The “Laws” of Lifting (and other tips to reduce the risk of low back pain)
We have all heard the saying, “lift with a straight back”, but is this advice any less of an old wives’ tale than the 5-second rule for dropped food, or weeing on a jellyfish sting? Research done by WA physios and academics in 2019 suggests not. The lifting with a straight back message started back in the 1940s but gained weight in the 60s when a Swedish physician named Alf Nachemson took spinal segments and squeezed them in a vice to determine vertebral disc pressure at different angles. Nachemson’s studies were seemingly groundbreaking but failed to take into account one important thing – whether or not his lab studies had any relevance to risk of low back pain in the real world.
The 2019 study called “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”, led by Physiotherapist Nic Saraceni from Curtin University, concluded that bending your back during lifting does not appear to increase risk of low back pain.
Here are some other myths to watch out for which are floating around with weak or no evidence:
Back belts/lumbar supports for prevention in LBP
Ergonomic training sessions on lifting techniques
Shoe inserts/orthoses for prevention of LBP
Regular manipulative treatment for prevention of LBP
So how do we reduce the risk of low back pain when lifting, and what is the best management should it occur. Well, the important thing to remember about lower back pain is that you’re probably going to get it, but it’s how you deal with it that matters. The likelihood that you will experience low back pain at some point in your life is estimated at 60% to 70% in industrialized countries. So be calm if back pain does occur, and see below for the best management techniques.
There are however certain things you can do to lower the risk of injury or minimise the impact. When lifting, as said best by science writer Paul Ingraham: “What matters most is so obvious that it’s hard to get wrong: mostly just keep objects close to the body and balanced, and avoid lifting in awkward postures or when fatigued.”
In general, strength training is the number one method of injury risk reduction, according to science. A regular gradually progressed home or gym strength training program will slowly increase the capacity of your tissues to be able to tolerate more load before an injury occurs. A physio from 4 Life Physiotherapy can help construct a program appropriate for your fitness level.
If you experience lower back pain, the first thing to do is review with a physiotherapist for an assessment to ensure there is no significant structural damage. If all clear, the physio will likely recommend a combination of hands-on therapy, and advice to reduce the load as far as you need to avoid further aggravation, but to continue normal activity to the extent that you are able to tolerate it. This advice is supported by research performed in Finland in 1995 where a study cohort was split into three – one group assigned to bed rest, the second prescribed light back-mobilising exercises, and the final group told to avoid bed rest, not to engage in mobilising exercises, and to continue ordinary activities as tolerated. After 3 and 12 weeks, the patients in the third group had a better recovery than those prescribed either bed rest or exercises. Recovery was slowest among the patients assigned to bed rest.
So remember, keep yourself strong, only lift loads you’re confident with, keep the load close to your body, and most importantly, lift the way you’re most comfortable.
To flex or not to flex – N Saraceni et al.
Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review – K P Martimo et al.
How to prevent low back pain – A K Burton et al.
The treatment of acute low back pain – bed rest, exercises, or ordinary activity? – A Malmivaara et al.