How to Safely Progress Your Deadlift After a Lower Back Injury

Here’s how to get back to deadlifting safely after a lower back injury

Your lower back pain is improving through persistent efforts! Hooray! Now it’s time to reintroduce the activity that gave you lower back pain to start. So, how can you safely progress your deadlifting after a lower back injury to avoid re-injury? It can seem a little scary, but I promise you, it’s not! The brain will allow the body to perform movement patterns and tolerate weights as long as we are thoughtful and considerate about it. We need to now reload the system through a concept called “graded exposure.” This means that we need to start performing the movement pattern that caused the injury again, except we must manipulate the parameters around it. For example, decreasing the depth of the deadlift, the weight you’re using, and/or the type of weights you are using (i.e. kettle bells or hex bar instead of barbell). I also advise having a professional evaluate your technique. I wrote a blog on Lower Back Pain After Deadlifting previously. It is also important to perform a proper warm up to prevent low back pain. I wrote another blog about The Best Exercises for Low Back Pain.

Below, I share some of the specific barbell deadlift alternatives that I use with my clients as we return to pre-injury form! Throughout the process, I monitor their symptoms, asking how they feel during, directly after the lift, that night, the next morning, etc. If they do have pain during the activity, I ask about the irritability and duration of the low back pain. How long did it last? How bad was it from 0-10, with 10 being the worst? Did it radiate anywhere else? I will make additional modifications to the program based on these answers from my clients. I like to use a green light, yellow light, and red light system. What the heck is that you might ask? Check out the graphic below for some more details. Green light means proceed and progress, yellow light means proceed with caution, continue to monitor symptoms and don’t advance yet, and red light means hold off and regress (body is not ready for that kind of training yet).

Barbell Deadlift Progression:

1. Suitcase Kettlebell Deadlift (partial range)

2. Suitcase Kettlebell Deadlift (full range)

3. Conventional Kettlebell Deadlift (partial range)

4. Conventional Kettlebell Deadlift (full range)

5. Hex Bar Deadlift (partial range)

6. Hex Bar Deadlift (full range)

7. Barbell Deadlift (partial range)

8. Barbell Deadlift (full range)

My clients work with me 1-2x/week, so we traditionally progress the movement pattern every week, as long as we were in the “green light” zone after the previous session. Once you are back to barbell deadlifting lighter weight without low back pain, you can begin to add more weight to the bar. The evidence isn’t 100% clear on this, so I like to have my clients add weight based on RPE (rating of perceived exertion). This is a scale from 1-10, with 1 feeling like almost no work at all, and 10 feeling like an all out, max effort. I want that number to be 4-6 initially, a moderate intensity (for the first few weeks), then 7-8 afterwards. Again, checking in and making sure you aren’t experiencing excessive pain or reproduction of symptoms that last beyond 24 hours. There is a difference in feeling the back pain you once felt and feeling sore muscles (like you normally should after a lower body workout). You can see a graphic of the RPE scale that I created below:

Rating of Perceived Exertion (RPE Scale)

I hope you find this type of content helpful to your healthy, active lifestyle. Or if you’re trying to get healthy and active, I hope this helps you to realize that living a healthier life isn’t as hard as it is made to seem. Small changes yield big results over time. Be patient with yourself. You will get better. You will get stronger. And you will thank yourself later. 

If you, or somebody you know is struggling with low back pain, or difficulty returning to exercise after injury or surgery, please feel free to reach out. My name is Dr. Paul Nasri, PT, DPT and I am an orthopedic manual physical therapist in Industry City. I would be happy to help you get back to what you love, pain free!

Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioners. Please consult with a trusted provider.

Dr. Paul Nasri, PT, DPT, OCS, COMT

Doctor of Physical Therapy

The Game Plan Physical Therapy