Low back pain is now the number one cause of disability around the world (1). Most adults will experience low back pain at some point in their life (2). In 2015, low back pain was the cause of 60.1 million disability-adjusted-life-years. One disability-adjusted-life year is considered one lost year of “healthy” life. Therefore, a staggering 60.1 million “healthy” years were lost due to low back pain in 2015.
The question remains then – how can we protect ourselves from this injury? Is it ‘harmful’ to do particular exercises in the gym that could increase susceptibility to developing low back pain? A common perception from the general public is that doing exercises such as squats or deadlifts in the gym may contribute to lower back problems. The purpose of this article is to present the current research literature on this topic.
Here is a refresher video on squat and deadlift technique:
Below are relevant research studies and their outcomes;
One study analysed people aged between 25 and 60 years of age with 3 or more months of low back pain or discomfort. They performed 11 sessions of the deadlift exercise over 8 weeks. Over these weeks the exercise was progressed by either increasing the number of lifts and/or the weight on the bar. Two months and 12 months following the training period participants were shown to have a significant improvement in their reported pain and function scores (3).
Another group of researchers investigated the effect resistance training had on those aged between 16 and 60 years of age with a history of low back pain greater than 3 months (4). Various outcomes of the exercise regime were assessed including; reported pain and disability scores, back extension endurance testing, as well as the amount of fat surrounding the lower back muscles (erector spinae and multifidus). Prior to this study it had been known that those with low back pain demonstrated greater of amounts of fat around the lumbar spine (lower back) and less cross-sectional area of the lower back paraspinal muscles on MRI (5,6,7,8,9). The exercise program included such exercises as deadlifts and squats (amongst others) performed three times per week for a 16 week period (4-months). Results revealed significant improvements with a 72% reduction in pain scores and 76% reduction in disability scores. In addition, a reduction in fat tissue around the lumbar spine and increased cross sectional area of the paraspinal muscle tissue was also seen. Muscular endurance testing of the lumbar extensors was significantly improved which has been suggested as a possible risk factor for low back pain.
Another study also investigating lumbar multifidus muscle size changes in those with low back pain (seeking care for greater than 3 months) following performance of a deadlift exercise (10). Participants attended a maximum of 12 sessions over a 2-month period with initial sessions focused on executing “proper technique” with lower loads of 10-20 kilograms of three to five sets of 10 repetitions. This was further progressed after subsequent sessions by increasing the total number of kilograms, increasing the sets to between 5 and 8 and decreasing the repetitions to between 3 and 5. The results revealed that the thickness of the lumbar multifidus muscle increased significantly over this period.
A study that initially analysed the MRI scans of the lower back (thoracic and lumbar spines) of Swedish elite athletes at the highest possible international or national ranking from four different sports (weightlifting, wrestlers, orienteers, and ice hockey players) (11). Some of these athletes experienced back pain and some did not. Fifteen years following these initial scans were performed a repeat MRI was undertaken of these athletes. Interestingly, new abnormalities were not seen amongst athletes of the different sports which included the weightlifters. Two other authors (Wirth and Zawieja) have recommended a goal of between 1.5 and 2.0 times bodyweight to be achieved for a deep squat; which weightlifters commonly will lift. This MRI study suggests that there is no long-term detrimental effect for weightlifters, who perform heavy squats and deadlift exercises, with regards to structural injury on an MRI scan.
A group of researchers aimed to evaluate whether any individual factors of participants with low back pain could predict who may benefit from deadlift training (12). The exercise regime involved up to 12 sessions over an 8-week period. Main findings showed that higher self-reported measures of disability and pain intensity as well as poorer performance on the Biering-Sorensen test (an endurance test of the back extensor muscles) could predict that deadlift training may not initially be appropriate for that group of people.
In summary, research suggests that for those experiencing low back pain there is no increased risk of injury in the lower back with strength training (including deadlifts and deep squats) (13) and in fact can have a rehabilitative effect (3). In these studies “optimal lifting technique” was taught to the participants (12). It is recommended that if you are considering performing such exercises as the deadlift and squat that speaking with a physiotherapist or a personal trainer is important to ensure correct technique is being achieved. For those experiencing low back pain; an assessment from a physiotherapist can help decipher whether deadlift and squat training would be appropriate options to include in your exercise regime.
Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., … & Smeets, R. J. (2018). What low back pain is and why we need to pay attention. The Lancet.
Lemeunier, N., Leboeuf-Yde, C., & Gagey, O. (2012). The natural course of low back pain: a systematic critical literature review. Chiropractic & manual therapies, 20(1), 33.
Aasa, B., Berglund, L., Michaelson, P., & Aasa, U. (2015). Individualized low-load motor control exercises and education versus a high-load lifting exercise and education to improve activity, pain intensity, and physical performance in patients with low back pain: a randomized controlled trial. journal of orthopaedic & sports physical therapy, 45(2), 77-85.
Welch, N., Moran, K., Antony, J., Richter, C., Marshall, B., Coyle, J., … & Franklyn-Miller, A. (2015). The effects of a free-weight-based resistance training intervention on pain, squat biomechanics and MRI-defined lumbar fat infiltration and functional cross-sectional area in those with chronic low back. BMJ open sport & exercise medicine, 1(1), e000050.
Mengiardi, B., Schmid, M. R., Boos, N., Pfirrmann, C. W., Brunner, F., Elfering, A., & Hodler, J. (2006). Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology, 240(3), 786-792.
Kjaer, P., Bendix, T., Sorensen, J. S., Korsholm, L., & Leboeuf-Yde, C. (2007). Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain?. BMC medicine, 5(1), 2.
Pezolato, A., de Vasconcelos, E. E., Defino, H. L. A., & Nogueira-Barbosa, M. H. (2012). Fat infiltration in the lumbar multifidus and erector spinae muscles in subjects with sway-back posture. European Spine Journal, 21(11), 2158-2164.
Fortin, M., & Macedo, L. G. (2013). Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Physical therapy, 93(7), 873-888.
Wiggs, M. P. (2015). Can endurance exercise preconditioning prevention disuse muscle atrophy?. Frontiers in physiology, 6, 63.
Berglund, L., Aasa, B., Michaelson, P., & Aasa, U. (2017). Effects of Low-Load Motor Control Exercises and a High-Load Lifting Exercise on Lumbar Multifidus Thickness. Spine, 42(15), E876-E882.
Baranto, A., Hellström, M., Cederlund, C. G., Nyman, R., & Swärd, L. (2009). Back pain and MRI changes in the thoraco-lumbar spine of top athletes in four different sports: a 15-year follow-up study. Knee Surgery, Sports Traumatology, Arthroscopy, 17(9), 1125-1134.
Berglund, L., Aasa, B., Hellqvist, J., Michaelson, P., & Aasa, U. (2015). Which patients with low back pain benefit from deadlift training?. The Journal of Strength & Conditioning Research, 29(7), 1803-1811.
Hartmann, H., Wirth, K., Mickel, C., Keiner, M., Sander, A., & Yaghobi, D. (2016). Stress for vertebral bodies and intervertebral discs with respect to squatting depth. Journal of Functional Morphology and Kinesiology, 1(2), 254-268.