There is growing evidence that in an occupational setting the way in which we lift an object up does not have an effect on injury outcome for lower back pain.
New in vivo studies have demonstrated little difference in intradiscal pressures and recent MRI studies show us that changes on a scan (including degeneration, disc protrusions etc) can be normal and are common in people with no pain at all.
We know that current forms of manual handling training are ineffective at reducing injury and traditional advice such as bracing the ‘core’ when you lift poses little benefit. The ‘spinal sparing’ model is derived from largely in vitro studies which look often in animal models and dead tissue. It does not translate into the pain experience of a living breathing human.
So how does this translate into performance? Should we worry about the way in which we lift in a performance context?
The answer is likely the dreaded phrase – ‘it depends.’
The study in question has looked at how lifting kinematics differs between certain individuals depending on their natural spinal curvature. What it found was:
Those with increased lumbar lordosis (or a more curved spine) in standing preferred to lift in a stoop style
Those with straighter spines prefer to squat lift
Natural ‘squatters’ adapted more easily to stoop lifting that natural ‘stoopers’ to squat lifting
But what does this all mean? Well, the first thing it means is that all of us move differently and we all have different preferred lifting styles. Trying to blanket our advice to everyone in a work or performance context is likely adding to the problem.
This paper speculates that tailoring lifting styles may help to reduce the onset of ‘potentially dangerous maneuvers’ implying the onset of pain. I think the honest answer to this question from current research is that we aren’t too sure about it leading to injury one way or the other. The weights tested in occupational based studies are relatively low compared to those attempted in a performance or gym environment.
What we do know is pain is complex. There are a multitude of things that can contribute to you experiencing pain. Biological things are part of the picture of course. How much we lift and the load we put through our bodies and whether we exceed capacity is one, but there are other psychological and sociological reasons too.
What we believe about injury and its causes matter, our relationships matter, sleep matters along with a multitude of lifestyle factors. How you lift something is likely only a very small part of the picture.
Another thing we know is that lower back pain injuries in weightlifting are no more prevalence than in any other non-contact sport. Suggesting again that the physical load is part of the picture but not all of it.
Performance also requires certain movements to be stronger than others. If the required outcome of training is to increase explosive power from the posterior chain then the likelihood is that lifting in a more traditional squat position is going to be more beneficial and likely more efficient in terms of technique. It’s worth reminding however that this does not relate to pain or the development of injury.
My advice as a physiotherapist would be:
If you need to train something specific, adopt the position that will help you achieve that most efficiently
Fitness professionals should tailor their advice to each individual regarding spine positions
Don’t overly worry about spinal flexion as long as there are no sudden large changes in position and load. Gradual exposure to loads in new positions is key
Encourage movement variability. Athletes should be made stronger in lots of different positions to reduce injury risk
Avoid negative, nocebic language regarding your back. ‘Glass back’ ‘your back might go’ ‘your discs will slip’…this terminology needs to be gone from work and performance environments.
1. Pavlova, Anastasia & Meakin, Judith & Cooper, Kay & Barr, Rebecca & Aspden, Richard. (2018). Variation in lifting kinematics related to individual intrinsic lumbar curvature: An investigation in healthy adults. BMJ Open Sport & Exercise Medicine.