Deadlifting: Risk vs Reward
Few exercises are more feared for injury risk than the deadlift.
This is true of the general population and, unfortunately, many health-care providers.
This fear is mostly unfounded; the evidence paints a different picture.
This article explains the risks and benefits of deadlifting.
The plan is as follows:
Injury prevalence from deadlifting
Deadlift technique and injury risk
What matters for injury risk?
Benefits of deadlifting
Take-home points
Injury prevalence from deadlifting
Research measures injury rates as the number of injuries per 1,000 hours of participation.
Data doesn’t exist for the deadlift alone; hardly anyone only deadlifts.
However, we can get close enough.
In the sport of powerlifting, the reported number of injuries that occur per 1000 hours is between ~1-4. [1]
In CrossFit, there tend to be ~2-3 injuries per 1000 hours of participation. [2]
Importantly, these numbers are quite low.
By comparison, soccer and basketball see ~8-34 injuries per 1,000 hours, varying by level of play, game vs. training, etc. [3,4,5]
Statistically, you’re safer on a deadlift platform than on a soccer field.
It’s also worth noting that inactivity does not reduce musculoskeletal/orthopedic pain risk.
In fact, sedentary populations tend to experience pain MORE than active populations. [6,7]
To summarize:
Your risk of experiencing pain or injury is never zero
Inactive populations tend to experience musculoskeletal pain MORE than active populations
Among all means of undergoing activity or exercise, deadlifting has some of the lowest rates of injury recorded
Deadlift technique and injury risk
Many deadlift variations exist: conventional, sumo, Romanian, single leg, stiff leg, and others.
Each variation has its own appropriate technique.
One recommendation is central to all of them, though: keeping a “neutral spine” throughout the lift.
Ask anyone on the street, and they’d probably say the key to a safe deadlift is “not letting your back round.”
The problem: almost all evidence suggests this isn’t actually a risk factor for injury.
A 2020 systematic review and meta-analysis in the Journal of Orthopedic & Sports Physical Therapy best captures this. [8]
The researchers compiled all available human evidence on the relationship between lumbar flexion (low back bending) and low back pain.
As an isolated variable, lumbar flexion showed no relationship to lower back pain.
Historically, spinal bending was thought to risk disc herniation.
However, this has ONLY been demonstrated in porcine cadavers (dead pigs) and then extrapolated to humans. [8]
The problem with this is clear:
You are not a pig
You are not dead
As it turns out, being alive is a pretty important confounding variable.
What matters for injury risk?
Thus far we have established the following:
Rates of injury from deadlifting are far lower than generally perceived
Imperfect lifting technique does not seem to increase risk of injury
So, what does matter for injury risk?
Generally speaking: load management. [9]
There are three “dosages” of deadlifts you can impose on yourself:
A dose that is too little and will not cause any stress to the system and will not elicit any adaptation
A dose that is just right, causes moderate stress to the system, and reliably improves fitness
A dose that is in excess, causes high stress to the system, may promote a fitness adaptation but also comes with increased injury risk
The goal of any training program is to stay in that middle range.
Bending over to pick up a pen is essentially a deadlift.
The only real difference is the weight, and perhaps how much attention you give your technique.
Point is: the action of a deadlift is something we cannot get away from. It is a fundamental part of life.
As you improve at deadlifts, that second category shifts to heavier weight or more volume; providing a protective effect in everyday life.
Deadlifting becomes risky when you’re continually in that third category.
For example, performing near-maximal deadlifts multiple times per week.
Consider, instead, if you deadlifted 1-2x/week at an overall effort level of ~6-8/10; with maximum effort sets being utilized less often.
This would provide a sufficient stimulus to elicit improvements in strength and muscle size, with injury risk being reduced to a near negligible level.
There’s another crucial component of load management.
Proper load management should take everything else about your life into account.
The obvious external factor is your other training, both additional weight lifting and other modes like endurance training.
Less obvious factors to take into account include your sleep status, nutrition status, levels of stress, etc.
A deeper dive is beyond this article’s scope, but the key points are:
Your focus should go here before it goes to technique when attempting to reduce risk of injury
These concepts apply to all exercises, not just deadlifts
Benefits of deadlifting
Deadlifting offers all the general benefits of resistance training.
These include, but are not limited to:
Reduced risk of sarcopenia
Increased basal metabolic rate
Improved cognitive abilities
Decreased risk and better management of diabetes
Decreased risk and better management of cardiovascular disease via reducing blood pressure and improving blood lipids
Increased bone mineral density / reduced risk of osteopenia and osteoporosis [10]
Beyond this, the deadlift has a few unique benefits worth noting.
First, the deadlift arguably trains the widest variety of muscle groups simultaneously.
More specifically, it trains many muscle groups productively.
In other words, many exercises that seek to train everything end up training nothing well. This is not true of deadlifts.
If you’re strong on the deadlift, you almost certainly have a well-developed back and legs.
There are many different ways to deadlift, but this is sentiment is true for all of them.
This can provide a potent time-saving effect if you do not have much time to dedicate toward strength training in the week.
Second, it is arguably the best exercise for improving bone mineral density in key areas.
The problem with osteopenia and osteoporosis, states of decreased bone density, are that your risk of fracture increases substantially.
Some of the most common sites of fracture due to decreased bone density are the hip and the spine.
Bone is most potently stimulate to improve in density when it is loaded from multiple directions, as per Wolff’s law. [11]
The deadlift allows you to provide mechanical tension to these areas through varying angles, given that you begin the lift in a hinged position and end in an upright position.
Thus, there is unlikely to be any exercise more efficient than the deadlift for bone mineral density improvements.
Finally, as discussed, deadlift training likely reduces your risk of everyday injury.
Imagine two people had to pick up a 100 pound object.
One person has never trained deadlifts before, while the other recently deadlifted 225 pounds.
It’s fair to say that such a lift is more likely to hurt the untrained person than it is the trained person.
Concluding points
Key takeaways:
Deadlifts are a part of life. If you pick a pen up off the ground, you are performing a deadlift.
Rates of injury from deadlifting are much lower than what is stereotypically thought. Most recreational hobbies pose greater risk from a pure statistical standpoint.
Deadlift technique is also not nearly as closely associated with injury risk as stereotypically thought. Your form does not need to be perfect and your risk of injury remains low.
Proper load management is a much more potent lever to pull to reduce injury risk- but this is true of all exercise; not just deadlifts.
Strength training in general is amongst the most health promoting of habits you can undergo across the board. Deadlifts provide the specific benefits of being time-efficient, optimal for bone mineral density, and potentially reducing injury risk in day-to-day life.
