Traditional advice to keep a straight back while lifting has been further challenged by new Curtin-led research that found no link between lumbar flexion while lifting and lower back pain, either in people who had a history of back pain or those that did not.
With nearly half (46%) of Australian nursing assistants reporting hurting themselves while lifting, moving, or helping a patient, and 50% of nursing staff considering leaving the job due to the physical stress and injury involved, the findings have key implications for the health industry.
Lead author Curtin PhD student Mr Nic Saraceni, a Lecturer from the Curtin School of Allied Health and physiotherapist with some 12 years’ experience, said that lifting remains a major risk factor for lower back pain and there is a widely held belief that lifting with a more rounded or flexed lumbar spine is incorrect and should be avoided.
“The advice to avoid flexing the lumbar spine is promoted globally in occupational health by gym instructors and health care practitioners,” Mr Saraceni said.
“But recent literature reviews have questioned this, finding no high-quality evidence to support the current advice. Our study further challenges the current advice – what you often see in people with lower back pain is that they are doing exactly what they should be.”
According to AIHW, in 2019 back pain and associated problems were the third leading cause of disease burden for both males and females – one in six Australians had back problems, with related pain impacting daily activities for 38% of those affected.
“So, when you see them in clinic as a physio, 99 times out of 100, they’re scared of lifting, worried about bending and lifting because they’re in pain, yet essentially following the exact advice to a tee. It’s really across the board,” Mr Saraceni said.
These repeated clinical observations, reinforced by experiences from treatment (where people have benefited from not using ‘correct’ procedure) led the team to question the common guidelines.
“If you’re seeing people follow all the advice and they’re in extreme pain, it makes you think, well, maybe that advice isn’t right for everyone at least,” Mr Saraceni said.
“So we went back and thought, where did this advice come from?
“And essentially, the advice comes from cadaveric studies in the eighties and nineties, which was conducted in a lab using pig’s bones and impressions – there’s no human data to support that,” he explained.
“So we studied people who had been in manual industry, people who lift over a hundred times a day and had done so for many years, and tried to see if they were following that advice: are these people lifting really carefully and cautiously, are these people really strong?
“We looked at a whole range of biomechanical factors.”
Participants included workers who had been in manual employment for at least five years either with or without a history of lower back pain.
Intra-lumbar flexion was measured as workers performed 100 lifts from the floor (25 with an empty box and 75 with a box weighing 10% of body weight), with levels of pain reported after every 10 lifts, so that the relationship between lumbar flexion and change in pain intensity could be explored.
“And what we found is they’re not doing any of the things that we think they’re doing: compared to the people in pain, they were bending their knees less, they were twisting to lift, they were flexing their spine nearly at the end of the range of flexion,” Mr Saraceni said.
In fact, the clinical team found no in-vivo evidence for the common advice and training to minimise lumbar flexion during lifting to prevent or manage lower back pain.
“We think that there’s more important risk factors than just how you lift,” Mr Saraceni said.
“Our studies then went on to look at what other factors might be important and what we’re starting to see is that it’s quite individualised.”
The team observed three key factors common to people with a history of lower back pain associated with lifting: they tended to report pain in other areas, including headaches, neck pain, and knee pain; they exhibited comparatively poor sleep; and were more fatigued.
“All that training and advice makes biomechanical sense, but it’s more about load minimization, being trained and accustomed, being strong and fit, and looking after your whole health,” Mr Saraceni said.
“That’s the way that I think guidelines should be going down, and that’s what our future research is going to be doing to see if we can prevent these back pain flare ups.”