Today is a big day for Barbell Rehab, as we have our first guest article! This article was written by Dr. Ben Geierman, PT, DPT, CSCS, and I think he NAILED IT. You can find him on Instagram @ben_barbellrehab. Without further ado, let's get to Exploring Posture and Deadlifts Through a Pyschological Lens!
It's Like the Common Cold
Low back pain: rumor has it the best way to avoid back pain is typically to simply avoid breathing, eating, and sleeping… aka not be alive. It’s pretty common… so common, that if you don’t experience it at some point in your life, you’re probably a unicorn.
One of my favorite blogs compares low back pain (LBP) to the common cold. Like the common cold, LBP can often come on without any obvious reason and then disappear a few weeks later just as the typical cold so often does.
Now this isn’t to say that all low back pain is harmless
Pain is inherently protective in nature, and as a result, seeking out a qualified health care practitioner to rule out any red flags is always a good idea. However, once serious pathology is ruled out, what is the best route to address the pain experience and attempt to reduce symptoms and resume our valued activities that enrich our everyday lives?
Turns Out...A Lot of Things Work
Without boring everyone with too much research, it’s safe to say there are a lot of things that seem to help with LBP! One popular exercise approach is using motor control exercises. A 2016 Cochrane review on motor control exercises describe them as follows;
"Motor control exercise (MCE) applies principles of motor learning to integrate control and coordination of the spine muscles for functional activities. Exercise is individualised and tailored upon initial assessment of each patient’s individual posture, muscle activation and coordination.
MCE is designed to train muscles that are identified as having poor control (often deep trunk muscles such as multifidus and transversus abdominis) and to reduce the activity of muscles that are overactive (often large external trunk muscles such as rectus abdominis and erector spinae muscles) (Hodges 1996; O’Sullivan 1997).
This intervention progresses from static isolated contraction of deep trunk muscles towards integration of these muscles into simple static activities, then to dynamic tasks and finally functional activities (Costa 2009; Macedo 2012)."
There are a number of flaws to the model of MCE to “correct” motor control “dysfunctions,” but the dissection of this reductionist approach is out of the scope of this blog. For more info, see here.
Typical Core "Stability" Exercises
Traditionally, MCE are the typical core stability exercises. This usually involves one lying down on his/her back and progressively moving towards standing exercises once muscles are “firing correctly.” However, a 2014 systematic review looking at the effectiveness of stability exercises versus general exercise concluded,
"There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion."
This was a bit of a mic drop, as basically all systematic reviews conclude saying something about how we need further evidence…
Which brings us to the mystical deadlift! If you’re reading this blog, it’s probably because you have an interest in strength and conditioning/rehab. Well, lucky for you, you’ve come to just the place for some deadlifting tailored rehab support. Let's talk about posture and deadlifts.
Deadlifts for Low Back Pain
Deadlifts for LBP rehabilitation has gained some solid support in the evidence recently between Berglund 2015 , Aasa 2015 , and Welch 2015.
Now, at this point, I want to emphasize that there are a lot of great exercise options to tackle LBP. For more information about this, check out the article here. But, I’d like to explore why I specifically favor deadlifts over other forms of equally supported “traditional” exercise interventions.
The importance of posture in terms of its role in causing pain has been sufficiently and thoroughly debunked. See here, here, here, here, and here.
Additionally, posture’s significance has mostly risen to power as a societal construct opposed to actual scientific evidence showing “poor” posture leads to pain and injury.
However, I’d like to look at posture through more of a behavioral/social psychology lens. Through this alternative lens, I see posture as more of an intriguing “opportunity” to shape our perceptions about our body and spin the narratives we adopt about ourselves.
Posture Through a Psychological Lens
There is a plethora of scientific evidence to support the notion that postures can influence our feelings and perceptions and vice versa. This should be no surprise, as I’m sure everyone has experienced the tendency to hold “taller” postures during positive and energetic moods and more “closed” postures during gloomy moods (see here). Todd Hargrove writes beautifully about the two way street of posture and mood here.
To begin exploring this connection, consider this except from Niedenthal et al, 2005:
"Wells and Petty (1980) reported that nodding the head (as in agreement) while listening to persuasive messages led to more positive attitudes toward the message content than shaking the head (as in disagreement).
Cacioppo, Priester, and Berntson (1993) observed that novel Chinese ideographs presented during arm flexion (an action associated with approach) were subsequently evaluated more favorably than ideographs presented during arm extension (an action associated with avoidance).
Duclos et al. (1989) led participants to adopt various bodily positions associated non obviously with fear, anger, and sadness and found that these postural states modulated experienced affect.
Strack, Martin, and Stepper (1988) unobtrusively facilitated or inhibited the contraction of the zygomaticus (smiling) muscle by asking participants to hold a pen in their mouth while they evaluated cartoons. Participants judged cartoons to be funnier when smiling was facilitated rather than inhibited (see Stepper & Strack, 1993, for related findings).
Bargh, Chen, and Burrows (1996) showed that participants in whom the elderly stereotype had been primed subsequently walked down a hallway more slowly than did participants in whom the stereotype had not been primed.
Schubert (2004) showed that making a fist influenced men's and women's automatic processing of words related to the concept of power."
Need Any Further Convincing?
These studies give a great overview of the influence postures and movement have on our emotions and perceptions, but for those who are still skeptical of any relationship, here’s another cool one!
Chandler & Shwarz (2009) investigated the associations between a “thumbs up” and a “middle finger” gesture and how the gestures influence assessments.
The authors disguised the intents of their study by framing it as a study on multitasking, and had subjects either extend their middle finger or thumb upward through a motion detector while reading a story about a person named Donald. Sure enough, the subjects extending their middle finger perceived Donald to be more of a jerk, while those extending their thumb thought of him as likeable and smart.
Let's Talk About Power Posing
Now, let’s talk about what is probably the most well known study, where the famous “power posing” idea seen in Grey’s Anatomy came from along with the famous 2012 TedTalk.
In 2010, Dana Carney, Amy Cuddy and Andy Yap conducted a study that found that holding a “high power pose” for one minute increased testosterone levels, decreased cortisol, and increased risk tolerance and feelings of power compared to a “low power pose.”
Another study by Cuddy et al in 2015 looked at the effects of power posing before mock interviews. The participants adopting the higher power pose were rated as more impressive during their interviews and more deserving of the job compared to the lower-power pose group. Now while these findings are quite astonishing, it’s important to acknowledge that not all recent trials have echoed the same results. There is a great commentary on the topic that can be found here.
There is some evidence that the phenomenon is still valid (powerful postures making people feel more powerful), but it is a smaller effect than originally thought and works much better for subjects that are familiar with the proposed benefits; AKA expectations of a positive effect powerfully influence the effects themselves.
Finally, I’d like to discuss one last study, which may be most relevant for my argument. In a study by Bohns & Wiltermuth in 2012, the authors looked to see if different postures (framed as yoga poses) affected pain perceptions in individuals, under the premise that “perceptions of control and self-efficacy have been linked to reduced sensitivity to pain.” They found that participants who adopted ‘dominant’ poses exhibited higher pain thresholds compared to participants in ‘submissive’ or ‘neutral’ poses.
The authors state in their discussion:
"Experiment 1 suggests that power posing may be a useful tool for pain management. Even individuals who do not perceive themselves as having control over their circumstances may benefit from behaving as if they do by adopting power poses."
The Self Perception Theory
Finally, I’d like to make note of the social psychology idea proposed by Daryl Bem known as “self perception theory.” In their 2015 book, The Wisest One in the Room, Gilovich & Ross provide a wonderful description of the topic,
"His (Daryl Bem) self-perception theory holds that when internal cues available through introspection are weak, ambiguous, or absent, we infer the nature and strength of our beliefs and priorities from our actions and the surrounding circumstances."
Essentially, when we lack certainty of how we feel about something, we often look to our actions and environment to assign meaning. I see this as a powerful opportunity to evoke perceptions of strength, robustness, and adaptability into those with LBP by utilizing the powerful postures that accompany deadlifts through self perception theory:
“I’m deadlifting, so my spine must be strong and resilient!”
Build Psychological and Physiological Strength with Deadlifts
In conclusion, deadlifts are a phenomenal movement choice when deciding how to approach LBP. Not only are they well supported in the physical rehabilitation research but also in the psychological literature I’ve presented here.
Additionally, compound movements such as deadlifts can improve overall strength and conditioning and produce a plethora of other health benefits such as reducing the risk of preventable chronic diseases. But the greatest advantage of all is… THEY’RE FUN!
“Flipping the script” per se and increasing self-efficacy and confidence in one’s spine through deadlifts during a vulnerable pain experience (instead of perpetuating fear and malignant beliefs that can potentially exacerbate symptoms over time) is about as good as it gets!
Strength alone won’t prevent LBP, but I’ll take the sequala of Safety In Me Signals (SIMS) produced through a progressively loaded deadlift approach over lying down motor control exercises any day of the week!
- Macedo LG, Saragiotto BT, Yamato TP, Costa LOP, Menezes Costa LC, Ostelo RWJG, Maher C. Motor control exercise for acute non-specific low back pain. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD012085. DOI: 10.1002/14651858.CD012085
- Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskeletal Disorders. 2014;15:416. https://doi.org/10.1186/1471-2474-15-416.
- Lederman E. The fall of the postural-structural-biomechanical model in manual and physical therapies: exemplified by lower back pain. Journal of Bodywork and Movement Therapy 2011;15:131-138.
- Niedenthal, P. M., Barsalou, L. W., Winkielman, P., Krauth-Gruber, S., & Ric, F. (2005). Embodiment in Attitudes, Social Perception, and Emotion. Personality and Social Psychology Review, 9(3), 184–211. https://doi.org/10.1207/s15327957pspr0903_1
- Chandler, J.J., & Schwarz, N. (2009). How extending your middle finger affects your perception of others: Learned movements influence concept accessibility.
- Carney, Dana R., Amy J.C. Cuddy, and Andy J. Yap. "Power Posing: Brief Nonverbal Displays Affect Neuroendocrine Levels and Risk Tolerance." Psychological Science 21, no. 10 (October 2010): 1363–1368.
- Cuddy, A. J. C., Wilmuth, C. A., Yap, A. J., & Carney, D. R. (2015). Preparatory power posing affects nonverbal presence and job interview performance. Journal of Applied Psychology, 100(4), 1286-1295. http://dx.doi.org/10.1037/a0038543
- Bohns, V. K., & Wiltermuth, S. S. (2012). It hurts when I do this (or you do that): Posture and pain tolerance. Journal of Experimental Social Psychology, 48, 341-345.
- Gilovich, T., & Ross, L. (2016). The wisest one in the room: How you can benefit from social psychologys most powerful insights. New York: Free Press.