It’s believed widely that we have to protect our back while lifting things from the floor and watching our mechanics is part of that. But is one posture for lifting actually safer and protective than another?
Somehow some way, we’ve been told to keep the spine straight, keep the item in front of us, and lift with the knees instead. But where did this idea come from? Isn’t it interesting these suggestions become meme-like and we just basically accept them as fact?
So which one is it? Is it better to round your back with locked knees (aka stoop posture)? With a squat posture with a neutral spine? With a wide-legged stance with knees out?
It depends on who you ask really.
A study interviewed Manual Handling Advisors (MHAs) and Physical Therapists (PTs) on their views on safe lifting postures and back beliefs (Nolan, O’Sullivan, Stephenson, O’Sullivan, Lucock, 2019).
Of these lifting postures, they were asked, ‘Which lift do you consider to be the safest’?
Interestingly enough, the MHAs held a stronger belief that straight back lifting was safer than the PTs did. The MHAs viewed the back as vulnerable, needs to be protected, and back pain is different than pain in other parts of the body. What’s promising is that they believed staying active is important when back pain is experienced but with care. But perhaps ‘being active with care’ reinforces fear, negative illness beliefs, and guarded movement behaviors/rules.
It’s unclear how the ‘being active with care’ message is perceived by patients but it’s important to clearly educate clients with solid information to trust their back. There’s evidence suggesting patient beliefs are highly influenced by practitioner beliefs so we’ve better be careful how and what we tell clients.
Is it possible that, we as therapists, sway our patients’ behavior by telling them one way is better than the other? I’d say so. It’s important to clarify and ensure they understand our lifting suggestions.
People who relate their pain to a structural cause or a pathoanatomical reason tend to have poorer outcomes (Briggs et al, 2010). This is reason enough to suggest that manual handling advisors reflect contemporary evidence that there is no single ‘safe’ loading posture so folks don’t worry they’ll damage their backs by lifting ‘wrong.’
There’s gotta be at least a safer way to lift right?
Well, the load that’s placed on the lumbar vertebra depends on proximity of the object to the person and the weight of the load, rather than the lifting technique.
One study found a small difference in load when comparing stoop and squat lifting in 4 males with vertebral implants measuring sheer and compressive forces in their backs (Dreischarf, Rohlmann, Graichen, Bergmann, Schmidt, 2015).
Lots of studies have found inconclusive evidence on superiority between stoop and squat lifting. It’s because the methods used vary across studies and didn’t control for certain variables such as foot stance, proximity of object to the subject, weight of object, gender, weight location, etc).
But here’s what we can deduce –
- If the load is easy or light to a person, there’s a minimal difference in spinal compression whether a person stoops or squat lifts.
- Having the object closer to one’s body or between the knees is easiest on the spine.
- When a load is too wide, squatting is no better than stooping because the knees get in the way which creates more trunk inclination, therefore more compression. A wide leg stance is tends to be more helpful here because it allows one to get closer to the object.
- If a person has to grab an object from the bottom, there’s no clear winner in lifting technique. They all result in high back loads.
- If a person has lower back pain and flexion is too provocative, then lifting with a neutral spine or in a way to minimize load would be appropriate. But it’s important to elucidate that it’s not because our spine can’t handle the load. The back is just sensitized and requires alternate ways to pick things up in order to dampen down the sensitivity.
Preparation and training helps any type of lift
There’s something to be said about conditioning oneself for a loading task such as lifting something from the ground.
If someone is unaccustomed to an activity or a load, this might influence a person’s tendency towards injury and a painful event, rather than the manner the activity is undertaken or the magnitude of the load (Gabbett and Whitely, 2017).
In other words, someone who lifts things for a living can train for these loads they’re likely to experience at work and make the person feel strong, resilient, and capable at the specific type of loading. In order to challenge the belief of ‘protect your back,’ one can ‘trust your back’ by practicing lifts that are work-specific or important to him/her and get better at it.
So it may not be a matter of protecting your back with a ‘correct’ way to lift, but it can prove beneficial if one trained at a specific type of lifting. I’m confident you can lift things with a rounded back and feel pretty damn strong, fearless, and capable about it if you trained and conditioned yourself.
Here’s an example of a Jefferson Curl exercise which might shock those in the camp of ‘keeping the spine neutral at all times.’
This move can train someone to stoop lift as long as he/she is conditioned to handle the load.
I hope this post was helpful in stretching your thinking about lifting.
- Nolan, D., O’Sullivan, K., Stephenson, J., O’Sullivan, P., Lucock, M. (2019).How do manual handling advisors and physiotherapists construct their back beliefs, and do safe liftng posture beliefs influence them? Musculoskeletal Science and Practice 39:101-106.
Briggs, A.M., Jordan, J.E., Buchbinder, R., Burnett, A.F., O’Sullivan, P.B., Chua, J.Y., Osborne, R.H., Straker, L.M., 2010. Health literacy and beliefs among a community cohort with and without chronic low back pain. Pain 150 (2), 275–283.
Dreischarf, M., Rohlmann, A., Graichen, F., Bergmann, G., Schmidt, H., 2016. In vivo loads on a vertebral body replacement during different lifting techniques. J. Biomech. 49 (6), 890–895.
Gabbett, T.J., Whiteley, R., 2017. Two training-load paradoxes: can we work harder and smarter, can physical preparation and medical Be teammates? Int. J. Sports Physiol. Perform. 12 (Suppl. 2), S2–S50.