The Best Damn Deadlift Article for Physios
Oh the deadlift. Of all barbell movements out there the deadlift seems to have the most awe and fear surrounding it. For some health providers deadlifts conjure up images of heavy barbells, excessively rounded spines, and sore backs. In reality, as with any lift, the deadlift comes down to:
- Proper technique, individualized to the athlete and his/her dimensions
- Proper programming, both of the deadlift and other exercises
- And; as always; management of other factors such as workload, sleep, nutrition, and mental health
In the third and pen-ultimate article of this series I dissect the deadlift.
Disclaimers: you’ll be familiar with these if you’ve read the previous entries in the series but:
- This focuses on raw, not equipped lifting
- This is not a performance series, just one designed to get physios and other rehab professionals comfortable with coaching, cueing & modifying the deadlift
- Perfect technique does not 100% guarantee injury free
- I also highly recommend checking out the masterclass by Travis Pollen on Injury Prevention Theory into Practice to understand the complex aspects that can influence and contribute to injury prevention.
Part 1: Proper technique – from the bottom up
As a disclaimer before we get started, these are guidelines. With the deadlift, there is more trial and error when finding the ideal technique in comparison to the squat.
As with the squat I usually start with Stu McGill’s hip scour or pelvic rock test (as described in his books Low Back Disorders, Ultimate Back Fitness and Gift Of Injury) to determine which stance can allow maximum hip flexion with minimal (you can never 100% eliminate) spinal flexion.
If you’re not a therapist, try having your client simulate squatting and deadlifting with different stances and different toe positions (toes forward and toes out) to find which stance allows them to get deepest while minimizing visible lumbar flexion.
There are a few situations where I do recommend specific stances (i.e. conventional or sumo):
- I recommend sumo more for people with back pain particularly aggravated with flexion and/or compressive load. I also prefer sumo more for people with sciatic tension.
- I recommend conventional more for people who have hip pain and/or lack the hip structural anatomy to deadlift with a wide stance.
…and if you can deadlift with a mix of stances, more power to ya.
Torso vs shin angle
This is influenced more by foot width (as above) and torso vs femur length. A longer femur, short torso lifter will likely have a higher hip position with more forward lean, whereas a longer torso and short femur lifter can have a lower hip (almost squat like) deadlift position. I discuss this more in the video below, but to make a long story short the popular cue of “get your hips low” may be helpful for some but for others it may mean more movement & wasted energy.
Overall height is a big factor too. The >6 foot tall strongman athletes will have to get down deeper AND have their knees go quite a bit more forward than your short, stocky powerlifter will have to.
Foot position under the bar
This will be determined by the first two points. You want the bar as close to you as possible so that when you’re in the bottom position the bar is right on your shin, but not so close to you that when you get down you actually push the bar away from you or (and I’ve seen this happen) so far away from you that you have to pull the bar up towards you at an angle. If you have a more vertical shin, the bar will start further from the toes but if you have an angled shin the bar will be closer to the toes.
Last but not least is grip width. Too close of a grip can risk pulling a bicep and losing upper back tightness yet too wide of a grip (i.e. a snatch grip deadlift) can greatly increase the distance the bar has to travel.
A good general guideline I use is to pull your shoulder blades down, imagine you’re trying to crush oranges in your armpits. Keep the arms straight down and usually where they end up is good to go. You may have to move them in or out a tiny bit based on stance, so that they aren’t overlapping with your legs, but that provides a good start.
Part 2: Common technical flaws & coaching cues
No matter how hard you try, you will always get into some lumbar flexion with deadlifting. I’m referring to excessive lumbar flexion here – to where it’s clearly visible. This can be due to:
- Poor ankle and/or hip mobility and/or hamstring flexibility
- Not deadlifting the right way for your body type (refer to Part 1)
- Anatomical limitations – some really tall people or people with hips shaped in certain fashions may not be able to pull from the floor and may need a trap bar or an elevated deadlift
- Too much weight and/or weakness in the lats and spinal erectors. If they can do a movement properly with lighter weight but can’t with heavy weight (even with coaching), usually it’s a weight issue
- Poor body awareness which can often be fixed by the following cues:
- Depending on the height of the client (bear in mind I’m 6’5”) I will either stand or kneel in front of the client and get them to show me the logo on their shirt.
- I also like the Tony Gentilcore cue of trying to squeeze oranges in the armpits
- The Lifter’s Wedge drill from Brian Carroll and Stu McGill can also be helpful for some. I even get some clients to do it with a broomstick at home.
Side note: I am a fan of broomstick squats and deadlifts to help practice technique for clients who are:
- Recovering from an injury and want to practice technique but may not have the tolerance to have a bar on their back once or multiple times per week
- Clients who can only do the lifts once a week in a gym; whether it’s due to load tolerance, equipment access or other reasons; and want to get technique practice through the week.
Usually I find knee valgus is an issue of either:
- Having the feet too wide apart (i.e. sumo) – which is just improved by bringing the feet in a touch closer. This fixes the issue in almost all cases.
- Poor body awareness – the cue of corkscrewing the legs into the ground usually fixes this issue
Overarching of the back in the deadlift is usually due to:
- People being so concerned about going into flexion that they go too far the other way
- Poor body awareness in the setup – I like Chris Duffin’s cues for bracing (see below video) as well as the strategies of:
- Mirror coaching (i.e. mirroring what the client does and then showing them what I want them to do)
- Pulling the ribs and chin down. This is more of an internal cue, which I prefer to use as a last resort, but can be used if the other ones aren’t working.
- Execution – the above cue for setup also applies during lockout. I also like the cue of (and this is appropriate for some but not all clients) cracking a peanut or squeezing a $100 bill in between your buttocks to cue hip extension rather than lumbar extension.
- Too much weight
The stripper deadlift is a term used for when the butt shoots up first in a deadlift before the bar even gets off the ground. It can be due to a couple factors:
- Weak quads: although it’s pretty rare to see people who’s quad strength is the limiting factor in a deadlift
- Hips too low: if you find you (or your clients) have your butt shooting up before the bar gets off the ground, you may want to try starting with a slightly higher hip position (as long as it’s not a stiff leg or romanian deadlift) and go from there as per the above video on hip position. Quite often this simple trick helps.
I do find bent elbows to be an issue in people with poor body awareness and/or with people who are getting back to deadlifting in some form with super light weight. It isn’t an issue with low loads but higher loads are where you get bicep tears.
I use mirror coaching as well as the cues of “reach your arms to the floor” (while keeping everything else still) or “show me your triceps” to cue elbow extension.
Part 3: Injury modifications
This is almost exactly copied and pasted from my bench article, but before making big modifications you need to consider the clients’ programming. Many of the programming mistakes I see people make in regards to the deadlift are:
- Deadlifting too frequently, one that I see in the “high frequency club.” While I’m not against training a lift multiple times per week, you should progress volume and frequency slowly and on an “as needed” basis rather than going in all guns blazing.
- Remember that some of the greatest lifters of all time such as Stan Efferding, Eric Lilliebridge and Brian Carroll would (at various points in their careers) only deadlift heavy every other week due to the strain on the body. If you want to work technique at a higher frequency I’m fine with broomstick or empty bar movements but bear in mind the deadlift does take a lot in terms of recovery.
- Ego lifting
- Not taking a deload
- Not taking into account strain on the back during other activities: I’m never a big fan of pain free people trying to avoid spinal flexion altogether but for people trying to maximize their performance in the barbell lifts, it is an approach I recommend as heavy barbell lifting can tax the body. it is anecdotally helpful to minimize spinal load through the day to maximize capacity for hard barbell training.
- Proper recovery: eating, sleeping and psychosocial factor management
Flexion + Extension
Refer to above cueing on back rounding and arching. Some clients may want and need to lift with a flexed spine, and I’m OK with that, but in these cases I find I need to make the following modifications:
- Less volume of deadlifting with more recovery in between sessions
- Higher emphasis on assistance work
- Emphasizing a more rigid “Stu McGill-esque” style of movement outside of the gym to maximize the amount of flexion capacity used for deadlift training
Some people reading this will say “oh there’s no research showing lifting technique is associated with back pain” and my response is that those studies didn’t involve hundreds of pounds of weight. Future research may prove me wrong, and I’m OK with that, but for now I either like to minimize spinal flexion or if I have to load into it, I will do it very cautiously.
Compression is usually an issue of too much weight and/or volume or just having people deadlift who may not be built to do or tolerate it well. This is usually a case of backing the workload down to a more manageable level and building up slowly.
If you’re concerned about losing training effect you can also try doing deadlifts at the end of a back or lower body workout to get more stimulus out of less weight, as long as you can still hold your form.
Some taller clients anecdotally don’t do well with deadlifting. If they aren’t dead set (see what I did there) on powerlifting, strongman, olympic lifting or crossfit they can do other options such as:
- Trap Bar Deadlifts
- Block or Rack Pulls (just don’t go overboard on weight & turn them into an ego lift)
- Other hip hinging movements such as DB or BB RDLs, Single Leg RDLs or others…
For sciatica I usually prefer switching to sumo lifting and (if needed) elevating the bar higher so it doesn’t put tension on the sciatic nerve.
This usually comes down to again just elevating the bar to a tolerable level and working down from there.
I found for myself, and for other people I’ve talked to, that too much sumo deadlifting gets the hips/SI joint cranky. In situations where clients can’t do conventional but also can’t tolerate sumo all the time I usually recommend a rotation of rack/block pulls with conventional stance and sumo off the floor so as to maximize training effect but keep the workload on the hips & SI joint more tolerable.
This wraps up the deadlift and ends the penultimate article in this series. Come back next time when we discuss the final lift in this series – the Overhead Press. If you enjoyed this blog then check out Dr. Travis Pollen’s masterclass on Injury Prevention: Theory into Practice. In the meantime – stay strong and thanks for reading!
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