Question: Patient with lower back pain was being treated with PRI. He is doing well and wants to return to dead lifting. Does he just lift as before with PRI activity as primer? Or are there changes in his technique? Is it practical to maintain PRI positioning - knees bent and pelvis inlet in extension during this particular activity?
Answer : Respecting that each coach and athlete has their own style, as well as intensity and set of expectations they focus on while training, we tend to meet them where they are at, and focus on merging belief systems and paradigms to optimize performance of various biomechanical relationships. If you have no experience in this domain, it would be best practice to pair up with a strength coach or personal trainer in your community who is familiar with PRI and can help your patient transition back to lifting. I suggest looking on the PRI website for a PRT in your community.
In the case of the deadlift, we want the athlete to be able to properly coordinate a hip dominant movement strategy to raise and lower the weight away from the ground. Observation for technique must go beyond the hips and lumbar spine. We must identify how body segments are organizing to hold the load and get the hips through.
Before suggesting any changes, it may be educational - for both you and the patient - to capture some video footage of his current strategy being used and analyze his movement preferences through a PRI lens:
- How are the hips and thorax being integrated and how are they moving through space?
- Is the lift being executed with excessive reliance on the extremities or is the core (pelvis + thorax) being properly integrated?
- How is the ground being used?
- How is gravity being managed?
- What kind of strategy (ankle, knee, hip, back, or trunk) is being used to lower and lift the load?
An efficient movement strategy in a compound lift is going to include good collaboration front to back, side to side, with no bias in rotation.
With a compound symmetrical lift, each leg should be used symmetrically to properly distribute the external load and keep the center of mass balanced in respect to the line of gravity.
An inefficient movement strategy may include:
- early sternal or trunk elevation
- excessive back extension without synchronized AF pelvic extension
- plantar flexing the ankles and de-grounding the heels
- early or too much knee extension and quad use
- pulling the weight up instead of pushing into the ground to get the hips through
- not keeping the center of mass balanced between the two legs.
It is not necessary to think about maintaining pelvic inlet extension throughout any compound lift. For proper ergonomics, in a sagittal plane movement pattern like a deadlift, the pelvis and thorax need to synchronize their movements. The pelvis will need to move through a zone of motion to properly manage the hips, thorax, neck, and external load. **During compound lifts, the goal should be to move with the pelvis and thorax synchronized and well controlled.
I do recommend keeping the knees bent. We look for pelvic extension to be initiated before knee extension. If the knees extend too early or lock out, the hips will not be able to get through before the back extends. We don’t want the back muscles to be overused or the knee strategy to be the prime mover. Proper timing of various segments extending is important.
- We want hyperactivity managed so the center of mass and load can be lowered toward the ground and then we want extension coordinated so all moving parts are working together to push the center of mass and load away from the ground.
Hyperactive chains of muscles (rib elevators, pecs, lats, QLs, paraspinals, posterior intercostals, lateral quads/ITB, and calves) need to be able to inhibit to lower the weight in a controlled fashion. Often times at the set up and during the descent, people hang on to “too much” and over recruit. We look for hyperactivity to be minimized so intrinsic organization can naturally neuro-reflexsively be created.
- When I say inhibit in this context, I means to tone down, soften, and relax. The chains may be active with opposition– we just don’t want them “hyper”active.
- Over bracing abs is a form of hyperactivity which disrupts natural neuro-reflexsive stabilization.
- If the set up is poor and disorganized, chain reactions will further alter biomechanical relationships. Neuromuscular tone at set up and start position is key to successful coordination of body segments.
With a deadlift, compared to a squat, more attention is placed on the hip strategy.
- The shin angle should remain fairly vertical and the ankle joint doesn't move much. With properly grounded feet - hyperactive plantar flexion tone should be managed and dorsiflexion should be adequate to allow proper ankle range of motion.
- As they descend, their center of mass must shift back and they should become sensory aware of their heels and posterior weight shift (sway slightly backwards). From this position, extension movements are coordinated to push into the ground to get the hips through.
- Extension is most powerful when it is properly opposed, well grounded, and segmentally orchestrated to lift the weight.
- In this movement pattern, we are looking for good use of the ground and synchronization between the pelvis and thorax so that the pelvic/hip extension can properly sequence with knee extension and back extension strategies.
Lastly consider the external load configuration. A barbell placed in front of the feet is going to make it more challenging to synchronize all extensor mechanisms. If they are not able to achieve a full zone of apposition independently this becomes a risky load to manage without compensation. A hex bar helps to bring the load closer to the line of gravity and allows the athlete to better manage their center of mass so they can lift heavier with less risk. The hex bar will also help with grounding the feet and sensing the floor. If there is a lot of upper quarter asymmetry and the brachial chains have not been fully cleared, you may want to even consider using dumbbells.
Deadlifts offer a lot of functional integration and I think they should be integrated in most return to sport (i.e. lifting) programs. If done properly on a system that has attained a zone of apposition and that is able to coordinate a hip-thorax strategy well, deadlifts will help to maintain neutrality and promote postural balance.
*** Lastly, learn more about how patterns of hyperactivity and faulty biomechanics cause problems and inefficient movement patterns as well has how to regulate neuromotor tone by attending PRI Integration for Fitness and Movement Course.
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