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Returning to deadlift after a low back injury

In our previous blog “Deadlifts 101”, we talked about the different types of deadlift to suit individual needs. Today, we are going to take a deep dive into how to return to deadlifting after suffering a low back injury with the help of a real-life scenario.

As the deadlift is an important pillar of many fitness goals, whether it is hypertrophy or strength, going through an injury can be debilitating for some people. This means you may have to modify or delay your program, or forfeit an upcoming competition. Let’s go through an example of a real-life scenario to share some insight and tips of how to deadlift after an injury.

Case scenario: “Mr Doe presented to the physiotherapist after injuring himself at the gym just over 2 weeks ago. He reported going through the normal routine of his strength training and performed proper warm-up before his conventional deadlift. He went through his warmup sets without an issue and then moved onto his working set which included 5x5 working towards 170kg. He reported an acute sharp pain in his lower back during his deadlift and had to cease his workout at the time. He was not able to finish his workout program that day and had to go home and rest. The pain since then has been on and off as he’s been taking painkillers and avoiding sitting or bending down to lift or pick things off the ground.”

Upon his physio assessment, it was found that Mr Doe is likely suffering from a potential L4-5 disc injury with secondary muscle spasm in the surrounding area. His lower back pain can be classified as flexion and load intolerance; meaning any flexion/bending movement occurring at the spinal level can aggravate his symptoms and currently unable to tolerate any axial load or compression such as holding/carrying his baby for a prolonged period.

We performed the following test on Mr Doe by asking him: Do you feel pain or discomfort when you stand in a slouched position? If yes, you are likely to be flexion intolerant.”

“Now try grabbing the chair you are sitting on right now with both hands attempting to pull the seat up towards the ceiling, does it hurt your back? If yes, you are likely to be load intolerant.”

The good news for Mr Doe is that his pain from the seated pull test reduced or went away when he was asked to brace his core in a neutral position. This can indicate poor recruitment or timing of his core stability during deadlift.

Typically, disc related low back pain doesn’t usually happen overnight or from that one episode of aggravation; it tends to be caused by small bouts of stress or micro-traumas occurring at the spinal level. If this carries on over its capacity threshold, the collagen rings of a disc tend to break apart or “delaminate”, losing its ability to withstand load. Thus, it is super important to ensure you perform exercises with proper technique and movement so there is minimal to no movement occurring at the spine (neutral zone) when it is under load.

Now back to Mr Doe. During movement analysis of his deadlift technique, his hips shoot up early with both knees going into extension during the lift-off phase. Some minor movement in the spine (falls slightly into flexion) can also be seen. The early hip rise places his trunk into more horizontal back angle. This movement insufficiency leads to increased moment arm on the hip/ back and shear force through the spine. In this case, it means more work is required from the posterior chain i.e. hamstrings/glutes/lumbar erector spinae and potentially leading to overloading and muscle fatigue. Due to this issue, his core may be compromised where the spine is likely to fall into flexion. Now imagine attempting your personal best lift without knowing all these things.

The first goal for Mr Doe is to allow him to move as pain-free as he can early on, and this means addressing his poor movement pattern during his deadlift. A good exercise to address his issue is to implement a pause period during the early lift-off phase on a deficit.

Firstly, deficit deadlifting is performed with the person standing on an elevated platform, increasing the range of motion of the whole exercise. This means that by the time you lift a few inches off the floor, you have only reached the actual lift-off point in a conventional deadlift, thus, the term deficit. By this time, you have already started bracing and engaged your posterior chain and abdominal muscle to retain that neutral spine posture; adding a pause just allows us to address the endurance that is an integral part of postural stability. It is also wise to perform a deficit deadlift with a lighter load to focus on perfecting the technique and the timing of muscle recruitment.

This exercise was perfect for Mr Doe as he was able to demonstrate a pain-free deficit deadlift with a lighter weight. Let’s not forget to add other accessory exercises which help with his lower back, these include activation exercises such as side plank, curl up, bird-dog.

This blog just mentions one of many cases we see, it provides an insight into how important technique really is, especially if you are lifting heavy weights. But the specific diagnosis and treatment can vary depending on your presentation. Therefore, please consult a health professional about your particular set of circumstances.

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