Low Back Pain with deadlifts or squats? No. It’s not due weak glutes or abs

Guest Blog by Physiotherapist Tom Slezak from Switch Health 

When Trends become Trendy.

Health professionals can have a tendency to overcomplicate things that really aren’t that complicated. They also can get complacent and start telling clients what they want to hear. Weak glutes/abs have been the trend for the last 5 years. 

All of you have heard low back pain arises from weak glutes/abs or some other muscle; but this concept is not supported by any credible research. 

The idea that a ‘weak core’ is the reason for low back pain arose from a series of studies developed by Paul Hodges and Carolyn Richardson which found that people with low back pain often had structural and functional changes to the transversus abdominus (an ab muscle). However these studies have been misinterpreted and have since been heavily disputed. 

Are you testing strength or a skill?

Unless you have poor technique (something that will discussed below)- your glutes, hamstrings, quads, abdominals and lower back will all be targeted and strengthened during a squat and deadlift. So why would anyone assume these muscles to be weak?There is no evidence to say that you can simply switch off your glutes. 

Tests done by physios, i.e ‘Do a bird dog’ are testing a skill, not your glute strength. You do not have weak glutes because you are unstable in an unfamiliar yoga pose. You’ve been lifting weights up and down. Your training is not specific to being good at yoga poses.. it’s specific to lifting weights up and down. 

If I asked you to stand and balance on a bosu ball, unless you do this in your training, you’re going to suck at it.Therefore often these quick tests done with the physio aren’t able to accurately test your strength as they are not specific to what you do. They proves you are unadapted to a yoga pose, not that your ‘glutes don’t fire’. 

So why does my low back hurt when I squat/deadlift then? Huh? 

Injury occurs when a load exceeds the body’s ability to adapt and cope with that load” Canadian Physiotherapist and Chiropractor Dr Greg 

There are three very likely scenarios you’re overloading your lower back whilst squatting and deadlifting; and this is due to: 
1) Technique issues 
2) Load management issues a.k.a programming issues 
3) A combination of bothTechnique issues – why moving with load is completely different from an in-clinic assessment 

If you’re a powerlifter, you’re generally dealing with quite a bit of weight. Technique is important to ensure you are lifting weights efficiently and not overloading a specific area of your body.Most common technique flaws that overload your lower back include: 
1. Cat back deads 
2. Full good morning squat 
3. Sticking your butt out too much during squat (think typical Instagram influencer squatter in fluro tights)

How you perform a squat and deadlift under load may look completely different with less or no load. Therefore as a therapist the only way I can properly assess your technique is if I have a squat rack, barbell and some heavy ass weights; or if I see a video of your heavy squats. 

How to assess yourself 
First – film your set, then review if your current technique is placing your lower back under extra load. Check to see if you have: 
• Excessive anterior pelvic tilt (arching your back too much) 
• Excessive posterior pelvic tilt (loss of hip control leading to a butt wink) 
• Over-exaggerating chest-up cue during squat ultimately excessively anteriorly tilting your pelvis 
• Hips deviating to one side during squat.

Another HUGE issue for PL’s is an over reliance of utilising a reflex response to get them out of the hole of a squat. You’re classic dump and hope to bounce back out. This is a valid comp scenario, but if you miss time (or change depth) you get crushed. Those crushed reps put your back under huge load. You need to think about how long your dive and recover technique will survive. 

What else you can do 
• Have someone who knows what they’re doing have a look at your squat and deadlift 
• Find someone who has a great looking squat and deadlift and take pointers (Brett Gibbs) 
• If you’re technique breaks down at a certain point during your lift consistently train that portion of the lift. It’s highly unlikely it’s a specific muscle which is weak. E.g pause squats for bottom of the squat breakdown, snatch grip deficit deadlifts for the start of the deadlift 

When we see a lot of issues at the clinic 

Often this can also be due to super quick changes to your technique that place your lower back under extra load it may not have adapted to yet. 

Examples include: 
• Bringing your hips higher during a deadlift when you generally have your hips lower 
• You have started sinking lower in your squat than you’re used to 
• You’re a beginner and have just started low bar squatting recently when usually you high bar.Sudden technique changes particularly if you load them up straight away with a high amount of volume or intensity (weight) can be a shock to the body. 

Your body likes to be introduced to new things gradually and sometimes can freak out if it’s not gradual enough.If you want to alter your technique, go for it. However strip back the intensity and practice the new technique over a couple of weeks. Don’t just squat 20cm lower than you’re used to with 95% of your 1RM. Do 50% of your 1RM at a ~ 6RPE then gradually over 3 weeks work back up. 

Be careful with your load

Load management is often overlooked as a contributing factor to the development of low back pain. Let’s take a look at Lehman’s quote again.“Injury occurs when a load exceeds the body’s ability to adapt and cope with that load” 

Now consider the following types of load: 
1) Acute loads 
2) Chronic loads

Huge jumps in acute loads can be detrimental (ie, performing 3x12 of 140kg at 7RPE one week and all of a sudden you want to bang out 3x1 of 220kg at 9RPE the next week)What you have done is increased your intensity by 63% in one week. 

Remember, your body likes to adapt slowly to things. This will be another shock. And when the body gets shocked often you get pain and injury.Problems can also occur when training under high chronic loads as a result of training at a high intensity and/or high volume for an extended period of time. In general, your body can only work at high volumes and intensity for so long before things start getting sore. 

• A large portion of your work sets you’re pushing in to absolute fatigue 
• Consistently training 6-7 days a week without any consideration of having light days 
• Lack of de-load weeks 
• Spending far too much time lifting weights that are 80-100% of your 1RM 

You should be following basics: 
• Spend the majority of your program not reaching absolute fatigue in a set and not failing a rep  
• Program effectively in the 60-80% of your 1RM 
• Split your program in to either high volume/low intensity or low volume/high intensity and switch between these two every 8-12 weeks 
• Make small increases to your intensity OR volume each week (E.g 5% increase in weight week to week) 

Wrapping it up. 

Before feeling the urge to blame a muscle or any other structure in trying to reason why you have low back pain, please consider that:
• Technique and load management issues are far more likely to be the cause of LB pain with squats and deadlifts 
 • Minimal research links abdominal or glute weakness to having lower back pain• Understand your body responds best when progressions and technique changes are done gradually 
 • Most of your program for the big three lifts should be sub maxed and have you lifting within 60-80% of your 1RM 

Note: It should also be noted that psychosocial elements such as stress, poor sleep and mental fatigue can all also influence your likeliness of developing low back pain whilst performing these movements! 

 Reference:Hodges PW, Richardson CA (1996). Inefficient muscular stabilisation of the lumbar spine associated with low back pain: A motor control evaluation of transversus abdominis. Spine 21(22): 259-264.