Beyond the neutral spine: a narrative review and modern framework for low back injury prevention in deadlifting

Key Points

1. The traditional focus for injury risk reduction while deadlifting has been on maintaining a neutral spine.

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BACKGROUND & OBJECTIVE

In both rehabilitation and performance contexts, deadlift cueing has traditionally focused on maintaining a neutral spine. This tradition is based on biomechanical data showing an association between spinal flexion, intervertebral disk strain, and shear forces, which may increase injury risk (1). However, emerging evidence suggests spinal flexion during deadlifting is both common and less inherently risky than previously thought, especially for trained lifters (2).

This narrative review proposed a new biopsychosocial framework for reducing deadlift injury risk. Rather than overemphasizing spinal posture, the recommended priorities are proper training load management and progression, movement variability, dynamic core control, and optimistic psychological framing.

In both rehabilitation and performance contexts, deadlift cueing has traditionally focused on maintaining a neutral spine.

Believing the spine is fragile can contribute to kinesiophobia, fear-avoidance, and hypervigilance towards flexion, which can in turn negatively impact movement patterns and loading.

METHODS

For the narrative review, the authors searched multiple databases in December 2025. They collected a wide range of evidence related to the following topics around deadlifting and injury risk:

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