It’s conventional wisdom in the fields of weightlifting, body mechanics, and occupational health that lifting with a flexed spine, or rounded back, is bad. Surveys of health professionals in many different fields show that this is a very widely held belief. Most of these health professionals, as well as the general public assume that lifting with a rounded back is a risk factor for increased low back pain. This opinion is one that has been largely based on 2 things –
While there is certainly good information to consider in those studies, there are several problems with using these studies as evidence to make the claim that lifting with a rounded back is dangerous –
Why Does This Matter?
The implications for these findings are massive for the healthcare community, for professionals who deal with patients or clients with low back pain, and for the average person who is experiencing low back pain! Oftentimes, patients who have low back pain receive education that they should try to lift with a straight back, not a rounded back. Based on the current evidence, this is not justified, and is more likely actually leading to more low back pain. I say this because something that we do know from the research is that there is a massive correlation between fear of movement and low back pain. There is simply no evidence to support the practice of teaching patients to maintain a straight back to improve low back pain or to avoid injury. In addition to this, if you tell someone that they have to keep their back straight no matter what task they are doing, you are most likely creating more fear of movement than anything. There is also the practicality of it all – you just simply have to be able to bend and twist your back to do simple things like get out of bed, put on pants, and pick something up off the floor. The reality is that there is no movement that in and of itself is “bad”, just movements that you may not be ready for yet.
Instead Of Avoiding Lumbar Flexion, TRAIN IT
If lumbar flexion is something that aggravates your back, it’s not because this is a bad movement, or a movement that you need to permanently avoid. In most cases, it simply means you have some structure (muscle, tendon, ligament, joint) that is sensitive to that movement for some reason. If your back is really flared up and sensitive, maybe you do need to avoid bending straight over for some time, but it is important to restore that motion as soon as you can. There are lots of ways to do this. Here is a simple progression for training your tolerance for lumbar flexion.
There are a thousand videos we could put here, and you will likely have some other exercises in between a banded cat/cow and the weighted Jefferson Curl, but this just gives you a couple ideas to start with. Beyond simply needing this motion for normal daily life, there is also new evidence that shows that a flexed spine allows for better force production and efficiency in the low back muscles compared to lifting with a neutral posture, so it’s possible that some flexion in the low back is even ideal for allowing you to lift heavier loads. Later this week, we’ll highlight the Jefferson curl, and the clinical reasoning behind why we use it, and what it is good for.
- Caneiro, J., O’Sullivan, P., Lipp, O. V., Mitchinson, L., Oeveraas, N., Bhalvani, P., Smith, A. (2018). Evaluation of implicit associations between back posture and safety of bending and lifting in people without pain. Scandinavian Journal of Pain, 0(0). doi:10.1515/sjpain-2018-0056
- Coenen P, Gouttebarge V, van der Burght ASAM, et alThe effect of lifting during work on low back pain: a health impact assessment based on a meta-analysisOccupational and Environmental Medicine 2014;71:871-877.
- Dreischarf, M., Rohlmann, A., Graichen, F., Bergmann, G., & Schmidt, H. (2016). In vivo loads on a vertebral body replacement during different lifting techniques. Journal of Biomechanics, 49(6), 890–895. doi:10.1016/j.jbiomech.2015.09.034
- Grant Mawston, Laura Holder, Peter O’Sullivan, Mark Boocock, Flexed lumbar spine postures are associated with greater strength and efficiency than lordotic postures during a maximal lift in pain-free individuals, Gait & Posture, 2021, ISSN 0966-6362, https://doi.org/10.1016/j.gaitpost.2021.02.029.
- Nolan, D., O’Sullivan, K., Stephenson, J., O’Sullivan, P., & Lucock, M. (2018). What do physiotherapists and manual handling advisors consider the safest lifting posture, and do back beliefs influence their choice? Musculoskeletal Science and Practice, 33, 35–40. doi:10.1016/j.msksp.2017.10.010
- Saraceni, N., Kent, P., Ng, L., Campbell, A., Straker, L., & O’Sullivan, P. (2019). 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. Journal of Orthopaedic & Sports Physical Therapy, 1–50. doi:10.2519/jospt.2020.9218