A 5-minute read…
There is a common and popular belief that you should keep your back straight, stiff, and neutral as Switzerland when you lift things to reduce your risk of back pain and injury, and this is one of the most divisive debates I regularly have with so many people. However, it’s just not true!
Now before you all rush off to the comments section to post some PubMed links of your favourite moustached spine-saving guru’s research… Let me make it as clear as I possibly can, that I’m not saying we don’t have to or should NEVER lift some things, sometimes, with stiff, straight spines.
All I am saying is don’t be fooled into thinking that lifting something with a stiffer, straighter, more neutral spine reduces your risk of back pain or spinal injury. Because it’s just not that simple!
Where’s Your Evidence?
But where’s your proof and evidence for this Adam… I can all hear you all screaming through your laptops and mobile phones. Well, my evidence that lifting with stiffer, straighter spines doesn’t help reduce low back includes hundreds of thousands, if not millions of people over decades who have all been taught to lift things with stiff, straight backs, day in, day out at work.
The evidence I am talking about are the papers looking into the effectiveness, or rather I should say, the ineffectiveness of Workplace Manual Handling Training at reducing the rates of occupational back pain and injury.
So workplace Health and Safety Laws and compulsory Manual Handling Training was introduced in the UK over 50 years ago back in the early 1970s in an effort to protect employees from unfair and unsafe working environments and practices, as well as protect employers from high levels of employee absence and litigation due to workplace injuries. (ref)
These laws stated that all employers had to regularly educate and train all their employees, in both manual and non-manual based jobs on the importance and need for correct posture, workplace ergonomics and safe lifting techniques. This meant all employees are taught to lift anything weighing over 10kg close to the body and with a straight spine to avoid the risk of a back injury.
However, the unfortunate and unconformable facts are that these laws and this training haven’t reduced the incidence or prevalence of back pain or injuries in the workplace (ref). Now there are many questions as to why these workplace manual handling guidelines haven’t reduced rates of back pain or injury in the workplace, such as they weren’t adhered to by employees, or they were conducted properly by employers, or because back pain and injuries are multifactorial and not easily solved by simply asking people to pick things up a certain way.
Either way, the evidence tells us that Manual Handling Training that attempts to teach and train people to lift things with straight, stiff, neutral spines clearly does NOT reduce the risk, or rates of workplace back pain or injury significantly (ref, ref, ref). Yet it still continues on as if it does… this is utter madness… not to mention a day of my life wasted every year working in the NHS!
Burying Dead Bodies
So if keeping our backs stiff and straight when lifting things at work doesn’t significantly reduce our chances of getting back pain, what about when training at the gym? Or at home lifting the laundry basket? Or out in the woods trying to dispose of that pesky dead body you’ve had hanging around for a while? Well, the answer is… we just don’t know as there’s no substantial robust evidence either way.
However, I doubt that lifting technique is a significant factor in most back pains or injuries, in most people, most of the time. Even though a lot of back pain occurs when lifting, it doesn’t mean the lifting was the cause of the back pain. All back pain is complex and multifactorial, meaning it’s never caused by one, sole, isolated, independent factor such as how you lift something (ref).
Yes ok, lifting technique may have a part to play in some back pain, in some people, but if it does, it’s a small part, and usually the last contributing factor in a long list. For most people who hurt their back lifting there will be many other factors that contributed for far longer and far more, things such as their age, ability, strength, endurance, rest, recovery, capacity, capability, confidence, experience, exposure etc. All of these factors and many others determine if someone may or may not get an episode of back pain as they lift something.
When it comes to the risks of back pain and injury when lifting it may not matter that much how you lift things, but rather if you are ready and prepared to lift things, both physically and psychologically.
Lift With Your Back
It could also be argued that the constant advice to only lift with a straight back could be one of the reasons FOR the increasing amounts of back pain in our populations (ref). Constantly telling people to avoid bending, flexing, and twisting their backs under loads, can leave them weakened, deconditioned and under-prepared to tolerate these stress and strains when they inevitably occur in life.
It’s simply impossible, not to mention highly impractical, to avoid spinal flexion under loads and other forces such as shear and compression. It is, therefore, in my opinion, essential to prepare our spines to tolerate these loads and forces with gradual graded exposure to ensure they are robust and resilient.
Our constant advice to constantly avoid spinal movements outside of neutral is, in my opinion, a significant reason for the steady increase in chronic persistent back pain. I think all spines, in all people, need to be exposed to all movements, and all varieties of loads and forces, including spinal flexion when lifting things,
I think being exposed to and prepared for spinal flexion under load is both sensible and very much needed for many. However, as always there are exceptions to every rule, and I will admit that there are some people who find spinal flexion under loads to be painful and provocative and so avoiding this for a period of time to let it settle is sensible.
However, this avoidance should never be permanent, because for me the craziest thing any physio, coach, or trainer can do is ask someone to only do something, like lifting, one way all the time, forever. This would be like asking someone to only eat one type of food forever, drink one type of beer forever, or listen to one physio on the internet forever. This would be both disturbing and depressing and we would never dream of telling people this, so why is it any different with movement and exercises such as lifting.
Conclusion
So I hope you found this short read around lifting interesting, and I hope I have managed to convince or sway you a bit that simply educating, coaching, or telling someone to lift things with a straight back doesn’t automatically reduce their risk of back pain or injury.
So until next time… stay frosty… and remember you can’t go wrong trying to get strong… Now go lift something, those dead bodies ain’t gonna bury themselves!
Adam
I completely and utterly agree. Thank you for your ongoing clear thinking, and refusal to accept the status quo
I find myself agreeing with this post. Rules that are presented as absolutes fail in two ways. The first is that it leaves no room for considering when to deviate from the rule. There is an uncountable number of specific circumstances, many of which may be better served when ignoring the guidelines. It’s better to be prepared for a variety of situations and be able to reason about them than only ever following a rigid rule. The second is that it fails to ignore how inevitable deviation from it is. Any number of factors like exhaustion, being in a hurry or just an unfavourable position to lift from can and will result in ignoring the guidelines. It’s why there’s so many safety features in modern cars, because no amount of traffic laws will prevent all accidents. It’s a kind of thinking that I can only describe as “if everyone would do this thing perfectly, no-one would fail at it”, not a fallacy in itself but it becomes one when you consider the premise impossible.
Despite all efforts I’ve never been capable of keeping a straight back for deadlifts over 100 kg, according to what the ideal form looks like in the literature. But I can do the lift just fine with a bunch more weight and without too much impact on the form. This never hurt my back. In fact I’m quite sure it became much stronger from it which wouldn’t have been possible if I refused to ever break “perfect” form.
It doesn’t go for everything but I think there’s something to be said for paying attention to what feels more natural and comfortable. Slouching over when sitting is another such thing that is always regarded as inherently bad. But when you search for the reasons why, you see the same points parroted everywhere without references, to the point where the repetition itself is being regarded as evidence. These seem to go unquestioned. One argument you’ll see repeated is that it causes nerve impingement, but there seems little evidence for it. A quick search seemed to more readily yield studies that conclude there’s actually no significant relation. If I try to sit upright with what’s considered proper posture during office work, it feels a lot more exhausting and stressful for my back than just relaxing into whatever feels natural.
What strikes me in that discussion from a simple, non- study-trial-academic but common sense perspective: I have seen hundreds of functional MRI scans or f-xrays and have not seen a single lumbar spine “flexing” or “bending”. We flex our hips or not, or bend the thoracic spine nor not. If we bend or flex our backs from the lumbar spine perspective we bring our lumbar spine from lordotic to neutral, not from neutral to flexion. That is just not true. So flexed = relaxed & neutral could hint a more physiologically balanced distribution of load for discs and endplates and facet joints of the lumbar spine. Many of my patients & my own chronic LBP is much more intense “keeping by back straight” when lifting or bending compared to relaxed bending/lifting. Which gives a great chance for cognitive- functional interventions and “change by experience”. Doesn’t say, as you perfectly mentioned, that in some circumstances and for some individuals lifting or loading ” a bit straighter and tighter” can’t be more convenient. Let the hell do people what feels best. Back religions suck….
Yes please, and thank you!