Comment by KA01 | Hacker News Reader

Comment by KA01 | Hacker News Reader

I have an exercise physiology background (BS & former personal trainer), so I know a bit about this topic. I'm now a SWE and have had my share of back pain. Back pain can be caused by an imbalance of muscle strengths/weaknesses (e.g., strong anterior and weak posterior muscles) or poor stability during movement like walking and squatting.

The commonly-suggested treatment is to perform weight training- squats, deadlifts, lunges, rows, pull-ups, core stability exercises like planks and suitcase carries, anti-rotation core exercises like pallof presses. The idea is to strengthen weak muscles to improve muscle imbalances and stabilize your body when you move.

Exercise alone may or may not work. You need to screen for the root cause. This is a bit more involved, and the best advice I can give is to find a really good physical therapist and/or read "Rebuilding Milo". There's an entire chapter dedicated to back pain- anatomy, how to screen for back pain, classifying the back pain, and treatment. Other chapters are dedicated to hip and ankle. These joints can also be a cause too.

You can step away from your sitting position more often or buy a fancy chair but exercise is the ultimate solution here.

I know many skilled weightlifter who eventually fucked their backs doing deadlifts. I know even more unskilled folks who tried to learn, didn’t quite do them right and got the same outcome.

Deadlifts are great if you always do every rep perfectly. But it can be quite easy to let your guard down, or get distracted, or just not really realize your technique is a little off until you hit weights where irreversible damage happens. I think the game theory on deadlifts for the average joe is unequivocally “don’t do them”, especially because side there are so many other alternative and less risky exercises to build similar strength. You’re gonna be fine until the one time you’re not. The rest of those exercises are more than enough.

I understand. Compared to a common movement like a squat, the average joe rarely performs a hip hinge. If they do, it's likely with poor form. I've personally trained beginners. Most know how to squat but struggle with the hip hinge. The hip hinge needs more attention to learn than, say, the chest press.

There are risks for injury throughout the entire fitness spectrum- from being sedentary to powerlifting. Not exercising has its own set of risks. On the other end, your risks increase when you lift too much weight, move too quickly, push through fatigue, or disregard technique. That goes for any exercise. You can reduce risks by learning from an experienced weightlifter and/or hiring a personal trainer.

I've never heard advice for the average person to avoid deadlifts. The therapy and fitness industry advises the opposite- they should learn how to perform hip hinges. The stimulus placed by deadlifts, RDLs, or any front-loaded hip hinge is unique. Weight distributed anteriorly to the body puts a load on the spine. This exposes weaknesses in spinal stability, but it's also a great solution to improve it. The challenge is figuring out the readiness of the person prior to and during a program. Do they have adequate hip and shoulder mobility to maintain a neutral spine throughout the hinge? Can they maintain this spinal stability when progressing to heavier loads or higher volumes?

I agree there are higher risks of injury for deadlifts compared to squats or lunges. However, I would not remove them entirely from a training program because of their unique stimuli.

Fascinating! I'm curious to pick you brain a little bit more, given your background - got 15 mins to chat briefly?

Sure :)

Reply on news.ycombinator.com