Forward Bending is not so Evil after all!

This study investigated if objectively measured daily time spent forward bending increased the risk of developing or worsening of low back pain (LBP). The researchers looked at over 600 working blue-collar men and women in Denmark over a one-year period and analyzed how much they flexed at work and during their leisure time.

On average people spent roughly 7-8 minutes in forward bent position while at work and 7-8 minutes during their leisure activities.

Conclusion after 1 year of data collection: There was no association between daily duration of forward bending of the trunk and LBP.

Personal comment: I would have never believed this finding 20 years ago after my McKenzie training. However after reading hundreds of papers, I now appreciate that LBP is complex and that there are several risk factors to developing back pain. Contrary to what I used to believe and what most people still believe, bending forward is likely a small factor in developing back pain, if at all.
You may be saying, wait a minute Bahram, many of my patients say that their back pain started when they bent forward to pick up a box or something and they also complain about how painful bending forward is. How can bending forward not be a risk factor to developing low back pain? It obviously is!
Let’s solve that dilemma. We can agree that most patients who sprain their ankle were walking (or running) at the time of their injury. Once they have a sprained ankle, walking is quite painful. We can therefore safely conclude that walking is a risk factor for ankle sprains. PTs must therefore educate their patients to forever limit their walking in their daily life in order to decrease their risk of once again spraining their ankle.

I’m obviously being sarcastic by suggesting patients limit their walking as they may once again injure themselves. However as PTs we are engrained with the notion that we must educate our patients to sit up tall all the time and to avoid flexing their spine forever.

In my clinical practice, I focus on reducing the phobia that some patients have developed regarding forward bending. This is sadly often caused by well-meaning clinicians.

One of my primary manual therapy techniques is flexion Facilitation with Movement (FWM). If it does not peripheralize symptoms, if it does not worsen symptoms, it is OK to flex!

Reference: Lagersted-Olsen J et al Does objectively measured daily duration of forward bending predict development and aggravation of low-back pain? A prospective study. Scand J Work Environ Health. 2016 Jun 1;42(6):528-537.