10 Minute Tip #18: How to Deadlift with Back Pain | A modification hierarchy so you don’t have to stop deadlifting
AS ONE OF THE MOST COMMON MEDICAL CONCERNS, BACK PAIN WILL ARISE WHETHER OR NOT YOU DEADLIFT. KNOWING HOW TO MODIFY THE DEADLIFT FOR BACK PAIN OF VARIOUS TYPES IS IMPORTANT BECAUSE YOU’LL BE FACED WITH IT AT SOME POINT.
BACK PAIN WITH DEADLIFTS USUALLY PRESENTS ITSELF IN THREE WAYS:
Off the floor
At lockout
With the whole movement
There is almost always a way you can continue to train your deadlift through an episode of low back pain even if you’re using lighter weight or a deadlift variation.
In this podcast episode we discuss the three types of back pain while deadlifting and how to modify your movement to continue to train.
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Dr. Rori Alter, PT, PRSCC, SSC: [00:00:05] All right. Welcome back to the Progressive Rehab & Strength podcast. I'm your host, Dr. Rori Alter, clinical coach here at Progressive Rehab & Strength, with my lovely co-host, Dr. Alyssa Haveson. And we are well; she's also a clinical coach here at Progressive Rehab & Strength. And we are back with another ten-minute tip Tuesday. And in this ten-minute tip, we will be talking about deadlifting with back pain. And one of the most common misconceptions is that if you have back pain, you shouldn't lift. If you have back pain, deadlifts and squats will worsen it. If you don't have back pain, squats, and deadlifts will give you back pain, which is invalid. But this episode is coming in a month series on low or just back pain in barbell training and powerlifting. So if you are catching this podcast and are interested in learning about the back and barbell training, you should check out all the other podcasts related to the back and barbell training coming out in March 2023. So with that all said, with a ten-minute tip, we set a ten-minute timer, which I did not set up in advance. So I'll do that right now. And we discuss this topic and give you tips, tricks, and shizz to help you manage it. And usually, when that timer stops, we often keep going because we are bad at keeping things to ten minutes. So with that all said, I will hit start on the ten-minute timer set. There we go. Alyssa, Can you talk to me or us about back pain when you're deadlifting? So, the first thing we should discuss is, you know, where in the range of motion are you experiencing pain? And also, are you experiencing pain only at heavier sets, or are you also experiencing pain at super lightweight like your first, second, or third warm-up set? So why don't you chat with us about that?
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:02:10] Yeah. So and really, the answer to what to do depends. It always depends. There isn't one right answer. It's going to be about finding what works for each person. When we're talking about back pain and deadlift, yeah, it can arise at different parts of the movement, and where you're feeling that pain is going to likely affect how you address it and how you continue to lift really while addressing your symptoms. So the first question is, are you having pain off the ground? Are you having pain at the lockout or towards the middle of the lift? And are you having pain just bending over to put your hands on a bar? Well, forget how much weight is on it. Are you having pain just getting down to set up?
Dr. Rori Alter, PT, PRSCC, SSC: [00:02:57] Right. Raise your hand if that's ever happened to you. I'll raise two.
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:03:04] Yeah. And then, are you having pain just lifting or breaking the floor with 65 pounds 10-pound bumper on either side of the bar or as you get to heavier weights? So if the pain is happening from the ground and if it's happening just at heavier weights, then maybe we can stay at a weight that is just below that threshold of where that pain starts and then gradually progress that if you're having pain off the ground. So it doesn't matter what's on the bar or, you know, the lightest weight you can load. And a side note, an important part is that you're using bumpers. So put 10-pound plates on the bar and sit the bar on the ground.
Dr. Rori Alter, PT, PRSCC, SSC: [00:03:47] Like 10-pound metal plates. Yeah, that's smaller than a standard 45-pound bar that's.
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:03:52] Going to place the bar too low. And if you need to do that, you should elevate the bar to about mid-shin height, so it's at your normal height. So we're talking about 10-pound bumpers. So the bar sits where it would sit with 45s on either side. So if that is an issue, we will raise the bar.
Dr. Rori Alter, PT, PRSCC, SSC: [00:04:10] Raise the Bar.
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:04:11] And place it right above where you are having symptoms. So find that range where you're comfortable setting up and starting the lift. It could be a rack pull or a block pull and progress the weight in that range. And then, when we lower the bar and increase the range, we can lower the weight, progress the weight, and so on.
Dr. Rori Alter, PT, PRSCC, SSC: [00:04:36] Yeah, and I think another exercise or supplemental lift if you have pain off the floor is also the RDL. But I would argue to start with a rack pull because we start from a dead stop in the bottom position. So the RDL is less. What's the term? It's not that it's further away from the main lift than a rack pull, but you can use either. So those are the two I guess we would recommend the most if you've got pain off the floor. What about if you have pain at lockout?
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:05:16] Yeah. So pain a lockout, again, we have to consider if it is a heavier weight than that rule applies to both situations. So if you're having pain at lockout, no matter the weight on the bar, first, we need to consider your head position, neck position, breathing, or wearing a belt. And if you're not wearing a belt because you're lifting lighter weight or having back pain, put it on. It will give you support and a little more security while you're lifting as well.
Dr. Rori Alter, PT, PRSCC, SSC: [00:05:49] And a little more assistance with creating that Valsalva Maneuver, which we'll discuss shortly. We'll talk about belt breathing and bracing when you've got back pain. So what lift would we do?
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:06:05] We could do a halting deadlift so that we're not going into that end range of the deadlift. And again, find a load that is comfortable stopping before you get to that range of significant increase in discomfort or where you're feeling those symptoms, and then work on progressing the weight.
Dr. Rori Alter, PT, PRSCC, SSC: [00:06:31] Then lowering it over time. The other thing, and I think I use this very rarely, I will mostly use a halting deadlift if you've got pain at lockout. But one thing that you can add into the mix is if you're using the halting deadlift and you feel like you need a little more volume, you can try adding in a barbell bridge. So not a barbell hip thrust. I think that range is too large. So a hip thrust is when you're elevating your shoulders on a bench, but a barbell bridge is when your shoulders are on the ground. And the reason, even though that is a hip extension under load, it's in a gravity-minimized position, meaning gravity isn't pushing down through your spine. So sometimes, people with pain with extension or at the lockout don't have that same symptom when lying down. So if we want to train hip extension loaded hip extension when we can't stand for the deadlift, we can also bring in the halt, excuse me, the barbell bridge again, as I said, bridge versus bridge hip thrust. I like that it's a shorter range of motion. You get a lot of hip and spinal flexion in a barbell hip thrust when your shoulders are elevated. I have a question for you, Alyssa. I'm curious because I don't think we've ever discussed this together, so I'm curious to see your answer. And I think we kind of have had this question we wanted to cover going into this podcast episode from a different viewpoint. So my question for you is, if you're experiencing pain throughout the full range, like the pain is not position or range specific, you just have generalized back pain, and it's hurting when you deadlift, you can't pinpoint a range or a spot.
Dr. Rori Alter, PT, PRSCC, SSC: [00:08:29] What would you do?
Dr. Rori Alter, PT, PRSCC, SSC: [00:08:30] So let's say we've modulated load, and it's not load dependent. It's just kind of always there. What would you do?
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:08:43] Well, I would potentially see if changing the movement a little bit, even RDL with just the bar, changes how somebody feels, and it might not. Um, but we could ultimately pause deadlifting. Not pause. Deadlift. Not a pause. Deadlift.
Dr. Rori Alter, PT, PRSCC, SSC: [00:09:11] Okay, I see what you're saying. You would ultimately like to take the deadlift out if.
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:09:16] We can't train it without increasing symptoms, lowering weight, or making any of these changes.
Dr. Rori Alter, PT, PRSCC, SSC: [00:09:23] So let me give you a little bit more of a clue as to what I'm trying to get at here. Let's say this person's a conventional deadlift.
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:09:31] oh, sumo.
Dr. Rori Alter, PT, PRSCC, SSC: [00:09:32] Yeah.
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:09:38] We didn't get to that. So, sumo sometimes.
Dr. Rori Alter, PT, PRSCC, SSC: [00:09:42] Right. We were talking about like range versus this is like not a range issue, you know, And that's kind of when we would say, okay, for the time being, let's try to change just the back angle through the range of motion. Yeah.