Should We Change The “Lift With Your Legs, Not Your Back” Advice

Key points

  • Lifting with a flexed spine has been shown to increase force on the spinal discs and repeated bouts can cause disc bulges (“slipped disc”)
  • Lifting with a neutral spine may be beneficial for sports due to this posture being more hip dominant and can help create power
  • But
  • Spinal flexion is mostly unavoidable, especially in some sports and certain activities
  • Spinal disc injuries are not the only cause of lower back pain and lifting in a neutral posture can increase the risk of other injuries
  • Spinal “damage” does not have a good relationship to pain

What is current lifting advice?

Figure one shows the current advice on lifting. The “correct” posture, indicated with a tick” shows a lifting posture that maintains a normal spinal position (“neutral). The second posture is supposedly incorrect, as indicated by a cross, this shows a lifting posture that involves spinal flexion (bending over, using the back to lift and not the legs).

The reason we are told to lift like this is because in this posture the spinal discs are not loaded in such a way that the disc can be injured (although this has been contested). Think of the spinal disc like a jam donut, if you were to compress and squeeze one side of the donut you would cause the jam to be pushed to the other side. If this was done repeatedly (especially with high amounts of compression) you would eventually weaken the bread wall of the donut and the jam would come out. This, in essence, is a discal injury to the spine and can lead to spinal pain and symptoms like sciatic nerve pain (“sciatica”). This has been repeated again and again in laboratory environments and is a well-defined concept.

Additionally, a neutral posture may also be better for sports because the movement is more hip dominant. The figure below shows an elite level Olympic weightlifter performing a lift in a neutral posture.

Should we lift in a flexed posture?

I will start by saying that the case for actively lifting in a flexed posture is weak at best. However, there are some points that should be made that show that flexion is not the root of all lower back evils.

  1. Discs can herniate even in even a neutral posture – High levels of stress on the disk, even in the absence of flexion can lead to disc injuries. Although I would imagine that disc injuries occur MORE OFTEN in flexion postures
  2. A neutral spine does not protect against other injuries – a neutral spine and a high compressive load can lead to a fracture of the vertebral endplate
  3. Spinal flexion is unavoidable – It’s simply a must. Watch any golfer hit a drive, any martial artist, anyone pick up a pencil from the floor. We have to do it and there is some research to suggest that the body adapts to this kind of loading.
  4. Discal pain only causes 2-5% of lower back pain cases
  5. “Spinal damage” does not necessarily lead to pain – I recommend having a reading of the article we published that is titled: Is Your MRI Right?This shows that spinal pain is not necessarily related to MRI findings (such as a disc herniation)

A practitioner’s advice

If you are pain free, I would recommend that if you are doing a job that involves a lot of lifting or perform a sport where it is possible to control your position to lift (such as weightlifting), you should lift in a neutral posture. In activities with little load (such as tying your shoelaces) you should not worry about your back bending.

If you have lower back pain that is worse with flexion then you should avoid flexion where possible temporarily and then reintroduce as you are able with low load activities and stretches. Maintain a neutral spine when lifting.

A final thought is that there is more and more research suggesting that lower back pain is of a “biopsychosocial model” and has less to do with biomechanics (how we move) than we previously thought. Our thoughts and feelings are related to the pain we feel. Do not fear movement, this will only cause it to increase.

There is no bad time to see a professional if you have pain. Here at Joints and Points, we offer private physiotherapy and talking therapy services and a free 20 minute consultation, for those who are struggling with physical or mental health related issues. We do not operate on a waiting list and aim to see you withing 48 hours.

If you need help or advice, our physiotherapists and sports therapist’s at J&P are here to help get you back to health. Contact us to book an appointment, or find out more.

0151 345 6823 – Office Number in[email protected] – Office email

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