1.

“Implementing deadlift training in lower back pain patients’s rehabilitation

programs”

Katherine Todorov Katzarov

Abstract:
High-intensity strength training has been proven by research to be equally effective in improving active control
and stability in the spinal musculature , demonstrating a positive trend towards pain reduction and increased
local strength and hypertrophy.
Electromyographic analysis proves muscular activity of the posterior chain varies across variations of the
deadlift, implying the need for tailoring deadlift form according to individual anatomical characteristics and
muscular dominance.

Keywords :
deadlift, lower back, variation, conventional, sumo , spinal, hamstring, client, strength, hypertrophy

Lower back pain is a widespread disorder among adults, which is predominantly caused by the
atrophy and dysfunction of the lumbar stabilising musculature, leading to the implementation of faulty
movement patterns during daily activities , which inflict notable structural damage and inflammation in
the lumbar region.
Exercise therapy has been proven to help the structural recovery of the lower back cartilage
and musculature , and up to date 3 main methods have been effectively studied , analysed and utilised
– light corrective movement pattern training , low-load isolated resistance training for the m. erector
spinae and low-intensity rehabilitative motor control training targeting the multifidus stabilising
musculature.
In regards to the degree of pain relief and improvement of active muscular function in the
lumbo-pelvic region , experienced among lower back pain patients following exercise therapy ,
constituted by either low-load motor control exercise or high-intensity strength training, the Aasa-
study from 2015 found that corrective exercise outperformed strength training during active movement
control activities, but high-intensity training demonstrated a positive tendency towards pain relief via
the improvement if endurance and strength in the erector spinae and multifidus.
According to the Berglund 2016 study exercises focusing on spinal alignment may increase
the thickness of the lumbar multifidus muscles on the small side, irrespective of exercise load.
The increase in lumbar m. multifidus thickness does not appear to be mediated by either
current pain intensity or the magnitude of change in pain intensity.
Similar results have been demonstrated by the 2016 Bjorn Aasa study (which included 3
follow ups - 2 months , 12 months and 24 months post-trial period .
The results expressed by the Aasa and Berglund studies demonstrate a relative equilibrium
between the magnitude of effectiveness of low and high -load exercise regarding lumbar musculature
control , functioning and decrease in pain intensity , with the high-intensity strength training displaying
a positive trend towards pain relief and enhanced hypertrophy and stability of the lumbar musculature.
A systematic and comparative analysis of the results , demonstrated during the
aforementioned studies leads to the conclusion that high-intensity strength training for the spinal
musculature - the exercise employed being barbell deadlifts- has the potential to alleviate back pain and
enhance erector strength and active muscular control, thus being a safe and effective physical therapy
tool for lower back patients.

However , the question is how should the deadlift be programmed and coached , in order to
fulfil the needs and expectations of both active and sedentary adults, affected by lower back muscle
pain?
Methodological considerations regarding the correct implementation of deadlift training
include the pursuit of selecting the deadlift variation , suiting the client’s anthropomorphic
characteristics , thus tailoring the nature of the training session according to the individual’s unique
anatomical parameters.
 For example, the 2019 Cholewa study suggests the sumo deadlift may be slightly
mechanically advantageous for deadlift naïve individuals with longer torsos, while the conventional
deadlift may be better suited for those with shorter torsos, thus concluding torso length to be the prime
anthropomorphic factor affecting the deadlift variation employed during strength training.
2. By dispersing shear forces and tension evenly across the whole body a client would be able to train
more effectively in regards to developing maximal strength and endurance while sparing the lower
back muscles from excessive volume and intensity of work.
Additionally, findings by the 2019 Cholewa study imply that gender should also be considered
as a secondary factor affecting deadlift strength and endurance, as females outperformed males during
strength-endurance test, constituted of performing repetitions with 60%RM on the deadlift until
volitional fatigue, in return proving women benefit from strength training, higher in total volume and
slightly lower in intensity more , in comparison to men.
Selecting accurate loads for the deadlift allow clients to continue progressing towards peak
levels of individual strength performance, while simultaneously avoiding excessive structural strain on
the m. erector spinae and m.multifidus .
Regarding the well -researched subject of magnitude of muscular activity , demonstrated
during various deadlift variations, studies predominantly show the conventional barbell deadlift
superior for posterior chain (namely the activity of the m.biceps femoris, m. semitendinosus ,
m.semimembranosus , m.erector spinae and m.gluteus maximus) involvement , in comparison to
assistance deadlift exercises , such as Romanian or stiff-leg deadlifts.
For example , the Andersen study found biceps femoris activation in the upper part of the
hip hinge movement is 39% higher for the conventional barbell deadlift compared to the trap- bar
deadlift, while erector spinae EMG activity was equal in both exercise variations.
This particular finding implies that conventional deadlifts train the hamstring musculature
more effectively, in comparison to the trap-bar deadlift, while essentially generating the same
magnitude of lower back shear and compressive forces, granting athletes with a greater potential rate of
posterior chain strength and hypertrophy development.
Delving deeper into the essence of comparative analysis of the nature of lower extremity
muscular involvement , actively demonstrated during deadlift variations –namely the conventional ,
sumo and single-leg deadlifts- according to the 2002 R.F Escamilla and the 2021 Diamant studies,
based on electromyographic analysis , upper and lower body muscular activity considerably varies in
mean and peak intensity across the aforementioned hip-hinge exercises.
For example , in accordance to the 2002 R.F Escamilla study, comparing upper and lower
body muscular activity during sumo and conventional deadlifts the sumo deadlift demonstrated
considerably higher mean and peak EMG activity for the knee extensors musculature of the quadriceps
(predominantly the m.vastus lateralis and m.vastus medialis ), the middle region of the m.trapezius ,
the m.tibialis anterior , the hip adductor musculature (namely the m.adductor longus , m.adductor
magnus , m.adductor brevis) and the L3 and T12 paraspinal musculature, while the conventional
deadlift expressed greater magnitude of mean and peak EMG activity in the hamstring muscular
complex ( predominantly in m.biceps femoris , followed by m.semimembranosus and
m.semitendinosus) , the m.gastrochemius and the upper region of the m.trapezius.
The results of the 2002 Escamilla study imply that conventional deadlifts outperform sumo
deadlifts in terms of lower-body posterior chain and upper back muscular activity, while sumo deadlifts
activate the lower-body anterior chain , paraspinal musculature and middle trapezius, from which data
we can tailor the deadlift variation utilized during strength training , depending on the variations in the
patient’s muscular development of the aforementioned muscles-whether the patient exhibits anterior
chain/ middle trapezius dominance or posterior chain/upper trapezius dominance.
The 2021 Diamant study also applied detailed EMG analysis on amateur athletes in order to
detect the exact differences in posterior chain muscular activity between conventional and single-leg
deadlifts.
The results of the aforementioned study surprisingly demonstrated an increased mean and
peak activity of both the m. bicep femoris and m.gluteus medius in the unilateral deadlift , in
comparison to the conventional deadlift.
This particular finding suggests single-leg deadlifts are more effective for isolating the
m.gluteus medius in comparison to the conventional deadlift, having the potential to be included in a
training program as a hip-hinge assistance movement .
The Diamant study also found a correlation between body height and posterior chain muscle
activity, as taller individuals produced less force during the concentric phase of the contractions of both
the m.biceps femoris and m.gluteus medius.
 We can conclude that both studies demonstrate the grand magnitude of contrast between variations in
terms of muscular activity across the spinal, upper body and lower body muscular groups , and prove
its relations to stance, degree of active knee flex ion/extension and body height, leading to the
argument that deadlift form, variation and technique should be individually tailored along with
anthropometric factors, gender and height , in order to allow the muscles of the anterior and , most
importantly , the posterior 3.

chain to progress in terms of strength and hypertrophy , essentially alleviating the majority of tension
and forces off the paraspinal musculature and vertebral structures , sparing them from excessive
structural damage.

Apart from the methodological considerations of a client‘s individual characteristics (gender,

height , rate and nature of muscular development across the body, anthropometry )in order to
implement effective deadlift training via the active employment of meticulously calculated loads and
coaching of the exercise variation , suited to the clients’s anthropometric attributes, safety of the
vertebral discs should also be considered and analyzed .

For reference, the 1991 Cholewicki /McGill study , comparing joint movements in both sumo
and conventional deadlifts proved sumo deadlifting resulted in a 10% reduction in the joint moment
and 8% reduction in the load shear force at the L4/L5 level when compared with the conventional
deadlifting.

We can conclude that effective deadlift training, which main aim is lower back pain
alleviation should be individually tailored in terms of load, form and volume, being influenced by
height,bodily proportions, gender and muscular dominance , the sumo stance deadlift being proven to
be the safest deadlift variation and the conventional deadlift demonstrated to be the most effective for
inducing local strength adaptations and hypertrophy in the posterior chain musculature.

Declarations:

1. Ethics approval and consent to participate : Not applicable

2. Consent for publication :Not applicable
3. Availability of data and materials : Not applicable
4. Competing interests: I declare no competing interests have been involved in this
systematic review
5. Funding: Not Applicable
6. Authors' contributions: I declare I have analysed and systematised the information myself.
7. Acknowledgements (optional)
8. Authors' information (optional

Literature :
1. Bjorn Aasa et.al( 2015) Individualized low-load motor control exercises and education versus a high-
load lifting exercise and education to improve activity, pain intensity, and physical performance in
patients with low back pain: a randomized controlled trial, University of Umea, Sweden

2. J Cholewicki et.al ( 1991) “ Lumbar spine loads during the lifting of extremely heavy weights “ Med
Sci Sports Science , Department of Kinesiology , University of Waterloo, Ontario, Canada
3.Jason Cholewa et.al (2016) “ Anthropometric determinants of deadlift performance “
Department of Kinesiology , University of Coastal Carolina
4.Lats Berglund et al. (2015 ) “Which patients with lower back pain benefit from deadlift training?”
Department of Community medicine and rehabilitation, University of Umea , Sweden

5.R.F Escamilla 2002 “ An electromyographic analysis of sumo and conventional deadlifts Michael W.
Krzyzewski Human Performance Laboratory, Division of Orthopaedic Surgery, Duke University
 6.Victor Andersen et.al (2018) “ An electromyographic analysis of conventional deadlift, hex -bar
deadlift and barbell hip-thrust – a crossover study”
Faculty of Teacher Education and Sport, Sogn and Fjordane, Norway

7.Wiktor Diamant et.al (2021) “ Comparison of EMG activity between single-leg deadlift and conventional
bilateral deadlift in amateur athletes-an empirical analysis “
Institute of Movement and Neuroscience , University of Cologne

Katherine Todorov Katzarov

First-year Bachelor
National Bulgarian Sports Academy “ Vasil Levski”
Sofia, Bulgaria
0883567150

greaseyzappa@ gmail.com