Deadlifts & Low Back Pain: The Science Behind Healing & Injury Prevention

Deadlifts! Are they safe? Do they cause disc bulges? Can they heal disc degeneration? Are they the ultimate way to strengthen your posterior chain? Who should be doing them, and when should they be avoided? These are all fantastic questions, and I'm here to give you practical, evidence-based answers that make sense.

But first, let me share where this perspective is coming from. I've battled bouts of intermittent low back pain since I was 16—partly due to genetics (my dad had a bad back, and his dad had a bad back...), but also from lifting incorrectly, lifting too heavy, and then sometimes not lifting at all (which is often a mistake too). My quest to manage my own spine injuries led me to explore yoga, become a chiropractor, specialize in physical rehabilitation, and ultimately come full circle back to lifting and even athletic training.

Through this journey, I've changed my outlook on the deadlift as an exercise several times. However, after over a decade of helping others overcome back pain while keeping current with the latest research, I've reached a place of clarity and confidence about this exercise. My primary goal is to help others understand who should be doing deadlifts and when and how to safely add them as part of a comprehensive back-strengthening program. I'm excited to share everything I've learned—so let's dive in!

Deadlifts: Balancing Risk and Reward for a Resilient Spine

I refer to the deadlift as a double-edged sword. Lifting too much weight, using poor technique, or lifting too soon after an injury can exacerbate previous or unknown injuries (e.g., pre-existing disc bulge). However, most chronic and recurring back pain is accompanied by atrophy (deconditioning) of the deep musculature along the spine. Because deadlifts produce the highest muscle activation in the paraspinal muscles, they can be an excellent option for strengthening them. Additionally, body tissues adapt and become more resilient when progressively loaded: stress + rest = growth!

The trick is understanding the spectrum and types of back pain and identifying when deadlifts can and should be introduced safely. For example, introducing deadlifts too soon after a previous injury (even if it is no longer painful) can be detrimental. However, when done strategically using progressive overload, evidence shows that deadlifts can be part of a comprehensive rehabilitation protocol, not something to be avoided.

Why Deadlifts Are Essential for a Strong, Pain-Resistant Back

The deadlift doesn't target just one muscle; it gets all the major players needed for a more resilient and protected spine. For example, this exercise is THE classic for engaging the entirety of the intrinsic core and strengthening the posterior chain (hamstrings, glute max, erectors, latissimus dorsi).

How Deadlifts Strengthen the Intrinsic Core

The intrinsic core is THE foundation for spine stability. When key muscles (multifidus, transverse abdominis, diaphragm, and pelvic floor) engage synergistically (co-activation), they evenly distribute forces across spinal segments and protect the spine from excessive strain. Deadlifts, when appropriately performed, train the nervous system to recruit ALL intrinsic core muscles simultaneously.

Research has shown that deadlifts alone can significantly enhance core stability without additional core-specific exercises. In a study examining untrained college students, a 5-week progressive deadlift program led to substantial improvements in overall core stability (as measured by the Bunkie test) despite no other core training. This reinforces the idea that a well-executed deadlift is an effective way to develop a more holistic, stable core.

The Multifidus Muscle: Your Spine's Hidden Stabilizer

The biggest predictor for low back pain is having had back pain in the past. Essentially, once you've had a first episode of low back pain, you're in a new risk category for having it again and again. One reason is that the spine's deepest and most protective muscle  (multifidus) begins to decondition and atrophy at an exaggerated and accelerated rate after experiencing back pain.

The multifidus muscles (deepest spine stabilizers) play a critical role in segmental stability, protecting each vertebra from shifting and shearing.

Recurring low back pain ultimately leads to lowered proprioception (body awareness), which in turn leads to decreased muscle engagement in that area. Muscles of the lower back begin to feel tight. However, they are actually slowly deconditioning (losing muscle mass and strength), therefore becoming less capable of protecting the spine. In time, this cycle worsens and ultimately exacerbates chronic pain.

How Deadlifts Strengthen the Multifidus

When deadlifts are performed correctly, the spine should be relatively "locked in place." The multifidus muscles, responsible for stabilizing each vertebra, must resist the forces trying to pull the spine into flexion or rotation. This engagement forces the multifidus to contract isometrically, acting as a "micro-adjuster." Over time, with sufficient load, the muscles along the spine can become stronger and more robust (hypertrophy), which is critical for spinal protection.

The Mental Game and Natural Pain Management

The most significant benefits of strength training may go beyond just building muscles. For example, resistance training is of tremendous value to the mind and nervous system. Over time, it modifies how the brain experiences pain while additionally building confidence in one's ability to move without fear of pain.

Consider that the deadlift is simply bending over to up a "dead weight" from the floor. Being able to pick things up without pain is critical. Unfortunately, many people become fearful (fear avoidance) of basic functional movements, which is a massive predictor for increased chronic and recurring back pain. Performing deadlifts with proper technique in a safe environment helps rebuild confidence, reducing fear of movement. Over time, this creates a more empowered mindset, changing from feeling "weak and frail" to "robust and capable."

Finally, exercise, including strength and conditioning, has several mechanisms that make it a natural pain management strategy. There are beneficial changes in the brain, nervous system, and hormones that effectively change pain tolerance after consistent exercise routines. For example, lifting weights has been shown to downregulate pain signals by activating the central nervous system's natural pain-modulating pathways.

Deadlifts vs. Traditional Physical Therapy for Low Back Pain

When it comes to spine health and rehabilitation, both traditional physical therapy (PT) and deadlifts have a role to play. Bodyweight exercises commonly used in Pilates, yoga, and physical therapy are gentler and often more appropriate in the early stages of injury recovery. They improve body awareness, coordination, and foundational strength while minimizing strain on the spine. However, once a solid foundation is built, deadlifts take rehabilitation to the next level by developing greater resilience, strength, and confidence in movement.

Limited research directly compares deadlifts and traditional PT for low back pain. However, one notable study—"Effects of Low-Load Motor Control Exercises and a High-Load Lifting Exercise on Lumbar Multifidus Thickness"—found that both low-load exercises (such as core stability work) and high-load deadlifts were equally effective at increasing multifidus muscle size on the side of dysfunction. The issue? This study only lasted eight weeks and focused solely on multifidus hypertrophy without assessing long-term strength gains, function, or pain reduction. Although this study concludes that these two approaches are similar, there is a strong argument that strength training would be superior for longer-term muscle growth and adaptations.

Why Strength Training (Including Deadlifts) Matters

While low-load exercises (yoga, bodyweight movements, and traditional PT) help activate and coordinate weak muscles, they primarily tone existing muscle tissue rather than stimulating significant hypertrophy (muscle growth). This makes them useful for early rehabilitation and neuromuscular re-education, especially for those who have been sedentary or inactive.

However, actual muscle development requires progressive resistance training. Deadlifts and other weighted movements provide the mechanical tension necessary for hypertrophy, particularly in the multifidus and spinal stabilizers. Studies suggest that deadlifts (≥70% 1RM) create enough mechanical load to significantly increase multifidus cross-sectional area, making them more effective for long-term spine strength and resilience than isolation-based rehabilitation exercises.

When is it Safe to Begin Deadlifting After Low Back Pain?

Deadlifts can be an excellent tool for building a more resilient spine—but they do carry risk. By placing significant forces on the lumbar muscles and spinal segments, they create adaptations that can prevent future injuries and recurring pain. However, if introduced too soon, they can also exacerbate underlying or previous injuries. As a rule of thumb, avoid deadlifts during the initial healing phases of an injury.

Because there is no universal timeline for every individual, it's best to wait until the injury has sufficiently healed before adding deadlifts back into your routine. Consulting with a qualified spine specialist, chiropractor, or physical therapist ensures a tailored approach based on your unique recovery. Additionally, working with a professional for several workout sessions before deadlifting is essential. Technique, including form, bracing, and regressions, will set you up for success, minimizing the risk of re-injury.

Once sufficient recovery has occurred, studies show the ability to hold a back extension >60 seconds is a good indicator of adequate back endurance before beginning a deadlift routine. Working with exercises such as bridges and bird dogs before progressing to the deadlift is beneficial.

The authors also emphasized that,

"Regardless of patients' age, sex, body mass index, pain-related fear of movement, movement control, and activity, the deadlift exercise seems to be an effective intervention. We stress the importance of strength and conditioning professionals being skilled in technique instructions and providing feedback when instructing the deadlift exercise and progressing training for individuals with mechanical low back pain."

and

"Strength and conditioning professionals should not hesitate to use the deadlift exercise in their everyday practice, but before considering deadlift training for individuals with mechanical low back pain, our results suggest that pain intensity and the endurance of the hip and back extensors should be evaluated. For example, if low endurance of the hip and back extensors and high pain intensity are found in an individual with mechanical low back pain, then other interventions should be considered before initiating deadlift training."

Considerations for Making Deadlifts Safer

The most significant risk factor regarding form with deadlifts is if the spine rounds while under load. For example, if you start with good form (neutral spine), get halfway up and then allow the spine to flex (round forward). This is especially detrimental when using heavy weight. If the spine must flex forward, it's better to start and maintain that same spine posture throughout the entire lift.

Using too heavy of weights can also lead to a back injury. Heavier loads inevitably increase the magnitude of forces on the spine. This can also make it more challenging to maintain good technique, resulting in buckling of the spine. Deadlifting for spine health is not the same as deadlifting for powerlifting. Max effort and maxing out is NOT healthy for the spine. A good rule of thumb for your exercise program is to keep the weight and repetitions to about 60-70%. As you become more experienced, increasing weight will become less risky.

Additionally, sudden jerky movements at the beginning of a deadlift can also cause injury. When low back muscles go from very loose and relaxed to heavily engaged too quickly, it puts unnecessary additional stress on the back. To reduce this risk, it's recommended to remove slack and create tension just before beginning the lift. 

Bracing, Intra-Abdominal Pressure, and Deadlift Tips

• Hinge your hips backward while keeping a neutral spine
• Knees can bend, but they should not go forward
• Keep the shoulders pulled back (squeeze shoulder blades together)
• Squeeze the lat muscles (keep elbows tight to the body)
• Pull the slack out of the bar and maintain tension throughout the core
• Keep the weight close to your body (bar close to your shins)
• Take a deep breath in
• Tighten the abdominal muscles as if bracing/preparing to be karate chopped along the sides of your stomach muscles
• Push through the heels as you stand up
• Drive your hips forward and stand up tall without arching your back at the top

Safer Deadlift Variations

Traditional barbell deadlifts demand precise technique and can be challenging—especially for beginners or those rehabbing a back injury. If you’re looking for a gentler on-ramp to deadlifting, start with variations like kettlebell deadlifts or trap bar deadlifts. Both allow you to keep the weight closer to your center of gravity, reducing strain on the lower spine and minimizing the need to scrape a barbell along your shins.

• Kettlebell Deadlifts: The kettlebell sits between your feet, helping you maintain better alignment and a more controlled hip hinge. This makes it easier to master proper bracing and neutral spine positioning—skills that will carry over to heavier lifts down the road.
• Trap Bar Deadlifts: By letting you stand within the bar rather than behind it, trap bars promote a more upright torso and a neutral spine position. Many lifters find this variation more comfortable on the back and shoulders, while still challenging the glutes, hamstrings, and core.

Once you build confidence and refine your technique with these variations, transitioning to a conventional barbell deadlift becomes safer and more intuitive.

Do Deadlifts Cause Disc Bulges?

In decades past, disc injury and degeneration were thought to be primarily "wear-and-tear" caused by heavy physical loading and occupation. However, studies now highlight that genetics play a more significant role than previously considered. For example, twin research shows heredity factors may explain up to 74% of adult disc cases.

In addition to genetics, other predominant factors related to disc degeneration and injury include smoking, obesity, poor diet, and even lack of sleep or poor sleep quality. Interestingly, not much evidence points to heavy lifting being a consequential risk factor for disc injuries.

Mechanical explanations for causing or accelerating disc damage include repetitive bending (especially flexion), prolonged sitting without changing positions, and bending while twisting under load. Dr. Stu McGill, one of the most cited researchers of low back pain, says that cycles of flexion are most predictive of disc damage over time. Essentially, collagen fibers in the disc's outer layer slowly unravel after years of repetitive bending.

A final consideration is the consequences of being too sedentary. The spine discs don't have direct blood flow and rely on movement for nourishment. This means that not staying active is highly detrimental to discs and the spine.

Collectively, all of this means it's unlikely that one single event, such as a deadlift, will cause a disc bugle. That said, deadlifts (especially if too heavy) produce a significant force within the spine. If there's an existing bulge (herniation), performing deadlifts can absolutely make it worse and delay healing. This is even more true if excessive weight or improper technique is being used. However, after appropriate therapy, deadlifts are extremely valuable in the final phases of rehabilitation.

Can Deadlifts Impart Healing or Regeneration of The Intervertebral Disc?

A 2015 study explored whether specific spinal loading through exercise could stimulate healing or regeneration of the intervertebral discs. The researchers found a dose-response relationship between spinal loading and regenerative processes. Their final conclusion was:

"Although high loading at high volumes and frequencies might accelerate degeneration or produce disc injury, high loading—when performed at low volume and low frequency—appears to induce potentially regenerative mechanisms, including improvements in disc proteoglycan content, matrix gene expression, rate of cell apoptosis, and improved fluid flow and solute transport."

While the study examined various forms of resistance training rather than deadlifts specifically, the findings are highly relevant. Deadlifts are one of the most effective exercises for loading the spine, making them a strong candidate for producing similar benefits.

Why This Makes Sense

Intervertebral discs are avascular, meaning they lack a direct blood supply and rely on movement to facilitate the exchange of nutrients and waste. This study reinforces the idea that loading the spine strategically—followed by proper recovery—could play a role in maintaining or even improving disc health.

Balancing Load and Recovery

It’s crucial to note that high-volume, high-frequency spinal loading may accelerate degeneration, while low-volume, low-frequency loading— even with heavier weights—may have regenerative benefits. While the study doesn’t provide specific guidelines, a general takeaway for spinal health is:

• Moderation is key. Heavy loading may be beneficial, but excessive volume and frequency could be counterproductive.
• A reasonable starting point: Deadlifts once per week may allow for sufficient stimulus while providing enough recovery time.
• Individualized approach: Not everyone’s spine responds the same way to lifting. Listen to your body and adjust frequency or volume accordingly.

This research highlights an important nuance in spinal loading: deadlifts and other resistance exercises, when done correctly and in the right amounts, may not just build strength but could also play a role in disc health and longevity.

Best Treatment for Low Back Pain From A Deadlift

Low back pain after deadlifts can happen if you have a pre-existing back injury, lift too much weight, or have improper technique. For acute low back pain (less than two weeks) after deadlifts, it's advised to take it easy. Bed rest and avoidance of all activities are not recommended. However, keeping stress off the spine while it heals is necessary. Home remedies include ice, NSAIDs, and gentle therapeutic stretches and exercises. 

The best therapy for low back pain after deadlifts will depend on which tissues are injured. Common injuries after deadlifts include facet joint sprains and lumbar muscle strains. As mentioned previously, deadlifts alone probably do not cause disc bulges. However, if there was an existing bulge, heavy deadlifts would exacerbate it.

Often, a combination of treatments will help most with pain relief and speed up the healing response. The following are excellent therapies to help with low back pain.

• Spinal decompression
• Chiropractic adjustments
• Myofascial release
• Acupuncture
• Rehabilitation and therapeutic exercises

Disclaimer: The information in this article is educational and not a substitute for personal medical advice. Always consult a qualified healthcare provider for individual diagnosis and rehabilitation guidance. There are many reasons deadlifts are an excellent exercise for the spine. However, there are nuances involved and working with a professional is recommended to see if deadlifts would be a good option specific for you.

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