As a Doctor of Physical Therapy, my patients frequently ask me about low back pain and weightlifting. Unfortunately, low back pain is the most common musculoskeletal injury in the world according to the World Health Organization. Chances are that you will experience low back pain at some point in your life. If this is the case, then you want to know your best options in terms of treatment and pain management.
What Causes Back Pain?
Before we dive into the pros and cons of deadlifts for low back pain, it is important to understand what actually causes low back pain. The same statement by the World Health Organization mentions that 90% of low back pain is “non-specific”. This refers to pain for which we are unable to determine a root cause. In my experience, patients often become hyper-focused on finding the cause of their pain and they end up missing the point of treatment. Your low back pain could come from a herniated disc, scoliosis, arthritis, stenosis, or many other causes. While it can be helpful to know the cause of the pain, it is more important to begin physical therapy as soon as possible. I will often see patients delay treatment for weeks while they look for a physician who can tell them what is actually happening in their back. That is valuable time that you could have spent working with a physical therapist to decrease pain and improve your quality of life. The longer you wait for rehabilitation the worse your symptoms can become.
Most patients that I see with low back pain suffer from physical and mental limitations when it comes to movement and strength. The physical limitations can be irritated tissue such as a herniated disc or strained muscle. Oftentimes when you herniate a disc, it hurts to bend forward due to pressure on the damaged tissue. This is a physical limitation that prevents you from sitting or bending comfortably.
Just as important are the mental limitations that patients can establish when they suffer from back pain. They become afraid to bend forward because they remember that it hurts to do so. They gradually perform fewer movements that they think will cause pain, which results in greater limitations in daily activities. If you never bend forward because you think that it will hurt, your body will become less mobile and you won’t be able to bend forward when you need to pick something up. This can result in pain or discomfort which will cause your body to further restrict movements. You can imagine how often this turns into a painful cycle that only becomes worse as you become more restricted.
Pain of any type is often your body’s response to a load that it cannot handle. Imagine if you were doing biceps curls with 20 pounds comfortably and then tried to curl 50 pounds. You would probably feel pain while curling and afterwards because your body was not used to that load. This is a protective signal from your body to not hurt itself. Similarly, imagine that you never stretch at all and then try to do the splits. Your body is not accustomed to stretching in that way and it will probably cause you to feel pain. Our back is no different than any other part of our body. If we lift a weight that we are not prepared for, it can cause pain. If we move or bend in a way that we are not familiar with, then we might feel pain. It is important to understand that pain is often a result of your body being confused and unfamiliar with a movement or sensation, it is not necessarily related to tissue damage.
What is a Deadlift?
Let’s discuss what a deadlift is. Many people have seen others deadlifting at the gym or in an Instagram video, but it can be intimidating to try yourself. The first thing to understand about deadlifts is that there are many different types depending on your needs and abilities. A conventional deadlift is what you have probably seen in videos: there is a barbell on the floor with weight and you pick it up.
Sumo deadlifts also involve lifting the bar from the floor, but with your feet further apart.
You can also modify deadlifts to a height that is more comfortable by using a squat rack.
Deadlifts can even be performed with dumbbells if that is more comfortable or you don’t have access to other equipment.
Much of the apprehension that I see in people involves the idea that deadlifts have to involve heavy weight being lifted from the floor. That is not the case, especially when you first start lifting weights. You will probably start with lighter weight and less range to perfect the movement and feel comfortable. If you have previously experienced low back pain, you are going to progress slowly so your low back is comfortable with the movement.
It is important to understand that deadlifts are one of the most functional exercises that you can perform. People struggling with low back pain often fear picking up and moving an object. Deadlifts are a way to train your body to handle that load in a safe way. If you can deadlift 200 pounds then the 30 pound box is going to be a lot easier to move than if you can only deadlift 100 pounds.
Are Deadlifts Safe with Back Pain?
The answer is complicated. If you had asked me several years ago I would have been more apprehensive about recommending deadlifts, especially if you have pain with bending forward. Today, I find myself trying to introduce mobility and strength exercises earlier in the rehab process to help patients feel better, faster. Your body will tell you if you can handle a movement, so if you have significant pain with deadlifting then it is probably not something that you are ready to attempt.
However, if you can handle lifting even light weight off of the squat rack, there can be benefits. Lifting weights can help relax muscles and improve your mobility without aggressive stretching. It can also help strengthen your back muscles to decrease pain with other activities and make you more resilient in your day to day movements. Finally, having the confidence to lift weights can make you feel better about your back and overall health. If you see that you can safely lift weights in a way that you have been avoiding, you are more likely to feel optimistic about your overall progress.
There are many ways to perform a deadlift, some of which I highlighted above. The most important concept is to do what is comfortable and gradually progress as you are able. It can be helpful to have a coach or physical therapist who is familiar with weight training to help monitor your form and progress the weights as appropriate. Deadlifts or any other exercise should be part of a comprehensive treatment plan that can include manual therapy, mobility exercises, and strength training. No one exercise is perfect and you need someone who can provide a variety of options to help your rehabilitation.
You will meet many healthcare practitioners who advise against deadlifting with back pain. I believe this to be an antiquated notion that delays healing. Think of your body as a cup filled with water. The water is different stresses that can cause pain. If the water runs over the edge of the cup then you have a painful episode and have to take time to heal. You have two options to prevent pain: decrease the water or build a bigger cup. Decreasing the water involves lowering any provocative activities such as lifting weights or exercising. This can be a good initial strategy to let your body progress from the acutely painful episode that you experienced. Unfortunately, many people think that the long term answer is also to avoid any activities that may cause pain. In my experience, I prefer to build a bigger cup as soon as possible. If you start getting stronger then you will feel better and it will be a lot harder to hurt yourself again.
At Eclipse Wellness we work with our clients to get them out of pain and keep them out of pain. If you are in the Northern Virginia area and interested in coming up with a long term plan to address your pain that doesn’t just involve avoiding certain activities for the rest of your life, then reach out at danny@eclipsewellnessnova.com. Thanks for reading!