Demystifying the Deadlift and its Role in Rehab

As I was scrolling on Twitter the other night, I was pleased to stumble upon a recent CrossFit campaign for the "Lifelift". It was a short video that aimed to rebrand the deadlift, portraying it as an everyday, functional exercise that could be trained and mastered by people of all ages and fitness levels. This of course is a concept that has been floating around the "woke" rehab and physical therapy community for quite awhile (specifically in regards to the treatment of low back pain); however, I find that the idea of incorporating deadlifts into a treatment plan is still difficult to digest for many patients and healthcare practitioners.

 I wanted to take the time to address common concerns or assumptions that are made about the deadlift and to share the reasoning behind why so many members of the rehabilitation community have taken the time to learn the movement and teach it to patients. I figure if the deadlift is "demystified" in a sense, we may all better understand its utility and debate its merit in the rehab sphere with a mutual understanding of the movement.

What is the deadlift?

Deadlifts are a "hip-dominant" lift which involves hinging at the hips with a neutral spine to preferentially load up the posterior chain (the glutes, hamstrings and spine). As opposed to squats which involve more flexion at the knee and increased quad loading, deadlifts utilize the hip hinge to allow for more forward flexion at the trunk and increased loading on the glutes and hamstrings. A conventional deadlift typically starts with the legs hip-width apart and hands just outside the legs in an alternated grip (one hand closed, one hand open) with the bar resting over the mid-foot. During set-up, hips sink down so the shins are touching the bar. The lift is then initiated by taking the slack off the bar, taking a deep breath, driving through your heels and pulling up with the bar remaining close to the shins and maintaining a straight path upwards. As the pull occurs, the glutes and hamstrings are engaged and the back remains neutral. To lower the bar, the movement is initiated at the hips and then knees, keeping engagement throughout the body until the bar is lowered completely.

Naturally, there are dozens of other cues that can be given when coaching a deadlift but that’s a general breakdown of how it is performed and why it is different from other lifts. Now onwards to the fear surrounding this controversial exercise and its relation to rehab… 

Deadlifts are dangerous.

Are they though? This theory stems back to the concept that spinal flexion is dangerous and should be avoided, ESPECIALLY when it is loaded. Although there is research out there to validate that loading with a flexed spine has a relation to back injuries, many of the studies are in-vitro (done on dead animals), which of course cannot translate the load adaptive capabilities of a living, human spine. There also is research indicating that repetitive lumbar extension or flexion does not lead to LBP (see this) . I could go into further details regarding the complicated link between spinal flexion and low back injuries but instead I'll just refer to some much smarter people who have already done a great job summarizing the topic- see Greg Lehman's post (here) and Sam Spinelli’s (here).

 We also know that the load placed on the spine actually varies greatly person to person according to the activity being carried out (here). This is particularly interesting because it confirms that our spine does not work in predictable ways and further demonstrates how resilient and adaptable a structure it truly is. Deadlifts should not be feared for their element of spinal flexion just like we should not be fearful of bending down and picking up our phone if it drops unto the ground. What are you going to do in this situation? Leave your phone on the sidewalk and walk away like a lunatic? No. You're going to bend down and flex your spine and that's okay because you're a normal, functioning human being!

Deadlifts, just like any other exercise, are only dangerous when they are performed at a load that you have not already built up the capacity for. If you've never deadlifted before, you likely shouldn't start with 300 lbs. Similarly, if you USED to be able to deadlift at 300 lbs. but took a two month hiatus from the gym, your body has likely lost the load capacity it previously built up and once again- you should not start at 300 lbs. The key to safe, productive and beneficial exercise is progressive loading and proper form (although form is an arguable point- let's save that for another post).

Okay, great. But my doctor/chiropractor/physical therapist told me I shouldn't lift more than 5 lbs.

Yikes. If I had a dollar for every time I heard this one, I'd already be retired and sipping on a daiquiri in the Maldives. I will never understand a healthcare practitioner putting a finite limit to how much weight a person may lift in their lifetime because it completely negates the fact that our bodies are adaptable and can grow load tolerance according to what it is exposed to. Sure, I understand post-operative restrictions while a patient is healing and likely still in an inflammatory stage; however, I would think they should be safely and progressively loaded to build strength in their spine once they've moved beyond that stage.

You will have to lift weight at some point if you want to lead a satisfying, functional life. If you bring groceries into your house, you are lifting weight. If you need to grab a storage box and place it in your attic, you are lifting weight. If you need to move a chair from your living room to your kitchen, you are lifting weight. This leaves you with two options- you can either 1. Spend your life avoiding lifting anything greater than 5 lbs. to "protect" yourself and subsequently weaken your spine and injure yourself at an attempt to lift a grocery bag…. or 2. Progressively and safely train your low back to improve its mobility, manage load and safely lift through its range of motion so you are prepared to manage everyday functional activities like lifting, carrying and squatting. It's as simple as that.

But I have no urge to look or feel like a powerlifter.

Neither do I! (This is a lie. If someone wants to join me at the gym and put away my plates every 5 minutes after I dead…  I would be eternally grateful. The laziness of re-racking weights is literally what limits me from doing this more often.) Just because you choose to deadlift, that does not mean you will eventually be thrown into a powerlifting meet. A deadlift is a fundamental movement that has somehow inherited a bad reputation in the rehabilitation realm. No matter when or at what weight you initiate the movement, it should be taught at a comfortable load and progressed accordingly.

Many women in particular also express fear they will look "bulky" if they start lifting heavier weights or performing bigger lifts. First, if you like the "bulky" look, that is awesome. Embrace both your inner and outer power! However, if that's just not your thing and you're fearful your body shape may change in ways you're not comfortable with, realize this…. It takes WORK to bulk up. Women do not have the high levels of testosterone (an anabolic, muscle-building hormone) as men do thereby making it far more difficult to "bulk up". Deadlifting at a progressive weight will tone our your body in a positive light; however, it will not make you bulky without any other changes made to your lifestyle.

But, I'm sore!

 Good. This is a post for another time but if you tell me you are sore I will first differentiate if it is a pain which indicates pathology or soreness related to DOMS. If you then clarify that it is just soreness, I will congratulate you. Soreness means we're getting somewhere.

In summary…

 As long as humans choose to lift and pick things up, a deadlift will continue to be a functional movement for clients and patients of all ages. We should not run away from an exercise that can so clearly benefit our everyday function while also enhancing our core and muscle engagement throughout our body. So instead of teaching our patients to live their lives walking around with awkwardly stick straight spines and an eternally tucked chin, let's just all agree…. To bend.