Have you had back pain for a while? Is it worse after lifting? Are you under the impression that you should keep your back straight and brace your ”core” when you lift”?
Well, you might want to think again.
It’s almost part of our culture that you should “keep your back straight” when you lift. However, it’s important to update culture and ask: what’s the evidence for this advice? Well, you may find it surprising, but the evidence for this advice is surprisingly poor.
Traditional advice to keep the beck straight was based on the theory that disc injury could explain back pain and that a straight back was safest for the discs. However, contemporary evidence calls this into question on two fronts. Firstly, back pain cannot be explained by injury to discs, especially when pain persists; and secondly, modelling data of the spine is contradictory in nature, its not clear that any spinal posture is protective of back pain when lifting.
Evidence has shown that people with back pain move and lift differently than those without pain. They move slower, bend the back less and typically have increased muscle activity around the trunk. Traditionally, this cautions way of moving has been viewed as a result of spinal damage, an adaptive change, which should be encouraged.
Contemporary research has challenged this theory. We now view this cautious way of moving as part of the problem, over protection. Its been shown that those who fear lifting and think it’s dangerous bend the back less and have more muscle guarding when lifting – and the more fear, the less the bend. So, beliefs about a movement influence the movement itself. Or to put it another way, movement is, in part, a behaviour influenced by beliefs.
When the movement behaviour we express places more stress on the spine, this can lead to a viscous cycle of pain. This is a common pattern I see, people trapped in movement patterns that exacerbate the pain. Treatment can be remarkably simple: after a thorough assessment addressing all aspects of your pain and how you make sense of it, it often comes down to giving you new strategies to lift, and confidence that lifting and bending is safe and that your spine is robust.
So, if you’re stuck with back pain when you lift, and you are following advise to keep the back straight and brace when you lift, then I would suggest you get an assessment from a skilled physiotherapist. Ring the clinic to make an appointment or for further information.
David Nolan, Clinical Specialist in Occupational HealthShare