Low back pain and lifting is a common complaint
.We are taught through various authorities that we lift with our legs and keep our back straight and spine in a neutral posture, bit like Switzerland. The idea being in that it protects our spine and we use the stronger muscles in our lower limbs to perform the task without injuring it.
Will this ideal neutral posture spare our backs from injury and does flexing or bending our backs when lifting cause injury to our back ?
The facts seem to not be a solid as we thought and it may be that the answer to how should we lift is : it depends !
To start lets compare the worlds strongest man lifting a 300kg boulder ! to the worlds strongest weightlifter lifting a 200kg bar !
Note the position of their spines through the lifts..
Here’s a slow motion of an The Olympic champion super heavy weightlifter moving 200kg as a comparison
They are very different techniques for the task of lifting. Certainly big Tom Stoltman seems to embrace the flexed spine whereas big Lasha maintains that ideal neutral spine when lifting. So who has the best lifting technique for their low back ?
What the research says regarding spinal posture and low backs and lifting
Here is a summary of the points made in the article “revisiting the spinal flexion debate prepare for doubt” its seems to be a bit of a boxing match of views of scientists. The two combatants in this battle apear to be Rocky “Neutral spine” Balboa versus Clubber ” flexed spine ” Lang. ( I’m a child of the 80’s what can i say !)
In the “neutral spine don’t bend your back when lifting” corner.
Here are the highlighted points for lifting with a neutral spine
There is great research showing that repetitive bending even in a small range, can lead to injury of the lumbar disc.
Lumbar discs have a certain number of flexion cycles available to them before they “fail”. Think of the chair in Ikea that is repeatedly pressed up and down to show how long it is before it crumples beneath you. This number is different between individuals and its probably highly likely that it can be improved upon with appropriate training.
It has been shown that the compressive strength of the spinal segments ,( this includes the disc, soft tissue and vertebra) are stronger in neutral postures (links here)
lifting from low heights needs a degree of flexion at the spine , this can increase low back pain (plenty of research on this but here is one link here)
Repeated lifting and bending on flexed spine postures reduces the strength of ligaments and capsular tissue in the lumbar spine through a process known as creep . However it is not known if this increases the risk of injury to the low back but is suspected to be a factor.
Lifting with a flexed spine creates more of a shearing force in flexed spines than in neutral spines. Anterior shear and cumulative compressive loading is often linked with injury.
there is NO research showing that a flexed spine is stronger in in-vitro studies or epidemiological studies when it comes to injury or pain.
a neutral spine is often associated with a more hip dominant movement strategy which may be beneficial for performance in many activities.
In the ” flexed spines are not the big evil when lifting” corner:
The evidence looking at lifting with a flexed spine
Studies have shown that disc injuries are possible even in a neutral spine suggesting that ideal lifting posture is not the whole story in back injuries and lifting.
a neutral spine is not protective of other injuries to the lumbar spine, e.g injuries to the cartilage on the vertebrae. The forces required are similar for those lifting with a neutral spine and those with a flexed spine.(link here)
Other studies have shown less loading and shear on the spinal segments when lifting in a flexed posture versus a neutral posture (link here)
repeated spinal flexion might be largely unavoidable. Some of the studies cited have shown that disc related injuries occur with flexion within the postural neutral zone.
the body adapts to stresses imposed on it. Its why muscles and tendons get stronger and bigger from lifting weights in the gym. It has been suggested that the spine adapts to flexion forces in a protective and adaptive manner.
A flexed spine during lifting can be both metabolically more efficient and is often associated with greater force output.
Other factors influencing Low back pain and lifting will include:
This will be a variable state and affect our ability to successfully complete or be able to lift a load. The more fatigued we are the greater the risk of injury.
Prior activity to the injurious activity.
If we have been sitting all day in a flexed position there is a a high probability that our soft tissue and muscles are not primed to lift. This is due to a phenomena known as creep. .
Tissue quality or genetics.
Some peoples tissues are stronger than others, that’s a fact of life . if you are lucky in the collagen lottery and have stronger tissue then you may be more more adept at lifting with sub optimal of flexed technique.
The shape of the disc.
Disc shape determines whether it is suitable to accept more compressive forces , the disc tends to be more bean shaped, or a rotational forces, the disc tends to be more oval shaped. So this may influence the ability to tolerate either flexion based lifting with load or better at tolerating rotational forces.
What’s the best advice regarding your low back when lifting ?
Greg Lehman has a great summary on his thoughts on flexion, posture, lifting and low back pain risk here
I’ll summarise it further :
Lumbar flexion and Repeated Low Load Activities
Don’t fear flexion in this case, your back was designed to bend and should cope with these types of activity with ease.
These are things like;
- bending over to tie your shoe
- Making the bed
- Picking clothes off the floor.
Repeated Flexion based activities
Don’t fear flexion.
There are so many sports and activities that involve flexion at your spine under load but have a low incidence of back pain. If your chosen sport or activity hasn’t caused you any issues then I probably wouldn’t worry.
However just as i would with runners or anybody that is active I do recommend that you prehab the area. Getting your spine fitter and healthier to tolerate the compressive and shear forces of daily life will only serve you well and allow you to continue doing what you do to the best of your ability.
Here are examples of exercises to help
Check out these exercises here and below
If you have Flexion Related Low back Pain
More often than not this may have a disc related component. In the acute early stage If it hurts don’t do it , give it time to settle and get back to its happy place. You wouldn’t jump up on down on a newly sprained ankle would you ? ( please tell me you wouldn’t).
If you have longstanding flexion type low back pain then its probably a sensible idea to:
- Rehab “the neutral spine” position
- Learn to hip hinge.
- Exercise to build resilience and desensitize the lumbar spine to flexion based movements.
- Progress to relevant flexion based activities and learn to load them .
Examples of neutral spine hip hinging exercises
Heavy lifting activities
Despite the strongmen we used as examples I’d suggest trying to stay in the neutral posture zone as much as possible to minimize the anterior shear forces at the spine and use the hip hinge and a braced core in a more efficient fashion to lift.
I’d advocate that if you’ve been sitting for long periods of time before lifting in the gym or around the house that you do some core activation exercises to off set any potential soft tissue creep in the discs and ligaments and get the muscle system primed. The Mcgill big four exercises are ideal for this
So really the answer what’s the best way to lift for your low back is:
It depends: on the
- the person
- the situation
- the task to be performed.
- What you have been doing prior to lifting, are you warmed up ?
The key to messages to lifting and the lower back are:
- Your spine is designed to bend and lift.
- Your spine and associated structures have the capacity to adapt to loading and exercise. It will get better at lifting with good or optimal technique as well as less optimal or “bad technique”.
- You need to be specifically strong for the task you want to do and need to do.
- The strongman that lifts the atlas stones will have done 1000’s of lifts over many years to which his spine has adapted to allowing him to lift up to 300kg with relative flexion in his spine.
- The weightlifter will have performed 1000’s of hip hinges in both dynamic and static situations to improve their lifting technique allowing them to lift over 200kg.
- Both will have developed a well conditioned and finely tuned core bracing system and will have perfected their techniques to maximise performance and minimise injury over many years.
- Warm up the spine before any lifting activity, especially if you’ve been sitting before hand.
Have the fittest and healthiest spine that you can.
If you have low back pain or are struggling with low back issues you can book in to see one of our team here
This article is a summary of the piece of work put together by Greg Lehman. For a more in depth look check out this link.