The Deadlift in Physiotherapy (Part 1)

The Deadlift in Physiotherapy (Part 1)

With the rise of powerlifting as a sport at both the competitive and casual levels, the deadlift has seen a surge in its popularity amongst the average gymgoer – head to any commercial gym and chances are you’ll see someone performing the exercise. A quick Google search will yield many tutorials on how to deadlift, articles on why you should be deadlifting, some videos on some mind-blowing feats of strength (see: Stefi Cohen pulling four times her bodyweight, and Eddie Hall deadlifting 500kg), and abundance of videos that have the words “gym” and “fail” in the title.

Some are less enthusiastic about the exercise; commonly cited reasons or beliefs for which include:

  • That deadlifting is bad for your back
  • That the deadlift is not a functional exercise
  • Not knowing how to perform the exercise
  • Not having good enough form or flexibility to perform the exercise
  • A fear of damaging the back (especially the intervertebral discs)
  • Having a pre-existing condition that will get worse from deadlifting

Many of these negative beliefs drive the perception of the deadlift as a high-risk exercise, with a premium placed on good form and technique by health and exercise professionals. But what exactly does “good form” mean? With regards to the deadlift, it usually means maintaining a neutral spine. Let’s unpack that.

When people talk about the neutral spine in the deadlift (or any other exercise), what they usually mean is that there are no visible deviations to the alignment of the torso throughout the up and down phases of the lift, i.e., a straight back is maintained. However, research has demonstrated that we cannot reliably identify when there is actual movement in the spine when observing a movement. For example, there can be up to 40˚ of spinal flexion (a.k.a. back rounding) happening during a squat despite what the alignment of the torso might look like, and despite the lifter’s best efforts to maintain “neutral”. So even when the back appears straight, you can’t really say what the spine is actually doing underneath the layers of skin, muscle, and fatty tissue.

Some have interpreted this research as indicating that form doesn’t really matter – if there is already some degree of spinal flexion occurring, what’s a little more? The body demonstrates the ability to adapt to the physiological stressors from regular training: muscles get bigger and stronger, cardiovascular fitness increases, and bone density improves over time. Following this logic, the body should theoretically be able to adapt to “imperfect” deadlifting technique as well. This line of thinking may also help to explain why you see some people get away with what some might consider imperfect technique and still lift monstrous weights off the floor, including most elite level powerlifters.

Ed Coan Powerlift
Powerlifters Ed Coan and Maris Inda with what appear to be rounded backs during the deadlift.

When it comes to deadlifting, a more recently popular idea is the neutral zone. In this conceptualization, rather than neutral meaning a single position, there is a degree of deviation that is seen as acceptable to continue to train within for most people. As long as the majority of deadlifting occurs in the neutral zone, you should be able to perform the exercise without worrying too much.

Deadlifting in Physiotherapy

As a physiotherapist working in a very exercise-based clinic, the deadlift is an exercise we prescribe frequently to patients as part of the rehabilitative process for a variety of conditions including lower back pain, hamstring strains, ACL rehabilitation, and even some shoulder issues. How we approach coaching the deadlift, and how much emphasis we place on form and technique will depend on the patient, their condition, and what their goals are. Whilst it’s clear that you can deviate from perfect technique and still get stronger and not necessarily injure yourself, there are definitely instances where form matters more.

Broadly, there are three main reasons why I might prescribe a deadlift to a patient. Firstly, we might include deadlifting for performance reasons. We may identify that an athlete requires a stronger posterior chain for their chosen sport, for instance, and prescribe the deadlift to build strength. Second, the deadlift may be a rehabilitative exercise for those with specific conditions. For example, we might prescribe it to an individual with low back pain as a way to improve their tolerance to picking things up off the ground. Or we may include the deadlift as part of the rehab for a torn hamstring muscle. Finally, for anyone who performs the deadlift regularly for fun, the deadlift will constitute a necessary part of rehab.

So – plenty of reasons to deadlift! What we’ll be doing over the next few weeks is discussing the deadlift exercise with respect to different populations, goals, and conditions; when form matters more (or less); and modifications you could make to the exercise to help patients maximize the gains they make. Stay tuned!