Should We Worry About Lifting Technique?

The importance of ‘lift with your legs, not your back’ in preventing back pain has recently been questioned.  The conventional wisdom is that we mustn’t stoop to lift heavy objects.  Instead, in order to avoid injury we should squat and lift with our legs, not our backs. Paul Ingram, a Physical Therapist from Vancouver, Canada, who specialises in Occupational Health, argues that this advice isn’t just incorrect, but counter-productive. “The truth is undoubtedly in the middle, but decades ago the pendulum of public opinion and ‘common sense’ swung all the way to one side and got suck there; I think it needs a firm (evidence-based) push back towards the centre”. Recent research suggests that the conventional wisdom is a myth. It appears that stooping to lift is not a significant risk factor for back pain, and most people don’t need to be taught how to lift simple, heavy objects ‘properly’.  Essentially the risks of poor lifting technique have been exaggerated.

Your back isn’t fragile and you already know how to lift things:

The ‘bark’ of back pain is often worse than its ‘bite’.  It also has surprisingly little to do with structural problems in the spine like degeneration, ‘slipped’ discs, muscle strains and pinched nerves. Although these things happen, they aren’t as common as most people think.

Back pain is complex. Whether we get back pain or not is influenced by many non-obvious factors such as our general health, stress load, sleep, and diet.

Although we can’t lift heavy objects any old way, we don’t need to be taught either. What matters is keeping the object close to the body. Neither stooping nor squatting has an obvious safety advantage.

The value of trying to change people’s lifting habits has been questioned for some time.  A 2008 review of evidence on lifting technique and low back pain found nothing to support the use of advice, or training, to prevent back pain.

Training people to lift ‘properly’ doesn’t work because backs are tough, robust structures and what makes them hurt isn’t influenced much, if at all, by how you lift. The conventional views on lifting are based on the assumption that the back is a fragile structure, which is simply not the case. It is therefore not surprising that training doesn’t make a lot of difference, as there’s no vulnerability to avoid.

Does heavy lifting increase the risk of back pain? 

A 2010 review concluded that its unlikely lifting was a cause of back pain in workers.

A 2012 review found little to no evidence for any connection between back pain and stooping repeatedly, or for long periods.

A 2011 review of eight reviews did not support conventional wisdom either.

This does not mean that no one will ever hurt their back lifting something at work, but obviously the connection is nowhere near as obvious as everyone assumes.

Does stooping to lift put more load on the spine?

It is almost impossible not to flex your spine when lifting something off the ground, and there is remarkably little difference between spinal load in different lifting techniques. Kingma et al measured the amount of spinal flexion in a straight back lift compared to a stoop lift. When lifting with a stooped lift, the lumbar spine flexed only ten degrees more.

The widely held view is that stooping puts a lot more strain on the spine.

Instrumented vertebral body replacements (VBRs) are high-tech gadgets installed in place of a vertebra. In a 2016 experiment, three patients with VBRs performed various lifting techniques and their implants measured the forces in straight back versus stoop lifts. The difference was negligible! Squatting is the supposedly correct and safe way to lift, but it caused only 4% less load on tissues.

This evidence casts doubt on the value of advice to ‘lift with your legs, not your back’.

A lesson from power lifting:

Deadlifts don’t look like a safe way to lift something heavy with your back. Yet the sport of power lifting demonstrates it is possible to do deadlifts regularly, without any obvious pattern of injury to back pain. These athletes are stooping over and lifting significantly more weight than anyone is ever going to at work.

Remember it is nearly impossible to NOT flex your spine when lifting something off the ground. Deadlifts bear a striking resemblance to how people are not supposed to lift, and yet the sport is amazingly safe. Backs are naturally sturdy and non-fragile, and power lifting is a great demonstration of that.

The evidence is not suggesting it is safe for an untrained person to try and lift huge loads willy nilly. Technique and physical training matters when you’re trying to get 100 kg off the ground! It’s a completely different thing than moving boxes around in a warehouse.

Don’t worry about how you lift…but don’t be a fool either!

Obviously you can hurt yourself if you are reckless with heavy loads. Technique does matter for extreme loads (the kind of loads no one would ever be expected to deal with at work). Strain hard enough and you will get an overload injury of the muscles and soft tissues in your back. But training for lifting technique is not important because lifting probably does not actually increase the risk of back pain significantly.

If you would like to clarify any of these issues related to lifting, please feel free to contact any of our Physiotherapists at Physiotas.

References:

Nolan D, O’Sullivan K, Stephenson J, O’Sullivan P, Lucock M. What do physiotherapists and manual handling advisors consider the safest lifting posture, and do back beliefs influence their choice? Musculoskelet Sci Pract. 2017 Oct;33:35–40.

Hadler NM. Back pain in the workplace. What you lift or how you lift matters far less than whether you lift or when. Spine (Phila Pa 1976). 1997 May;22(9):935–40.

Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational lifting and low back pain: results of a systematic review. Spine J. 2010 Jun;10(6):5

Ribeiro DC, Aldabe D, Abbott JH, Sole G, Milosavljevic S. Dose-response relationship between work-related cumulative postural exposure and low back pain: a systematic review. Ann Occup Hyg. 2012 Jul;56(6):684–96.

Kwon BK, Roffey DM, Bishop PB, Dagenais S, Wai. EK. Systematic review: occupational physical activity and low back pain. Occup Med (Lond). 2011 Dec;61(8):541–8.

Kingma I, Faber GS, van Dieën JH. How to lift a box that is too large to fit between the knees. Ergonomics. 2010 Oct;53(10):1228

About the Author:

Heather Cooper is a Physiotherapist at Physiotas in Launceston.

Heather is a postgraduate APA Musculoskeletal Physiotherapist with a background in Exercise and Sports Science. Her areas of expertise include tendinopathy, shoulders, children’s and adult sports injuries, and Pilates.

As a trained Pilate’s practitioner Heather has a strong focus on exercise based active rehabilitation, assisting clients recover from acute and chronic injuries. Heather instructs some of our weekly Clinical Pilates classes, in addition to the rehabilitation class. Heather has recently completed further training in the management of shoulder injuries, in particularly rotator cuff tears and tendinopathy, as well as tendinopathies of the upper and lower limbs.

Heather enjoys an active lifestyle.  Her favourite activities include running, cycling, bush walking, gardening and yoga.