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Why Romanian Deadlifts are The Key to Treating Hip & Back Injuries

Written by: Nick Jack
Category: 2014
on 23 April 2021
Hits: 891

Anyone who has read any of my previous articles about injury in the hip or knee region will know how much I emphasise using the Romanian deadlift (RDL) to correct movement dysfunction and muscle imbalance. The deadlift is such a great way to improve hip mobility while simultaneously improving core stability of the spine and gluteal strength of the hip. While the traditional deadlift is a great exercise, the single leg deadlift takes the movement difficulty up a notch or two as the stability and strength with the hip, knee, ankle, and feet are challenged to their full potential. Just like the single leg squat, this exercise demands perfect position for movement, as any deviation from optimal alignment will often see a person fall over to one side. In this article, I will explain exactly why this exercise is so good for treating nasty hip injuries like femoral acetabulum impingement (FAI), and lateral pelvic tilt, but also with back injuries like herniated discs, and SIJ dysfunction. I will also provide you with some excellent progressions to use to further enhance its relevance to sports and daily life. It really is the ultimate lower limb exercise to use in your training and should make up the foundation to build your workouts upon.

Where Did The Romanian Deadlift Come From?

Something I did not know until I did some research was where the name Romanian Deadlift came from. Apparently this was named after the Romanian weightlifter Nicu Vlad, an Olympic medallist in 1984, 1988, and 1996 who was elected to the International Weightlifting Federation Hall of Fame in 2006. During the goodwill games held in the US in 1990 he was conducting a clinic for weightlifters and during this clinic he was doing this exercise that nobody had seen before.

Someone watching asked what the exercise was he was doing. Nicu just shrugged his shoulders and said it was to make his back strong for the clean.  His coach also said the same; it was just a lift that Nicu had developed for his back and clean.  All the lifters were really interested to know more about it and someone asked what this lift was called.  There was a long pause and Nicu and his coach didn’t have a name, so Nicu said, “Let’s call it the Romanian deadlift or RDL for short,” and from that day it was forever known as the Romanian Deadlift or RDL.

While the RDL certainly has origins from Olympic weight lifting, this exercise was also being heavily used by therapists and trainers in the rehabilitation field with hip, back and knee injuries. However, its purpose was not to develop maximal lifting performance, but to improve the function and stability of the hip.

In the rehab field the RDL is often referred to as a hip-hinge as it requires very little knee movement but a large degree of hip movement. Anyone working with lower limb injuries will know how much influence the hips have with these injuries and often tightness with the hip flexors and weakness with the hip extensors is a big part of the problem. The deadlift and in particular the RDL is a perfect remedy for these injuries as it demands hip mobility with strength from the posterior chain. More on this later.

How to Do the Romanian Deadlift

The knee will be flexed about 20 degrees at the bottom of the movement and the tibia must remain vertical during the lift. The objective of this movement is to sit back as far as possible with the hips and maintain a neutral lumbar curve and perfect stability with your body. The most important part here is to maintain the natural curve of the lumbar spine by keeping an anterior tilt of the pelvis. Again critical for anyone who has back pain.

Instructions:

  1. Position the kettlebell on the floor between your legs so that you cannot see your shins in a mirror from the side.
  2. Standing with feet a comfortable width apart. Reach down keeping the natural arch in your low back, and neck tucked and grab the kettlebell maintaining good posture.
  3. Inhale and engage your core before you begin to stand to the top position, exhaling when at the top and gently rolling your shoulder down and scapula apart.
  4. At the top repeat the inhaling process before lowering to the ground.

Now that you know the technique of the RDL, you are almost ready for the single leg version. Before we get to that, how does the RDL compare to the more traditional versions? And why does it work so well with injury?

What Is The Difference With The Romanian Deadlift Versus A Traditional Deadlift?

The two main differences between a Romanian deadlift and a traditional deadlift are:

  1. The Romanian is performed from the top down, and the traditional is performed from the bottom up
  2. The traditional deadlift can lift much greater loads due to the involvement of the knees in the movement.

Both lifts are excellent exercises and neither one is more superior to the other. I will say however, that I prefer to start with the Romanian deadlift first to ensure correct hip mechanics and pelvic positioning before progressing to the serious loads of the traditional deadlifts. When working with injury the Romanian deadlift is the preferred choice as it has several unique elements to the movement that help to align the hip and pelvis. Anyone with knee pain will find this version works well, whereas the traditional version will hurt their knee. More on this later.

If your goal is to add serious strength and muscle, especially to the glutes, traditional deadlifts are the better choice this time. I prefer to use a trap-bar to do the serious lifts as this provides maximal leverage and minimizes the risk of injury. You also need to consider the height of the bar when working with maximal loads and many will need to base up the bar off the floor to ensure they can maintain optimal lumbar spine position. Failure to maintain the neutral position during the deadlift places the discs in the lower back at serious threat of rupturing. Bulging discs are the most common injury in the gym today and many of these can be avoided by learning good form with the deadlift.

Watch the video below for tips on technique regarding the trap-bar deadlift.

I also suggest to read the articles.

How the Deadlift Improves Hip Centration, Stability, & Gluteal Strength

Why does the single leg deadlift work so well with hip, back and knee injury?

With most common hip problems such as femoral acetabulum impingement (FAI) and Piriformis Syndrome, you will find weakness in the posterior muscles of the glutes and the beginning of what is referred to “anterior femoral glide syndrome". This is where the femoral head has moved excessively forward and is overly compressed in the acetabulum, creating the impingement feeling at the front of the hip and a reaction of trigger points in the glutes to try to restore the lost stability.

Take a look at the picture below where the image on the left (a) has the head of the femur right in the middle when you lift your leg. The picture on the right (b) shows how the head of the femur is unable to stay in the centre of the socket when you lift your leg and begins to move forward and eventually pinch the front of the hip. If this impingement is not corrected it will inevitably lead to osteoarthritis of the hip joint.

The RDL and especially the single leg RDL work perfectly with this problem to realign the femoral back deep into the glutes by releasing the hip and strengthening the glutes. The anterior pelvic tilt is essential for this to happen and allow the glutes to generate their full capacity for strength.

This is covered in great detail in the article – Understanding anterior pelvic tilt for restoring hip stability

While the bilateral RDL is a great start to retraining the anterior pelvic tilt, improving hip mobility and gluteal strength, it will have little effect on correcting the weakness permanently. Why? Firstly, it is very rare to find two hips with the identical problem and the single leg exercises expose any compensation and weakness you will not see in the bilateral exercises. Secondly, the bilateral exercise neglects the important role the feet must play in providing stability of the leg and its critical interaction with the hip during the action of walking.

The single leg stance demands significant more stability from the feet as much as the hip and it is these areas that most lower-limb injuries are created.  The muscles of the feet must provide adequate stability to guarantee optimal alignment of the ankle, knee, and hip when we walk. While the bilateral deadlift provides hip extension there is actually two more roles the glutes must perform when we are in single leg stance.

There is three distinct heads of the gluteus medius muscle that perform a unique role as the body moves. They are:

  1. The posterior fibres - These fibres contract at early stance phase to lock the ball into the hip socket. The posterior fibres therefore essentially perform a stabilising or compressing function for the hip joint.
  2. The middle/anterior fibres - These run in a vertical direction, help to initiate hip abduction, this is where the clam comes in which is then completed by a hip flexor muscle known as the TFL. The glutes work in tandem with TFL in stabilising the pelvis on the femur, to prevent the other side dropping down.
  3. The anterior fibres - These allow the femur to internally rotate in relation to the hip joint at mid-to-end stance phase. This is essential for pelvic rotation, so that the opposite side leg can swing forward during gait. The anterior fibres perform this role with TFL.

All single leg stance exercises performs these three key functions and help to stabilize the hip, act as a hip rotator, and lock the head of the femur into the socket, creating a very tight and stable hip joint during gait. This prevents the ball and socket joint from rattling around during walking and running.

Many people will need a series of isolated exercises to activate the glutes and when used in combination with hip mobility it can make the deadlift much easier to execute. You will find a stack of ideas to do this in the FREE checklist you can download below.

What happens when foot stability is lost and how easily can it create a chain reaction of problems that end up at the hip?

In our recent article about lateral pelvic tilt and leg-length discrepancy I discuss in great detail how important it is to use single leg exercises to correct this problem. In the picture below you can see the pelvis drops on one side and this faulty stabilisation pattern is called a Trendelenburg gait. This altered pattern shows weakness on the right glute medius as it is held in a lengthened position with the hips move laterally to the right dropping the pelvis on the left side. The weakness in the glute was most likely started by the feet collapsing.

This is a list of the various things you will see at the pelvis alone from this position.

  • As the pelvis sways sideways the pelvis is higher on the right side
  • The right side is adducted
  • The left hip joint is abducted
  • The right hip abductors are stretched and weakened
  • The left hip abductors and TFL are held in a shortened position

This does not even look at the valgus knee position or collapsed foot and poor Achilles alignment that is created.

What is the correct technique to use for the single leg deadlift? Basically, everything is the same as the bilateral deadlift except you are standing on one leg. Watch the video below from the 2:30 mark to see my explanation of how to do this correctly.

Instructions:

  1. Standing with one foot on a Swiss ball, a comfortable distance apart with body weight or holding dumbbells beside you.
  2. Draw your belly button inwards bend forward from the hips; go as far as you comfortably can keep a natural arch in your low back.
  3. Make sure you keep your shin as vertical as possible.
  4. Return to the top.

I like to use the Swiss ball in the beginning to assist the client in stabilizing. I prefer a Swiss ball over a bench as it provides some assistance but not too much. The ball can move around and the person needs to learn how to control it by improving their core stability and body awareness. The bench provides too much assistance and the person can even use the weight on the back leg to help too much which defeats the purpose of the exercise, which is to build stability and strength to the stance leg.

Why it is Best to Train the Deadlift BEFORE the Squat

During the assessment with clients on their first day I very rarely find a person who will execute a perfect bending posture, even after 10-15 minutes of explaining and helping them. This is consistent with people of all ages and also with injured or non-injured people. The bending movement which in this case is the basic Romanian Deadlift is by far the most difficult movement for people to coordinate and understand. It is no surprise to see the statistics on back pain so high when you see so many people move so poorly, even after being shown the right way.

Statistics show 9 out of 10 adults now experience back pain at some point in their life with only colds and flu beating low back problems for a Doctor visit. See our article – Why having a strong core will not prevent back pain for more on this.

The squat however, most people have a good idea of how to do this and while it may not be perfect it is much simpler for them to comprehend. In Gray Cook’s book called “Movement”, he states several times it is best to train the deadlift first.

He says, “Deadlifting should be the first exercise taught to anyone interested in weight training because it meets all the criteria of a great fundamental exercise. It can be modified, it promotes core stabilization, it demands good posture, it promotes shoulder stability and it forces the hips to be the driving force.”

In addition to this, I have found the squat in many cases is contributing to problems at the hip and the knee. The lack of hip mobility and strength that is found in the deadlift is the missing link to many hip and knee injuries. By avoiding the squat in the early stages of corrective exercise, and spending considerable time developing the skills, stability, and strength with the deadlifting variations instead, helps to correct the muscle and joint imbalances. And eventually this will correct the movement and motor program dysfunction encoded into the nervous system providing people with efficient movement.

As we discussed earlier with FAI and anterior femoral glide the deadlift is the best correction. The squat will continue to drive the femoral head upwards and into the acetabulum if the glutes are not strong enough or mobile enough to centre the femur into the hip socket. This is one of the main reasons I avoid using squats in the beginning if someone cannot deadlift correctly. Once they can demonstrate they can complete a Romanian deadlift correctly I am confident I can introduce squats and even lunges with very little chance of things going wrong.

Unilateral Strength Is Greater With Single Leg Exercises

Another very interesting thing to take not of with regards to single leg deadlifts is their capacity to build much more strength than their bilateral counterpart. This is known as the "bilateral limb deficit phenomenon". This is something that makes no sense for how can a more complex exercise where many things that can go wrong can increase strength more effectively than the simpler bilateral exercise?

The definition of this is as follows.

“When the sum of torque (force) generated by each limb (individually) in the unilateral condition is greater than that generated by both limbs simultaneously (bilateral condition), it is termed the bilateral limb deficit”.  To clarify, this means that the sum of weight lifted by both limbs individually is greater than that of the same weighted exercise done by both limbs simultaneously.

In simple language this means that a person is able to squat more than half of what they can on two legs. We are actually stronger with one foot on the ground than with two if you divide the total weight lifted by two for the bilateral exercise.

Some of the world's leading sport coaches like Mike Boyle have also found this to be true and completely changed their training styles to accommodate this. Here is a quote from Mike Boyle's book "Functional Training for Sports" which features on the front cover (see below) the rear foot elevated split squat.

"Every athlete we train can do the rear-foot-elevated split squat with significantly more than half what they can do in a back squat. In fact when we tested both front squats and rear-foot-elevated split squats, many of our athletes could split squat and front squat with the same weight! I know it seems impossible, but it’s not." - Mike Boyle

What this means for you is that even if you do not have an injury and are looking to add serious strength and muscle the single leg exercise is more likely to produce the best gains. You can read more about this in the article – Why unilateral exercises provide the greatest strength gains

Single Leg Deadlifts Combined with the Posterior Sling and Lateral Slings

Another critical factor to consider with single leg deadlifts is the influence it has over the core. The body really is a complex system made up of many chains known as myofascial slings. These slings, when they are working well, help us move efficiently, produce more force, and create more speed. There is four myofascial slings we need to do this.

The single leg deadlift is an excellent way to improve the efficiency of two of these slings.

  1. The posterior sling.
  2. The lateral sling.

The posterior sling is seen most commonly in the propulsion phase of walking. This is where the glute max of one hip works with the latissimus dorsi of the opposing side to create tension in the lower back region called the thoracolumbar fascia. The action of these muscles along with the fascial system is to prevent rotation of the pelvis when we walk and enable you to store energy to create more efficient movement.

The lateral sling connects the glute medius and glute minimus of the stance leg to the adductors and with the contralateral Quadratus Lumborum (QL). This sling plays a critical role in stabilizing the spine and hip joint in everyday activities like walking up stairs. This has obvious weakness with almost all hip/back pain sufferers and is a big part of the lateral pelvic tilt dysfunction. You can train these slings effectively when you begin to use the upper body in combination with the legs.

Click here to watch a video of all these slings in action. Once you have mastered this you can move to the next phase where you use more complex progressions to integrate the upper body with the legs.

Single Leg Deadlift Progressions to Use

If you have made it this far well done! By now you should feel your legs and glutes are incredibly strong and you are able to complete most leg exercises with ease. It is at this point you can begin to use several complex versions of the single leg deadlift to further enhance your stability and strength. In the video below I provide several versions you can try that incorporate contralateral upper body movement and changes in tempo and equipment.

Do You Need More Help?

If you currently suffer with hip, knee, or back problems you will find our online programs shown below a great resource that take you through all of the assessments and corrective exercises to get you back to full strength and out of pain. The single leg deadlift features prominently in ALL of these programs.

    

Summary

Wow, it is amazing how much influence one single exercise can have over how we move. You can now see why I rate the Romanian Deadlift so highly and in particular the single leg version. Always remember technique is everything and you will need to spend considerable time developing your skills and mobility to handle this efficiently. Many people I work with will struggle to do this at first but over time they improve and when this exercise becomes easier it is incredible to see how much it improves their overall movement.

If I could only do one exercise, this would be it!

For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 200 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily.

If you do need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.

About The Author

Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.

References:

  • Functional Anatomy of the Pelvis and the Sacroiliac Joint - By John Gibbons
  • The Vital Glutes - By John Gibbons
  • Movement - By Gray Cook
  • Corrective Exercise Solutions - by Evan Osar
  • Back Pain Mechanic - by Dr Stuart McGill
  • Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
  • Low Back Disorders - by Dr Stuart McGill
  • Ultimate Back Fitness & Performance - by Dr Stuart McGill
  • Core Stability - by Peak Performance
  • Athletic Body in Balance - by Gray Cook
  • Anatomy Trains - by Thomas Meyers
  • Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
  • Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
  • How To Eat, Move & Be Healthy by Paul Chek
  • Scientific Core Conditioning Correspondence Course - By Paul Chek
  • Advanced Program Design - By Paul Chek
  • Twist Conditioning Sports Strength - By Peter Twist
  • Twist Conditioning Sports Movement - By Peter Twist
  • Functional Training For Sports - By Mike Boyle
  • Athletes Acceleration Speed Training & Game Like Speed - by Lee Taft
  • Knee Injuries In Athletes - by Sports Injury Bulletin
  • The ACL Solution - by Robert G Marx
  • Understanding & Preventing Non-Contact ACL Injuries - American Orthopaedic Society For Sports Medicine