When most people experience back pain, whether it’s from a disc bulge, sciatica, a facet joint injury, or any other cause, they’re usually told things such as:
“You shouldn’t lift while dealing with this injury”
“Deadlifts are bad for your back”
“If you keep on lifting, your back will never heal”
However, this advice simply is NOT true. You can, and probably should, continue to lift weights and train even while dealing with low back pain (in most cases). The problem with just stopping lifting when you’re dealing with back pain is that, if done for a long enough period of time, you are going to become de-trained, and when you get back to the gym, you probably won’t be able to handle anywhere near the weights that you could before.
Add to this the fact that deadlifts aren’t inherently bad for your back, and there really is no reason to NOT do deadlifts when dealing with back pain.
In fact, there is research (Fischer SC and colleagues 2021) showing that deadlifts can be effectively used to treat low back pain when people are experiencing it!
So, we know that deadlifts can be used safely and effectively when dealing with low back pain, but the question is, how do we do this without flaring up the back pain?
The best way to do this is by modifying the deadlift training that you’re doing so that you can build up low back strength and endurance, while NOT flaring up your pain.
There are many aspects of training, and of specific exercises, that we can modify to meet those goals. Below, we are going to cover some of the best options.
Reduce load and/or volume
Many times, people who are experiencing back pain while lifting may find that there’s a certain amount of load (weight on the bar) or volume (reps and sets) that they can tolerate before their symptoms start to act up.
Anything above those load and/or volume thresholds, and their back pain starts to flare up. If you can identify these thresholds, you can modify your training so that you’re training just below them for a while, and then slowly increase load or volume over time.
For example, one of our past clients was dealing with back pain while deadlifting. Anything under 315 lbs felt perfectly fine, but once he put 315 on the bar, that is when his pain would start to flare up. As part of his rehab, we had him do his heaviest sets of deadlifts at 295 lbs for 2-3 weeks, and then slowly bump up to 300 lbs, then 310 lbs, and then finally 315 lbs. By that point, his pain had started to calm down, and he was able to lift 315 lbs without any problem.
After a little while you can slowly start bumping up the number of reps per sets, and decreasing number of sets, until you are back at your regular training level!
Shorten the range of motion
Sometimes, people who have back pain find that certain positions or parts of a lift are worse than others. Commonly, people find that the more bent over their torso is relative to the floor, the worse their back feels. In this case, you can simply change the range of motion of the lifts to temporarily avoid these positions, and then work back to them once the back is feeling better.
For deadlifts, you can do this by pulling from blocks or pins that are set to a comfortable height, and then slowly work that height down over time until you’re pulling from the floor once more!
Use specific tempos and/or pauses
Tempo is simply the speed at which different parts of a rep are performed. You will most typically see tempo written as a 4 digit number, such as W-X-Y-Z, in which:
W = Length of the eccentric/lowering phase
X = Length of pause at the bottom of the lift
Y = Length of concentric/lifting phase
Z = Length of pause at the top
When using tempo for training around pain or an injury, you can use deliberately slow tempos, or tempos that have pauses in them, to allow yourself to still train, but while minimizing the risk of aggravating the pain.
Examples of tempos that we like to use with our clients are:
3-0-3-0 tempo (3 seconds down, 3 seconds up, no pauses)
5-3-1-1 tempo (5 seconds down, 3 seconds pause at bottom, 1 second up, 1 second pause at top)
Alternatively, you can just use pauses during lifts (including multiple pauses during a single repetition). For example, if heavier deadlifts result in back pain, a good option is doing reps in which pauses are done just off the floor, below knee, and then again above knee.
Both of these options will allow lifters to still train hard (ie high internal intensity), but the pauses and tempos will force there to be less weight on the bar (ie lower external intensity).
Change exercise variation
For most lifts or exercises in the gym that aggravate back pain, there are variations that we can use that will likely feel much better.
These variations can come in the form of changing body position, such as doing sumo deadlifts instead of conventional deadlifts, or trap bar deadlifts instead of either of those two.
They can even be doing unilateral lift variations (single arm/leg variations) instead of the regular lifts. For example, you could do single leg RDLs instead of regular deadlifts.
Include some direct core work before lifting
Don’t get us wrong, we are NOT saying that “core weakness” causes back pain (because it doesn’t). But, that doesn’t mean that directly training your core can’t be helpful in this situation. These exercises can help build strength and endurance in the trunk musculature, as well as increase our confidence while lifting, which is a win-win.
Isometric exercises, such as plank variations, pallof holds/press, suitcase and farmer’s carries, and other trunk exercises in which you’re not actively moving the trunk are usually the best place to start, as they are often tolerated very well.
Just make sure to not take those exercises to the point of muscular fatigue/failure before beginning your actual training, as that could negatively impact your exercise performance.
If you wish to learn more, or just want to join an online community of lifters, make sure to request to join our private group here: https://www.facebook.com/groups/rebuildbarbell.
And if you’re interested in a free phone consult with one of our Doctors of Physical Therapy, you can apply for one of those by clicking here: https://barbellptp.com/request-free-consult/.