The key messages for lifting and the lower back are:
Before we get into some of the nitty gritty of lifting technique and the lower back I thought it best we start with the key points you should know.
- Your spine is designed to bend and lift.
- Your spine and associated structures have the capacity to adapt to loading and exercise. Therefore It can get better at lifting regardless of technique used
- Technique becomes more important as the objects or tasks get heavier.
- A fitter stronger hip and spine complex is always going to be an advantage.
- Warm up the spine with core type exercises before any lifting activity, especially if you’ve been sitting before hand.
Low back pain and lifting is a common complaint
We are often taught through various authorities that we lift with our legs by bending the knees and keeping our back straight and spine in a neutral posture . This will protect our spine and we can use the stronger muscles in our hips and thighs to perform the task without injuring our back.
Will this ideal neutral posture spare our backs from injury and does flexing or bending our backs when lifting cause injury to our back ? and do we need to do it every time we lift something ?
If you look at a spine it’s pretty clear that this is a structure that is meant to move , bend , twist, extend and a combination of all of these movements. It’s also pretty well known that the body is fantastic at adapting and getting stronger , think about how tendons and muscles adapt, get stronger and bigger when we go to the gym. How we get faster , fitter or better at a sport with training and practice. So its not too far a leap to think that the body and spine can adapt and become more resilient lifting with a flexed spine and it may not be as risky as we are all led to believe.
The case for lifting with a flexed spine
Here is a summary of the points made in this fantastic article written by Greg Lehman “revisiting the spinal flexion debate prepare for doubt“.
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.
- The body adapts to stresses imposed on it. That’s why muscles and tendons get stronger and bigger from lifting weights in the gym. It has been proposed that the spines ability to lift when in a flexed position can be improved with training. We can get better at being “bad”!
- A neutral spine is not a guarantee of being protective of injuries to the lumbar spine. Injuries can occur with the same force regardless of the spine being neutral or flexed. (link here).
- Neutral spines are not as neutral as we think , there is usually some degree of flexion when we lift with a neutral spine. Regardless of attempts to maintain a neutral spine it may actually be impossible to prevent these small flexion movements.
A common sense approach to lifting and your low back
Greg Lehman has a great summary on his thoughts on flexion, posture, lifting and low back pain risk here
I’ll summarize the main points here as we can probably subdivide lifting and a flexed spine into the following 4 scenarios :
- Situations that require lifting lighter weights
- Activities requiring repeated bending
- Pain when bending your back
- Heavy lifting / performance or sport related lifting
1. 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 activities like;
- bending over to tie your shoe
- Making the bed
- Picking clothes off the floor.
- picking up a bag
- sitting , (as a caveat change your position regularly, remember spines love to move).
2.If you have Low back Pain that is made worse with bending or flexion movements.
This may have a disc related component or may just be a lack of flexion tolerance in muscles , ligaments and other soft tissue structures in the lumbar spine.
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 so you can use your hips and strengthen the back muscles in a functional manner.
- Exercise to build resilience and desensitize the lumbar spine to flexion based movements.
- Progress to relevant flexion based activities and learn to load them
A good start is the McGill big 4 exercises , the videos of the birddog and side plank are part of this program. Once you have got this going we can look at progressing to other forms of exercise such as pilates , gym based rehab or more advanced bodyweight exercises.
3. 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. Think about rowing or cycling. 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 get your back stronger and fitter to cope better with the demands of that sport.
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.
Learn to use the hips to generate the movement and the force required to move the object while keeping tension in the supporting spinal muscles, the core !
Here are examples of exercises to help
Check out these exercises here and below
4. Heavy lifting activities: Performance related lifting
This is a different scenario where technique matters, and in the case of competition or performance related lifting technique is king.
Some objects are easier to lift than others e.g heavy barbell versus a boulder so technical alterations are required. However the better the technique the better the result and likely less risk of injury.
The strongmen lifting Atlas stones have perfected their technique for this awkward event. I’d guarantee in training they use the following principles to maximize performance and reduce risk of injury:
- neutral spines
- hip hinging
- braced abdominals to maximize performance and reduce risk of injury.
Advice for lifting in the gym
Technique matters , so don’t sacrifice form for more plates. 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 powerful hip muscles to hip hinge and a braced core in a more efficient fashion to lift.
Develop a strong and effective core using exercises like the McGill big 4 and hip hinge strength.
Before you go lifting in the gym
I’d also 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 ?
- How “fit” you are to lift
But the safest way to lift is to have the fittest and healthiest low back 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.
Ref: http://www.greglehman.ca/blog/2016/01/31/revisiting-the-spinal-flexion-debate-prepare-for-doubt
