Lifting technique has long been a much-debated topic when it comes to back pain and injuries. There is a widespread misconception that “wrong” or “bad” lifting technique is harmful to the back and can lead to pain.
This article will try to shed light on four common myths about lifting technique and, hopefully, show that the back is fortunately robust and is in fact able to tolerate a lot.
Myth 1: Lifting with a rounded back puts a higher load on the discs and joints of the spine
It has been assumed that lifting with a rounded back puts a higher load on the discs and joints of the back than lifting with a straight or neutral back. However, more recent research has found no significant difference between the various lifting techniques. There are complex factors that affect the load on the spine during lifting, and the position of the back is not the only deciding factor. (The load on the discs and joints during lifting is influenced by several factors, including anatomy, muscle activity and strength).
Myth 2: Lifting with a rounded back increases pain and damages the discs and joints
Research has shown that there is no clear link between lifting with a rounded back and increased pain or injury.
Several studies have examined the effect of lifting technique training in the workplace on low back pain and injuries at work. The surprising finding was that this training did not reduce the incidence or prevalence of back pain or injuries. This does not mean that you will never experience back pain after lifting something at work, but the link between bending forward to lift something and subsequent back pain is much weaker than previously assumed.
Lifting technique is probably not a significant factor in most back pain or injuries, in most people, most of the time. Even though a lot of back pain occurs during lifting, this still does not mean that the lifting itself was the cause of the pain. All back pain is complex and is influenced by a number of factors. This means that it is not caused by a single, isolated and independent factor, such as HOW you lift something.
Myth 3: Lifting with a rounded back is less efficient than lifting with a “neutral” back
Lifting with a rounded back is not less efficient and can in fact sometimes be even more efficient than lifting with a “neutral” or “straight” back. The back is strong, and when we lift we do so intuitively in a way that makes the back work as efficiently as possible.
Myth 4: You can avoid bending your back when you lift
When the back bends forward we call the movement flexion. It is impossible, and not least very impractical, to avoid flexion during lifts and other loading. It is therefore necessary to prepare the back to tolerate all types of movement and different loads through gradual exposure. That also applies to flexion of the back during lifts!
Being exposed to, and prepared for, flexion of the back under load is both sensible and necessary. However, there are always exceptions, and some people find flexion under load both painful and provocative, and therefore need to avoid it for a period. But this should only be temporary.
So what is the right way to lift?
“Lifting with your legs” has been shown to be no more effective at reducing injury where back pain is concerned than lifting with a rounded back. The human body has an incredible ability to gradually adapt to loads and develop tolerance over time. This means that if you gradually increase the load on the back, it can adapt and become stronger.
Lifting technique can play a role in some back pain in some people, but if that is the case, it is a small and possibly the last contributing factor on a long list of things that may have influenced the pain. For most people who get back pain after lifting, many other factors will have contributed to it over a longer period and to a greater degree, such as age, ability, strength, endurance, rest/recovery, capacity, experience and exposure. All of these factors, and many others, will determine whether or not you experience back pain when you lift.
When it comes to the risk of back pain or injury when lifting, it turns out to matter less how you lift and more whether you are prepared to lift something.
It should also be mentioned that “correct lifting technique” in strength training is not necessarily about injury prevention, but about force production and performance.
The conclusion is: lift with the back and legs you have, it is much more dangerous not to!
Our physiotherapists, chiropractors and manual therapists can help you if you get pain when you lift.
This post is inspired by Adam Meakins.
References:
- How to lift a box that is too large to fit between the knees. Kingma, I. et al. Ergonomics (2010).
- Effect of lifting speed and effort intensity on lower limb muscle activity and trunk kinematics. Kingma. I. et al. Ergonomics (2010).
- Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Cholewicki, J., and McGill, S. M. Clinical Biomechanics (1996).
- From Stopp to Squat: A coprehensive analysis of lumbar loading among different lifting styles. von Arx. M., et al. Front Bioeng Biotechnol (2021).
- Biomechanical basis of stability: an explanation to enhance clinical utility. McGill, S. M., and Cholewicki, J. Journal of Orthopeadic and sports physical therapy (2002).
- Injury prediction in military training. Hrysomalis, C. Journal of science and medicine in sport (2011)
- Proper manual handling techniques to prevent low back pain, a cochrane systematic review. Verbeek. J., H., et al. Work (2012).
- No consensus on causality of spine postures or physical exposure and low back pain: a systematic review of systematic reviews. Swain. C., T., V., et al. J Biomech (2020).
- What low back pain is and why we need to pay attention. Hartvigsen, J., et al. The Lancet (2018).
- Flexed lumbar spine postures are associated with greater strength and efficiency than lordotic postures during a maximal lift in pain-free individuals. Mawston. G., et al. Gait Posture (2021).
- Occupational interventions for the prevention of back pain: Overview of systematic reviews. Sowah. D., et al. J Safety Res (2018).
- To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-analysis. Saraceni. N., et al. J Orthop Sports Phys Ther (2020).
- Simulation of Multifactorial Causes of Low Back Pain. Cholewicki. J,. et al. The Spine Journal (2016).
- Questioning the value of manual material handling training: a scoping and critical literature review. Denis. D., et al. Appl Ergon (2020).
- Manual material handling advice and assistive devices for preventing and treating back pain in workers. Martimo. K., P., et al. Cochrane Database Syst Rev (2007).
- What constitutes effective manual handling training? A systematic review. Clemens. S., A., et al. Occup Med (2010).
- The effect of manual handling training on achieving training transfer, employee’s behaviour change and subsequent reduction of work-related musculoskeletal disorders: a systematic review. Hogan. D., A., M., et al. Ergonomics (2014).
- Current epidemiology of low back pain. Mattiuzzi. C., et al. The Journal of hospital management and health policy (2020).