How to fix back pain in the gym when squatting and deadlifting
The traditional barbell squat (back squat) and deadlift are two of the most common exercises performed at the gym and routinely given by physiotherapists as a functional strength exercise.
Whilst not essential exercises for non lifting athletes, they do provide an excellent starting point for a comprehensive gym program. Be it for athletes looking to enhance their performance, or everyday people trying to improve their strength and fitness the squat and deadlift are highly appropriate. However, they are also two of the more technically difficult exercises particularly for people new to resistance training or with limited experience in these types of lifts.
Why are these exercises so popular?
Have great cross over to sport specific movements such as jumping and sprinting
Is a great way to improve hamstring and lumbar spine flexibility
Enables co-activation of important muscles such as the glutes and quads in a functional movement
A great maintenance exercise for glute and quad strength
Helps increase power for activities such as sprinting and cycling
Helps prevent future osteoarthritis in at-risk joints such as the knees and hips
A good resistance exercise as part of 'core-stability' training
A great energy-burning exercise due to the recruitment of many large muscles during the movement
"I hurt my back with that exercise once so now I don’t do it anymore"
Due to the technical nature of the exercise and misinformation surrounding lifting being ‘bad for your back’ many people are wary or even fearful of performing these exercises.
Plus, we know the injuries around the spine have much greater fear avoidance patterns than those in other areas of the body.
Meaning we process that particular activity as being the cause of the injury or perhaps dangerous to perform again without significant injury risk (Think lifting information in workplaces or manual handling training). Which don’t often do with other areas of the body.
For example.. If someone sprained their ankle playing netball it is unlikely they would never play netball again…
Or tore their hamstring running do you think they would never run again?..
Possibly, but very unlikely.
As both these exercises are multi-joint movements, with multiple variations, learning good technique can be complex. Which I will do my best to help simplify.
Firstly - there is no perfect squat technique
When researchers have analysed the world's best powerlifters and olympic lifters there are significant differences in how they squat.
Much of this can be attributed to anatomical differences between athletes. As individuals we are all slightly different and this will affect how we best train a squat and perform the movement.
The video below gives nice summary of how different factors such as:
Tibia to femur ratio
Can all significantly impact our squat technique
In the below picture you will see variation to what many of you may have been told before:
‘Knees don’t go over toes’
‘Keep you back straight’
‘Feet hip width apart’ etc
None of which is wrong per se but does not account for the differences we all possess and our training history.
The video above is an example of a 180kg x 4 Rep ‘Jefferson Curl’ (flexed spine deadlift) by Danish Physiotherapist Johannes Korneliussen.
The spine is an incredibly resilient structure and given the appropriate stimulus can be loaded significantly through its full range of motion. Although, unless you have trained up to this, we wouldn’t recommend performing a Jefferson curl for the everyday athlete or fitness enthusiast.
What technique should I use?
Our joints are amazingly robust and adaptable providing we are smart with how and when we increase the amount of exercise we do.
So whilst there many considerations for good technique, here are my major tips regarding body mechanics for the squat:
1. Sit back
Sit back like you are going to sit on a chair. This will load your hip/hamstring complex, the most powerful muscle group in the body.
Research shows that the hip extensor muscles (primarily gluteus maximus) are most effective when the hip is flexed, which requires you to stick your bottom behind you on the way down.
‘Sitting onto a chair’ also prevents excessive lumbar extension (chest up) which unnecessarily loads the lumbar spine.
The other thing this does is keep the centre of mass (bar and weights) directly over the feet.
2.Keep weight evenly distributed on the feet
By keeping the feet spread the body stays nice and balanced. Whilst not as vital with low weights that are easy to manage as confidence and strength builds this becomes essential when dealing with heavy loads.
3. Bend at the knee and ankles
This is the predominant pattern difference between a squat and a deadlift.
Combined movements at the hip, ankle and knee allow the major joints and muscles of your legs to work in unison to form large levers that control the weight on the way down and drive the weight back up.
If you have major issues with your ankle or knee mobility you may need to work on these or use an alternate style of squat.
4. Maintain a controlled spine position
As discussed depending on how you train and anatomical differences you may get some spinal flexion or bending depending on how deep you are aiming to squat.
For novice it is recommended that you try to keep a relatively neutral position and avoid end ranges of both flexion and extension.
5. Maintain knee alignment
Find YOUR comfortable position in terms of foot placement and direction.
Hip width is a rough guide and many competent lifters prefer wider.
Keep your knees inline with your feet and hips (try to avoid your knee coming inside of your feet)
This will prevent undue stress on the knee joint and keep things loaded relatively evenly.
6. Lastly but perhaps most importantly is slow and steady...
Most injuries occur simply because of too much too soon! Be steady with your progressions and don’t overload yourself too rapidly.
Exercises to you progress toward Deadlifting following a back injury
Ok so you have had a back injury and wish to progress back to deadlifting. Here are some simple steps to help get you there.
Strengthen the back and hip
This is an important step to strengthen the tissue so it can tolerate the loads you are wanting to place on it. If you can comfortably bend past a certain range don’t try to lift past this range.
Work within a comfortable range and when your strength improves so will your mobility.
There are an absolute endless amount of options available but here are a few simple exercises that require very little equipment and can be performed in most gyms.
1- Chinese planks
2- Bent over rows
3- Banded good mornings
At the same time begin hip dominant exercises which don’t put much load through the lumbar spine
1 - Glute Bridges
2 - Hip thrusts
3 - Single leg deadlift
4 - Lunges (any variation will help)
Once you can comfortably perform lumbar loaded exercises and have began strengthening your hip and glutes it's time to put the two together
Below is a simple picture on how to modifying your deadlift to reduce the demands on the low back until you gain more confidence and strength
(Credit: Dan Pope Physical therapist)
Heavy Deadlifting and squatting may not be appropriate for everyone. If you have significant lumbar spine pathology or are unsure whether you will be able to return to your favourite gym exercises its best to seek out a good physiotherapist and get advice specific to your situation.