Saraceni et al.1 conducted a systematic review published in the Journal of Orthopaedic and Sports Physical Therapy to study if there was a relationship between lumbar spine flexion during lifting and low back pain. They set out to challenge the firmly held proposition that lifting with a flexed lumbar spine has a causative role in lifting-related LBP. Considering that back pain is the leading cause of disability globally; any insight into how one can reduce it’s risk is more than welcomed.
Health care practitioners, workplace health and safety personnel, and every gym bro all vehemently recommend lifting with a neutral back to reduce risk of injury. Is there evidence to justify the conviction this rule is delivered with?
Results
Thirteen papers from 12 independent studies, with 697 total participants were included in the study. One longitudinal and 11 cross-sectional studies were included. There was low-quality evidence of no longitudinal relationship between greater lumbar spine flexion during lifting and low back pain onset or persistence.
“There is no credible in vivo evidence to support the dogma that lumbar spine flexion should be minimized when lifting to prevent LBP onset, persistence, or recurrence.”
This paper concludes that the current body of in vivo (with living people) literature does not support the risk relationship between lumbar flexion and LBP.
Further, this study2 did not support the existence of an increase in disc pressure, compression, or shear strain when lifting with a flexed spine versus a straight. From this review, it appears there is no credible longitudinal or cross-sectional evidence to suggest that a more flexed lumbar spine during lifting is a risk factor for LBP onset or persistence.
2. Dreischarf M, Rohlmann A, Graichen F, Bergmann G, Schmidt H. In vivo loads on a vertebral body replacement during different lifting techniques. J Biomech. 2016;49(6):890-895. doi:10.1016/j.jbiomech.2015.09.034