Beyond the Neutral Spine: A Narrative Review and Modern Framework for Low Back Injury Prevention in Deadlifting

Traditional deadlift guidelines prioritize maintaining a neutral spine to prevent low back injuries. However, recent evidence questions whether moderate spinal flexion under load is inherently harmful, especially among trained individuals. This article proposes a modern, multifactorial framework for deadlift-related injury prevention that moves beyond rigid postural prescriptions. It integrates biomechanical evidence, load management strategies, movement variability principles, and dynamic trunk control. This narrative review synthesizes literature identified through structured searches of PubMed, Scopus, and Google Scholar, prioritizing peer-reviewed studies examining spinal biomechanics, load management, motor control, and injury epidemiology. Evidence suggests that trained lifters often exhibit natural lumbar flexion without clear prospective evidence of increased injury risk. Abrupt increases in training load appear to be consistently associated with elevated injury incidence, although relationships remain probabilistic and context-dependent. While technical factors, including spinal posture, may influence local tissue loading, current evidence suggests that rapid changes in training exposure and cumulative load management appear to be more consistent predictors of injury risk than isolated deviations from an externally defined "neutral" alignment. Movement variability appears protective, and dynamic trunk control is more functionally relevant than static core strength. A paradigm shift is needed in how deadlifts are coached and programmed. Injury prevention should emphasize progressive loading, adaptive movement strategies, and dynamic stability, rather than rigid technique enforcement. Rather than systematically appraising all available evidence, this review offers an interpretative synthesis to guide modern, evidence-informed coaching and rehabilitation practice.