Is lumbar spine flexion during lifting a risk factor for the development or recurrence of low back pain (LBP)?

This systematic review based on 11 papers concludes that…

“There was low quality evidence that greater lumbar spine flexion during lifting was not a risk factor for LBP onset/persistence, nor a differentiator of people with and without LBP.” (Saraceni et al 2019)

We simply need to get over our phobia of lumbar flexion. We certainly need to stop passing on our unjustified phobia of flexion to vulnerable patients. Flexion is a functional and fundamental movement of any body part including the spine.

It is NOT dangerous to flex the lumbar spine, as it is not dangerous to flex the hips, the elbows or the fingers.

Sure it is true that people often injure themselves while bending or lifting. Of course flexing is also often painful in those who have low back pain but that does not mean that lumbar flexion is “bad”.  It just means that some individuals with LBP are sensitized into flexion. Perhaps instead of avoiding it like the plague they need to repeat it more often without fear and gradually load the flexion by lifting heavier and heavier weights.

The most reasonable explanation for low back injuries related to lifting is that the load lifted has simply exceeded the spine’s loading capacity. So instead of avoiding lifting, it would be beneficial to regularly and optimally load the spine in order increase its lifting tolerance.

Go ahead, smile, bend forward and lift a reasonably heavy box and be assured that it is actually strengthening your spine and not damaging it. When we frequently lift tolerable heavy loads we in fact reduce our chances of injury in the future.

DISCLAIMER NOTE: I am not responsible if you injure yourself moving a piano or a fridge if you have not prepared your body to tolerate lifting heavy loads.  It takes years of training and, of course, good genes to be able to do that stuff!

Reference: Saraceni N et al To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-Analysis. J Orthop Sports Phys Ther. 2019 Nov 28:1-50.
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