How to Deadlift with Low Back Pain

Deadlifts are a top shelf exercise. Arguably the most “functional” lift performed on a regular basis due to the similarities in bending and lifting for everyday tasks like picking up your kids, moving boxes or furniture; it has a place in every person’s exercise program. 

Returning to a pain-free deadlift from the floor is a HUGE milestone for athletes returning from injury.

But what should you do when you’re not pain-free or don’t feel confident pulling from the floor? Instead of avoiding the deadlift all together we should scale it to where it’s challenging but non-aggravating. This strategy allows you to still train the pattern and the muscles while building the strength to return to pain-free deadlifting.

Below is a list of progressions and variations I use to modify the deadlift for pain-free performance until athletes are ready and able to pull from the floor.

Hip Thrusts. A great way to load your posterior chain while challenging your ability to control movement at the spine. 

Kettlebell Deadlifts. Reducing possible fear and anxiety associated with barbell deadlifts while increasing freedom of movement at the knees, the kettle bell is an underutilized deadlift modification. 

Rack Pulls or Elevated Deadlifts. BRING THE GROUND UP. Reducing the range of motion of the deadlift is one of my go to modification. Rarely do I have to eliminate deadlifts from a program. With proper cues to achieve spinal stiffness and appropriate bar bath an athlete can often times deadlift in a modified range without pain. If you don’t have access to lifter arms, simply place 45# plates under the barbell. This modification can be applied to any deadlift variation you choose.

Sumo Deadlift. With a wider stance and a more upright trunk position, this variation blends the demands of a deadlift with a squat. This reduces the amount of demand on the lower back and increases the load on the quads.

The deadlift is an important foundational movement. King at strength development for the posterior chain and lower back, but importantly it demands strength and resilience for bending and lifting tasks performed in our everyday lives. Lower back pain can limit your tolerance to conventional deadlifting, but these provided modifications should allow you to train the fundamental movement pattern: the hinge, while you restore pain-free movement to your deadlift.

Ready to restore your deadlift and resolve low back pain? Set up a phone consultation or schedule your initial evaluation with us to get started ASAP.

How to Guide: The First 6 weeks of Post-Operative Rehab

In March this year, I suffered a 90% proximal hamstring tear while sumo deadlifting in my garage gym. The majority of my hamstrings were detached and floating in my thigh a couple of inches down from my sit bones with the ability to do nothing. The worst thing about the injury: it happened with a lift I’ve never had trouble with, I’d never had hamstring pain before, and it happened on a day when I was feeling amazing on all my earlier lifts. In an instant, my whole world and self-view was turned inside out. My identity as a crossfit athlete and as a physical therapist was demolished. As an athlete,I could no longer run or lift heavy. I was trying to rehab myself, but nothing was improving. Still, I kept pushing because that's what we do, we go until we can’t. I was modifying and rehabbing, but everything was off. I replayed that lift in my head over and over again wondering about all the things that could never change my current situation.

After six weeks of rehab, an MRI, and countless conversations with clinicians who are also crossfit athletes, I made the decision to undergo surgical repair, amidst covid-19 and job security stressors. As a physical therapist, rarely do I consider surgery an option. Regardless of the quality of your rehab and the commitment you make to it; some injuries require a surgical intervention to return to higher level activities. I was still able to box squat 200 pounds, but I couldn’t walk more than 100 yards without feeling unstable. Each case is different and it’s important that you and your team have honest conversations about your function. Utilize research to determine surgery is indicated to make an informed decision about your care. Specifically in the case of a torn hamstring, outcomes drastically decrease after 6-8 weeks due to the level of scarring that can occur around the sciatic nerve and atrophy that takes place. If I never wanted to run or jump again I could have avoided surgery, but that did not align with my goals. Again, your intervention needs to match your goals.  

Warrior Rx Tip: Consult with people who understand your goals and your fitness community. If you’re getting advice from a physician or clinician who has no idea what your goals are or who has negative beliefs around your sport you may not be getting all the information or full expectations for your road to recovery. 

Surgery was only 2 hours. It required me to be under anesthesia and on my stomach. The surgeon made an incision just below my sit bones and carefully located my detached hamstring tendons. She then pulled them back up to where they should be and sutured them to the bone. 

My postoperative restrictions were pretty significant. I had 6 weeks of non-weight bearing crutch use, 24/7 use of a knee immobilizer so I wouldn’t straighten my knee, and no sitting upright. Not to mention the surgical site was right where nobody would want it making it feel like I had a tennis ball under one hip at all times. I couldn’t sit on the toilet comfortably, bathe or dress myself, drive, sit upright to eat, sit for more than 10 minutes, or stand for long periods of time. To say I didn’t know who I was would be accurate. 

Over these first six weeks, my emotional and physical self were tested. I didn’t feel like myself most of the time. I had to constantly fight thoughts that I would never get back to who I was in the gym, never achieve my goals.

Now, I’m not trying to downplay how difficult the recovery process will be for each athlete, but if you’re finding yourself in this mental place due to injury, here’s what I’ve learned from my experience. Hopefully a few of these will resonate with you and keep your head on straight. 

Trust the process. My protocol for the first 2 weeks did not allow for any physical therapy or time out of the brace besides assisted showering. The next 4 weeks let me perform heel slides, ankle pumps, and squeezing of my quads. As I looked over that 6 week protocol, the athlete in me doubted it. I thought, “obviously she doesn’t know what I’m capable of,” or “this is holding me back.” But as a physical therapist, I knew to respect those first 6 weeks. Whether you're post-surgical or just in a lot of pain, acknowledge that you may need some help...and you may need help holding yourself back . Even as a physical therapist focused in the crossfit space, I knew to collaborate for my own rehab. Specifically in tendon repairs, you need to respect your physiology. It does take that long for the repair to ensure you don’t have chronic weakness. You can’t see your own blind spots. Those early weeks of rehab are challenging, I get it. It doesn’t feel like you’re doing a whole lot, but it’s a building block phase. So find a physical therapist you trust who understands what you need to give you guidance.

Stay in the gym. Training your uninjured side is extremely valuable. Crossover-education strength gains have been well documented, and allow you to preserve strength in your injured limb even when you are unable to use it. Truthfully, my left (uninjured) leg became a monster, which will help me greatly in the later phases. 

Exercises to train your uninjured side:

For a hamstring recovery, this looked like awkward looking seated hamstring curls. 

For an achilles, loaded single leg heel raises. 

For a shoulder, dumbbell or kettlebell work. 

For all: 3 limb conditioning on the assault bike or rower. 

Honestly, a lot of days I didn’t want to train. It was easy to think it wasn’t worth it because it was just a reminder of what I couldn’t do and who I wasn’t anymore. But with planning and some creativity, it was the only time I felt like myself. This brings us to number 3.

Set a goal for something you normally would blow off. We all have our limiting skills and weaknesses that cause us to scale specific workouts. When you’re injured, it’s easy to only see what you’re losing. But setting a focus to progress a specific skill is a great way to combat your negative thought patterns. For me, skills and strength above the rings were my focus. Since I couldn’t use my legs, it was a great time to develop strength for strict dips and pull ups to address my specific weaknesses in the muscle up. It was a time in training where I didn’t have to acknowledge my injury. If you can’t come up with any ideas within your restrictions, ask a coach or shoot me an e-mail and I’d be happy to help you troubleshoot that.

Your spirit as an athlete will not die. Your love for the hard work and the grind through skills will stay with you. My rehab has only reinforced my mental toughness and focus. After I lost my identity as a crossfit athlete, I started to actually notice the movements and all the skill and strength required. The grit. The drive. My appreciation and gratitude for how I was able to work through them grew exponentially. As I gain the ability to work hard again, I appreciate my successes more, I push myself more because I want that feeling of breathlessness back. I can acknowledge my capabilities easier, and not put my head down when I cannot do something.

Lastly, your community won’t abandon you. This is perhaps the most important and most encouraging point. It is likely that you may not be able to see your own progress, but your community will. Anyone who trains in a group setting has a hidden advantage. In basketball it’s called the sixth man. Your community will be your greatest cheerleader.

Each recovery process begins with acknowledging where you are and then setting progressive goals to achieve a much larger goal. This process is easier when you’re working with individuals who understand not just your injury, but the demands of your sport. If you’ve undergone rehab, but feel like it left you plateaued in specific skills or lifts, or you’re just starting the rehab process after surgery email me at: abigailbird@warriorrxtucson.com or direct message me on instagram  @warriorrxtucson. I’d be happy to talk with you about your specific situation to get you back to achieving your goals.