; and
- they could gradually increase weight after the first 4 weeks.
- Good technique should be a priority. The instructions that were given to the participants in the study when increasing weight was that if the lift was so heavy that it altered technique, they weight should be lowered. This is a good rule for all weight lifts.
- There are many different ways to exercise regions of the body. In the first study, the authors muse about the potential beneficial factors to the deadlift exercise. Their explanation is that learning a deadlift takes significant motor control improvement as well, and this may contribute to the benefits seen.
While we cannot put too much stock into just two studies, it is worth noting that these articles have changed a lot of minds about back pain and the deadlift exercise (this practitioner included). I do not recommend this exercise for every person with low back pain. There may also be some individuals, for whom, the risks of a deadlift exercise may outweigh any potential benefit. It is valuable for us to be thoughtful and judicious when considering the best approaches (or condemning others) when treating low back pain.
If you have any questions about the deadlift or other exercises for low back pain or other conditions, please get in touch with us today.
Written by Ben Matheson. If you like our blog, you can read other articles here.here.
Berglund, L., Aasa, B., Hellqvist, J., Michaelson, P., & Aasa, U. (2015). Which patients with low back pain benefit from deadlift training?. The Journal of Strength & Conditioning Research, 29(7), 1803-1811.
Michaelson, P., Holmberg, D., Aasa, B., & Aasa, U. (2016). High load lifting exercise and low load motor control exercises as interventions for patients with mechanical low back pain: A randomized controlled trial with 24-month follow-up. Journal of rehabilitation medicine, 48(5), 456-463.
Mathieu Bélanger, MD, CCFP, CPSO Recognized Specialist (Chronic Pain), is the founder and President of Inovo Medical. Dr. Bélanger began his academic career by earning an undergraduate degree in kinesiology (i.e., the science of body mechanics) before enrolling in medicine at the University of Montréal. He is particularly interested in pain related to sports injuries and musculo-skeletal disorders. This interest led him to travel extensively for various types of training on pain treatment given by leading experts. Since then, his objective has been to play an active role in the development and delivery of the most sophisticated and effective treatments for chronic pain.