What is the most common cause of lower back pain from deadlifting?

Most Common Lower Back Pain from Deadlifting

The most common cause of lower back pain from deadlifting is nonspecific low back pain, typically resulting from muscle strain or ligamentous sprain, particularly during the squat or deadlift movements. 1

Types of Lower Back Pain from Deadlifting

Primary Causes:

• Muscle strain/ligamentous sprain: Most frequent cause in weight lifters, accounting for 23-59% of all injuries 1
• Nonspecific low back pain: Pain without identifiable specific anatomical source 2

Secondary Causes:

• Degenerative disk disease
• Disk herniation
• Spondylolysis
• Spondylolisthesis
• Lumbar facet syndrome 1

Risk Factors and Biomechanics

Deadlifting creates significant forces on the spine:

• Peak compression forces at L5-S1 can reach 17.2 kN
• Peak shear forces at L5-S1 can reach 4.2 kN 3

These forces exceed established injury thresholds for spinal segments, making the spine vulnerable to injury during heavy deadlifting 3.

Who Is Most at Risk?

Individuals most likely to experience lower back pain from deadlifting include:

• Those with higher baseline disability scores
• Those with higher baseline pain intensity
• Those with poor back extensor endurance (as measured by the Biering-Sørensen test) 4

Diagnostic Approach for Deadlift-Related Back Pain

When evaluating lower back pain in weight lifters:

1. Determine pain pattern: Mechanical vs. neurological

2. Assess for red flags:

   • Cauda equina syndrome symptoms (urinary retention - 90% sensitive, saddle anesthesia, bilateral leg symptoms) 2, 5
   • Signs of cancer (history of cancer, unexplained weight loss, failure to improve after 1 month, age >50) 2
   • Infection indicators (fever, IV drug use, recent infection) 2

3. Imaging: MRI lumbar spine without contrast if neurological symptoms are present 5

Management Recommendations

For Typical Nonspecific Low Back Pain from Deadlifting:

• NSAIDs for pain control
• Activity modification with focus on technique correction
• Address mobility limitations and muscular imbalances 1

For Those Who Can Safely Continue Deadlifting:

• Supervised deadlift training can be beneficial for those with:
  • Lower baseline disability
  • Lower baseline pain intensity
  • Good back extensor endurance 4

Technique Modifications:

• Increase muscle moment arms (can decrease compressive and shearing forces by 32-36%) 3
• Adjust muscle wrapping techniques (can decrease compression by 12%, though may increase shear by 19%) 3

Common Pitfalls to Avoid

1. Overlooking serious pathology: Always screen for cauda equina syndrome, which presents with urinary retention (90% sensitivity), saddle anesthesia, and bilateral lower extremity symptoms 2, 5

2. Inappropriate return to deadlifting: Ensure sufficient back extensor strength and endurance and low enough pain intensity before resuming deadlift training 4

3. Focusing only on pain relief: Address technique issues, mobility limitations, and muscular imbalances to prevent recurrence 1

4. Ignoring chronic exposure risks: Repeated exposure to high spinal loads during deadlifting may lead to microfractures, degeneration, and pathoanatomical changes 3

Remember that while deadlifting can be part of a rehabilitation program for some individuals with low back pain, it must be properly supervised and may not be appropriate for all patients 6.