1. Not everyone is built the same, has the same past injury history, the same skill level and movement competence or has the same goals. So why would everyone deadlift the same way?
2. Appreciating and measuring the differences in ankle, hip and spinal structure, mobility, motor control and function is the first step in programming the perfect deadlift variation for any client. Stop arbitrarily force feeding one variation over another without the data to back it up.
3. If you want to protect your clients and athletes, assess before you program. Use these assessment tools to gain objective data on mobility and functionality that directly effect the deadlift movement pattern.
4. Many people will NOT present with the mobility, stability and motor control to deadlift conventionally with the barbell. Use these ankle, hip and spinal drills to improve movement and function.
5. Chose the correct deadlift variation based on your assessment and findings, and prioritize cleaning up the limiting factors holding back the deadlift from becoming a long term pain-free staple loaded movement.
The Anti-Cookie Cutter Approach
When we are born, most of us have the same bones, muscles, ligaments, tendons, etc. Barring any type of birth defect, we are basically created the same structurally, but are we really?
Yes, most of us have the same muscles and bones. The structure and position of those bones are not always carbon copies when it comes to comparing one person to another.
When it comes to strength training, we need to make sure we account for individual differences in terms of exercise selection and variation in programming so that we aren’t trying to put a square peg into a round hole. If someone’s joint has some type of soft tissue, joint, or bony restriction, we need to structure the client’s programming appropriately to avoid causing damage.
Of course, the deadlift is one of the most simply complex compound movement patterns around. In this article, we are going to take a joint by joint approach to identifying and teaching the intricacies of each region and how it may potentially alter the type of deadlift an athlete or client needs. Lets start with the ankle joint.
There are various motions at the ankle, but specifically ankle dorsiflexion is important in the deadlift. If someone lacks the ability to allow the tibia to translate anteriorly over the foot, this will cause compensations elsewhere in the kinetic chain. Some of these compensations can include:
Mid foot Pronation
Hip Internal Rotation
Typically, the body will find a way to get the mobility that it needs from another joint. The compensation is usually at a joint that needs to be stable during the deadlift. For example, lack of mobility at the ankle can cause increased mobility at the knee or lumbar spine. It may not be safe, but if the body wants to perform a movement, it will find the most efficient manner to do that particular movement.
How do we know if a client has sufficient ankle range of motion (ROM)?
With my clients and patients, I have them perform a knee to wall test. As the name implies, we have the person stand 4 inches away from a wall and see if they can touch their knee to the wall without letting their heel come up off the ground, move into knee valgus, or subtalar pronation. Check out this quick ankle assessment below:
Knee To Wall Test From Side
Knee To Wall Test From Top
Start with 1st toe 4 inches away from the wall.
Make sure to not allow knee to go into varus or valgus collapse.
Heel must remain in contact with the ground the entire time.
If someone can reach the wall from 4 inches away, they have sufficient ankle mobility to deadlift.
If someone cannot reach from 4 inches, we want to see where they can reach from. I have them inch up to the 3.5, 3, 2.5 inch marks and then compare side to side. If there is an asymmetry in their ankle dorsiflexion ROM, I would recommend they perform some type of foam rolling/self-myofascial release work to see if it improves. If it does not, they should seek out a manual therapist to perform some form of manual therapy.
Just because someone may inadequate ankle mobility does not mean they can’t deadlift. It is just one of the first factors we need to consider when programming which deadlift variation may be best for them.
At the hip, the client needs adequate hip flexion in order to approach the bar and be able to get into the proper position.
For testing hip flexion, we ideally like to see the client be able to have the anterior aspect of their thigh reach the inferior aspect of their lower rib cage. This tells me that they have sufficient hip flexion.
If a client’s hip does not reach the inferior aspect of the rib cage, there can be a few limiting factors.
First off, increased soft tissue tone in the posterior aspect of the hip, specifically gluteus maximus, can cause a decreased amount of hip flexion. Performing some form of Self-Myofascial Release (SMR) to the gluteals can help to decrease that tone and improve hip flexion. Check this one out from Dr. John Rusin for example:
Second, increased soft tissue tone in the anterior aspect of the hip can also limit hip flexion. Now, you are wondering how muscles that are on slack can limit hip flexion. Well, if the muscles of rectus femoris, psoas major, iliacus, and/or tensor fascia lata have increased tone in them, this can cause an increase in anterior pelvic tilt. In turn, this increase in anterior pelvic tilt can decrease the amount of space for the femoral head to move in the acetabulum.
When testing passive hip flexion, we will typically ask the client where they “feel it.” Do they feel a stretch in the back of the hip or a tightness or pinch in the front of the hip?
If they feel it in the front, try performing some type of SMR or have a physical therapist, sports chiropractor, or massage therapist perform some form of soft tissue work to rectus femoris, iliacus/psoas, and/or tensor fascia lata and then re-test. Check out the SMR techniques below that are staples in my treatment programming:
SMR For Iliacus
SMR for Vastus Lateralis & Tensor Fascia Lata
SMR for Rectus Femoris & Adductors
If hip flexion improves and the sensation they feel as compared to the pre-test improves, then the anterior musculature at the hip can be to blame. What if the client still feels a deep pinch/tightness in the anterior aspect of the hip?
Then, we need to assess the client’s hip joint structure.
Assessing Hip Structure with The Scour Test
Check out this video tutorial of Dr. John Rusin assessing an athlete’s hip structure using the hip scour test.
Even though this test is typically used for squatting and assessing hip joint mobility, it can be useful to use to determine if there are bony limitations at the acetabulum and/or femoral head that are limiting hip flexion.
In the deadlift, there isn’t as much hip flexion required as with the squat, but it is imperative to make note if a client has limited hip flexion. When training, a client should not try to work through a hip pinch.
Once we have determined the client’s hip flexion mobility, then we need to assess the bony alignment of their hip joint. We go about doing this by checking passive ranges of motion into hip external and internal rotation in sitting and in prone.
Next, we want to assess the hip from a prone lying position.
The Craig’s Test
If some of you are not familiar with this orthopedic assessment protocol, below are some key points on how to position your client or patient, and what to key in on in terms of the test findings itself:
Start off with the client in prone.
Bend knee to 90 degrees.
Palpate the Greater Trochanter (“Hip Bone” on side of thigh) on the lateral aspect of the hip.
Rotate the client’s hip into full external and internal rotation.
As shown in the video, rotate less and less each direction until the greater trochanter feels the most prominent.
Measure the angle the tibia makes with the vertical axis.
Craig’s test is used to determine femoral torsion. Normal Hip Anteversion is 8-15 deg into hip internal rotation. If someone is less than 8 degrees, the hip is considered retroverted. This person will have a tendency to exhibit increased hip external rotation and limited hip internal rotation
If someone is greater than 15 degrees, their hip is considered anteverted. This person will have a tendency to exhibit increased hip internal rotation and limited hip external rotation.
This test provides information on the bony alignment of that particular client’s hip joint. If the client has retroverted hips (increased hip external v internal rotation), then this is going to determine which deadlifting variation is right for them.
If the client has anteverted hips (increased hip internal v external rotation), this will also determine which deadlifting variation is right for them.
Lets keep moving through this process and assessment to determine optimal deadlift style and setup.
The Toe Touch Test
Next area we want to assess is the client’s ability to perform a toe touch. Now, this isn’t determining whether or not someone has tight hamstrings if they can or cannot touch their toes. See why in a previous article I wrote right here for Dr. John Rusin, “Why Your Hamstring Stretching Habit Is A Hoax”.
What the toe touch assesses is does the client have the ability to perform a posterior weight shift in order to sit back into their hips in order to bend over and touch their toes. There are other areas of limitation here such as increased tissue tone in the thoracic and/or lumbar spines, etc, but for the purpose of this post, we want to see if someone can perform a posterior weight during the toe touch in order to perform a deadlift.
Here’s an example of a good toe touch:
And an example of a poor toe touch:
As you can see with the poor toe touch, the person is unable to touch their toes. They also don’t perform any type of posterior weight shift. If a person can’t perform a posterior weight shift, then they won’t be able to adequately “sit back” while approaching the bar and be able to do it in a safe and effective manner.
Here are a few correctives that you can try with your client to see if it cleans up their toe touch pattern:
Toe Touch Progression
Place toes on slightly elevated surface.
Knees and feet together.
Slow and controlled, push hips posteriorly and bend over and attempt to touch toes.
Return to standing.
Perform 10 reps then switch to heels elevated on elevated surface.
Can be performed supersetted or during a warm-up.
Supine Leg Lowering
Slow and controlled, raise one leg up as far as you comfortably can.
Make sure to maintain the down leg on the roller. Do not let it come up.
Perform in warm-up or supersetted for 5 reps per side.
If toe touch improves, then this is a corrective that could be supersetted into a workout and/or warm-up to improve deadlifting form.
If their toe touch does not improve, take note of this for when we determine exercise selection and/or refer them out to a movement specialist with manual therapy skills to determine the route cause. Either way, training can still be performed around this particular limitation, but do not try to work through this limitation.
Lets move into the next region of the body that we will be assessing for the deadlift, the thoracic spine.
The Thoracic Spine
The deadlift requires multiple areas of mobility and stability. At the thoracic spine, the client needs to have sufficient thoracic spine mobility. This is important in order to maintain a neutral spine posture when performing the lift and to decrease any type of mobility at the lumber spine when loading the movement.
In order to assess thoracic spine mobility, check it actively and passively. Check out the assessments below:
Here is the Active Thoracic Spine Mobility Assessment:
And the passive assessment for the thoracic spine:
Without getting into too much detail for this post, if someone has 50 degrees or more of thoracic rotation, that is considered adequate thoracic spine mobility. Measure thoracic spine mobility with the angle the thorax makes with the line of the horizon. As you can see from the video, this person has a normal amount of thoracic spine mobility.
If someone doesn’t have adequate thoracic spine mobility, these various drills can help:
Bench T-Spine Mobs
Maintain a flat lumbar spine and think “ribs down” towards belt line.
Stretch should be felt in lats or mid-thoracic spine.
Sidelying Thoracic Rotation
Lie on side. Place top leg on ball/foam roller at hip height.
Hold knee on ball/roller using bottom hand.
Rotate through mid back. Movement should be coming from mid thoracic spine, not from the shoulder.
Perform for 5-8 reps per side in a warm-up or supersetted.
Sidelying Rib Roll
Lie on side. Place top leg on ball/foam roller at hip height.
Hold knee on ball/roller using bottom hand.
Grasp the ribs of the side that you are lying on. Using that hand, gently pull ribs and rotate through mid back.
Perform 5-8 reps per side in a warm-up or supersetted.
If someone’s thoracic spine mobility still doesn’t improve, then they may need to see a movement specialist to determine what is limiting their mobility.
Now that the ankle, hip, toe touch, and thoracic spine have been assessed, deadlift variation can be assessed.
Adding Variation To The Deadlift
If someone does or does not present with areas of limitation as noted above, we do not want to start them conventionally deadlifting on day one. We should first start off with a variation of that.
For example, trying an elevated kettlebell deadlift.
If the client can perform that well, then decrease the step or box height and going to the floor with the kettlebell.
The next step would be to progress to a trap bar deadlift.
Trap Bar Deadlift
If someone can perform all of these variations with great form, then we can start to look and see how they perform the deadlift from the floor.
This variation may work well for some and not for others. If we look back to our assessment piece, if someone’s hips are anteverted (increased hip internal v external rotation), then sumo deadlifting may not be a good variation for them. Due to the lack of hip external rotation at the acetabulum, the client may not feel comfortable getting into a sumo stance deadlift due to the external rotation needed to descent into the setup position.
The next step is to check and see how well someone can perform with a conventional deadlift.
If they have the adequate ankle, hip, and thoracic spine mobility, this is a favorable position to be in in order to perform the conventional deadlift safely and effectively.
Choosing The Safest & Most Effective Deadlift
If someone is limited in any of the areas discussed above, then this does not mean they cannot and should not deadlift. The deadlift is an excellent exercise at building strength and stability. Try performing a variation of the deadlift as noted in this section as long as they can perform it safely and effectively. If a client needs to start using a kettlebell or trap bar and doesn’t exhibit proper form with a sumo or conventional deadlift, start there and strength train in a safe and effective manner. Give those suggestions a try and let me know what you think!
About The Author
Andrew Millett is a practicing physical therapist in the field of orthopedic and sports medicine physical therapy. He helps to bridge the gap between physical therapy and strength and conditioning. By evaluating and treating his clients using multiple lenses, such as the Selective Functional Movement Assessment (SFMA), Postural Restoration Institute (PRI), the main goal for all of his clients are for them to move and feel better and to keep their body functioning at high levels.