Dear Mark: Back Health and Weight Lifting, Blood Pressure on Primal

Dramatic lighting deadliftFor today’s edition of Dear Mark, I’m answering two reader questions. First, Will wonders whether his brother’s recent back injury from lifting a bag of mortar and his father’s lifelong bout with spinal stenosis following a deadlift injury should inform his exercise choices. Is the deadlift inherently risky? How prevalent is disc degeneration, and what does it mean? Then, Mike is a very active 52 year-old with a history of great blood pressure readings who’s been Primal for four months. At his latest checkup, his blood pressure and heart rate were elevated. Should he worry? What could it mean?

Let’s go:

Dear Mark,

A few weeks ago my brother slipped a disc lifting a bag of mortar (with improper form, obviously). However, he’s 24. He is healthy, fit, and a decorated athlete. So, he visits the doctor and the doctor informs him of the normality of his situation, saying, “90% of people will have at least one deteriorating disc in their back by the time they are 30 years old.”

Furthermore, my father has battled spinal stenosis since college after a deadlifting injury. He just recently had surgery which, while it did improve his mobility, totally took him out of commission for months upon months. On top of that, his exercise routine is now severely and permanently limited.

My question is, are deadlift and squat and other heavily weighted movements like that doing more harm than good?

I am 19 years old. I’m a big guy and I like to stay fit, so I do these types of lifts on a weekly basis. But am I setting myself up for a lifetime of back injury?

Please provide some clarity to me and the other readers. I do not wish to be another statistic.



Your brother’s story is a common one. If someone throws out their back, it’s usually because they lifted something wrong. It doesn’t even have to be anything particularly heavy. I’ve seen people throw out their back lifting a cat, or a jug of water, or a piece of trash. It’s a mix of bad luck, carelessness, and poor technique. So in some respects, that motion—picking stuff off the ground by hinging at the hips—seems inherently risky. If you can hurt yourself lifting a tabby cat, how could deadlifting twice you body weight ever be a good idea?

Well, there are some major differences.

Deadlifts are planned. It’s a formal occasion. You don’t just randomly reach down and grab the bar and lift it up any old way. You set yourself. You activate the musculature along the spine. You arrange your feet underneath the bar just so. You’ve been here a hundred times before. You know what you’re doing and what’s going to happen. Grabbing the cat darting between your legs is a split-second reaction, and that’s where mistakes are more likely to occur.

Bars with 45 pound weights on either end are designed to be lifted from the ground. Most people with two arms and two legs and no serious injuries or limitations can figure out a way to safely lift the bar.

There’s even research suggesting that deadlifts can improve symptoms in patients with low-level back pain, provided their back extensors are sufficiently strong and their pain isn’t too bad.

But I do agree that any exercise with the potential to increase jump height, bone mineral density, and overall beastly strength also carries some risk. So be careful:

Don’t deadlift when you’re tired. Deadlifts become dangerous when you’re fatigued. That’s why you don’t program heavy deadlifts after sprinting on the rower, back squatting for five sets of five, and maxing out your snatch; you’re liable to hurt yourself. Besides, to get the most out the deadlift you should go into it fresh.

Consider deemphasizing the squat. Many experts think heavy back squats are riskier than heavy deadlifts. Gray Cook recommends maintaining the squat and training the deadlift. In my experience, a lot more can go wrong when the heavy bar is on your back than when the bar’s in your hands. And if you still want great leg development, there are worthy alternatives to the back squat. I even went over 9 of them in a previous post. Single leg training (lunges, split squats) can be very effective and much easier on the back.

Back off if you get a funny feeling or premonition about the lift. If something feels “weird” on the last rep, cut the set short and call it a day. If your ego starts asserting itself and you feel like you should do “just one more set,” don’t. Go with your gut, and always err on the side of caution.

If you’re really cautious, have impeccable technique (i.e. you’ve been coached), stay on top of your recovery, don’t do anything overtly stupid (like max out after pulling an all-nighter), and keep your ego in check (the deadlift is a tool to improve your health, not a way to prove your worth), I think the deadlift can be safe. We’re designed for hip hinging, after all.

Lifting is extremely important, but it’s not everything. There are hundreds of other ways to get strong, fit, fast, and—yes—big. Don’t fall prey to barbell dogma.

As for the prevalence of structural damage to the spine, the “90% by age 30” doesn’t appear to be totally accurate but there is some interesting data in asymptomatic populations (people who report having no back pain).

  • 37% of asymptomatic 20 year-olds have disc degeneration. 96% of asymptomatic 80 year-olds have it.
  • 30% of asymptomatic 20 year-olds have bulging discs. 84% of asymptomatic 80 year-olds have it.
  • 29% of asymptomatic 20 year-olds have disc protrusion (a kind of herniated disc). 40% of asymptomatic 80 year-olds have it.
  • 19% of asymptomatic 20 year-olds have annular fissure (a tear in the tissue filling intervertebral space). 29% of asymptomatic 80 year-olds have it.

That’s about a third of otherwise healthy, asymptomatic 20 year-olds with apparently serious spine issues. I mean, degenerated discs? Hernias? Tears, bulges, protrusions? Sounds awful. Interestingly, the authors of the study suggest that many (perhaps most) structural injuries to the spine are incidental to the aging process and may not require or even benefit from therapeutic interventions. In patients complaining about back pain, any disc abnormalities found during the MRI might not even correspond to the site or intensity of the pain. They may present with a bulging disc that looks bad on the monitor but doesn’t actually cause the pain they’re complaining about.

Genetics play a role in one’s susceptibility to disc degeneration, too, so I wouldn’t ignore your father’s back injury history. That may have played a role in your brother’s incident.

I have been following the primal lifestyle now for about 4 months, eating and exercising primally. I am 52 and very active. My carb intake would average 90gms per day and we have no bad fats in the house pantry. I also consume almost no sugars. 6 months ago I had some tests done with the doctor and my blood pressure was 109/65, my resting heart rate was 54, my cholesterol scores were HDL 2.5 LDL 2.1 and Triglicerides 0.3. Today I had my blood pressure taken and was shocked to be told my heart rate was 70 and my blood pressure was 139/85, I must admit I was standing up and had been walking around for about 3 hours on a warm day. My question is can the primal lifestyle cause a massive jump in blood pressure or could it have simply been the circumstances of standing/walking and heat that affected the reading.

Thanks for your advice!


That’s a tough one. If anything, blood pressure tends to be higher in colder weather and lower in hotter weather.

During and immediately after exercise, systolic blood pressure goes up to reflect the increased blood flow and diastolic blood pressure goes down as the arteries dilate. As the day wears on, having exercised usually improves your 24-hour blood pressure. I don’t think this is it, as even if your blood pressure was elevated from the walk, diastolic should have been lower. Are you walking regularly? Regular walking has been shown to modestly reduce 24-hour blood pressure.

So I don’t think it’s the weather or the walking.

You say you’re highly active. Are you eating enough food? If not, you could be overtraining, which is often just another way of saying “undereating.” A common symptom of overtraining is increased sympathetic nervous system activity, which can increase blood pressure and heart rate.

Are you eating enough carbs? You may be one of those people who needs a few more carbs than most, especially if you’re counting fibrous green veggies toward your total carb count. As I’ve mentioned in previous posts, it doesn’t really make sense to count the carbs contained in foods like broccoli, kale, spinach, cabbage, etc. Those foods often take more glucose to digest and metabolize than they provide. No one’s “carbing up” with a big head of cauliflower, and trying to maintain a highly active lifestyle and heavy training schedule on fibrous veggies rarely works out. Try getting 90 grams of carbs from starchy tubers and fruit, if you haven’t been doing that already.

It’s important to keep in mind that a single reading is just a single reading: a snapshot of a physiological state that’s always in flux. You need a series of measurements taken days/weeks apart with everything else staying as constant as possible. Same time of day, same ambient temperature, same emotional status, same activity levels. So whatever you do, don’t look too deeply into this single reading.

That’s it for today, everyone. If you have any advice or input for Mike or Will, help out in the comment section!

Thanks for reading!

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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