I have been saying and writing for at least 14 years now that your back is not fragile. Most back pain isn’t serious, and has surprisingly little to do with structural problems in spines like degeneration, “slipped” discs, pinched nerves, and so on. Although these things do happen, they are not as common or inevitably painful as most people imagine.1
In spite of the good scientific support I’ve had for this kind of thinking all along, it’s still quite contrarian, still a radical concept for many people (even many professional who should know better by now). So it’s nice that the British Medical Journal has my back with a 2008 review of several years worth of evidence about lifting technique and low back pain.2 The authors came to a strong conclusion:
There is no evidence to support use of advice or training in working techniques … for preventing back pain or consequent disability. The findings challenge current widespread practice of advising workers on correct lifting technique.
I’m happy to see a medical journal publishing such a (previously) unconventional opinion.
The evidence may just mean that training simply didn’t have the desired effect on the behaviour and lifting techniques of workers. Maybe training would have done the trick if workers were trained more effectively? I doubt it.The conventional wisdom about lifting is based on an assumption of fragility that just doesn’t exist in the back.
I think that training people to lift “properly” probably doesn’t work because backs are actually tough as good boots, and what makes backs hurt (or get injured) isn’t influenced all that much — if at all — by how you lift things. The conventional wisdom is based on an assumption of a fragility that just doesn’t exist in the back, so it’s not too surprising that the training doesn’t make much difference: there’s no vulnerability to avoid.
And that’s not the only bogus assumption in this mess.
If lifting heavy things at work leads to back pain, then it would make more sense to be careful about how you do it. If.
As much as I appreciate their conclusions, Martimo et al. begin their paper with a whopper of another unjustified assumption, in the first sentence: “Heavy lifting at work increases the risk of back pain.”
If that assumption isn’t correct, the entire discussion is virtually a moot point, isn’t it? And yet the authors support it with only a single reference to a 1999 paper published in an obscure journal, International Journal of Industrial Ergonomics3 … and that paper supports nothing of the kind. It does not show that “heavy lifting increases the risk of back pain.”4 It’s a bogus citation! I am not making this up.
But that’s now ancient data in any case. Much more recently, a 2010 review concluded it’s “unlikely” that lifting was a cause of back pain in workers.5 A 2012 review found little to no evidence for any connection between back pain stooping over repeatedly or for long periods6 — a different angle on the same problem. Not enough reviews for you? Okay: a 2011 review of eight reviews “did not support” the conventional wisdom either.7
None of this mean that no one will ever hurt their back lifting something at work, but obviously the connections is nowhere near as obvious as everyone assumes. (Even the experts assumed it until quite recent history.) Likely there are major X factors.8
There’s no real smoke around lifting, so there’s probably no back pain fire.
No one lifts more than bodybuilders and powerlifters. And bodybuilders must wear those big thick belts for some reason!9 If it makes sense for them, it must make sense for occupational lifting too. Surely.
Or… maybe not. Major recent reviews of the science have shown that there’s little or no prevention benefit to such belts in the workplace.1011 •sad trombone• Interestingly, even hard braces are amazingly ineffective at reducing the forces on the spine!12 See Spinal Fracture Bracing: My wife’s terrible accident, and a whirlwind tour of the science and biomechanics of her spine brace — fascinating topic.
Supports, braces, and belts mostly just provide some novel sensory input that reinforces the idea of security and stability — a sensation-aided placebo. That is, you don’t just hope that it supports your back, it feels like it does. Unfortunately, this also strongly encourages the insidious idea that backs need stabilizing in the first place. And that’s how you lose The Mind Game in Low Back Pain.
Notice that deadlifts do not look like a “safe” way to lift something heavy with your back. And yet the sport of powerlifting demonstrates that it’s possible to do really stupendous deadlifts regularly without injury. These guys and gals are stooping over and picking up dramatically more weight than anyone is ever going to lift at work.13 For fun. They use their legs a lot, yes, but there’s still plenty of spinal flexion at the beginning of a deadlift — it looks pretty much exactly like how people are not supposed to lift.These guys & gals are stooping over and picking up dramatically more weight than anyone is ever going to lift at work. For fun.
I’m not saying that it’s safe for an untrained person to try to lift massive loads — technique definitely matter when you’re trying to get several hundred pounds off the ground! It’s a completely different thing than schlepping stuff around in a warehouse. But the range of what it’s possible to do surprisingly safely is just huge. If backs were actually prone to injuries when lifting 20-40 kilos with poor technique or training, it’s unlikely that people could ever safely multiply that by ten times, but they do. True, powerlifters are so trained that they’re almost like another species…but they were born with roughly the same anatomy. The point is that backs are naturally sturdy and non-fragile, and powerlifting is a great demonstration of that.
Obviously you can hurt yourself if you are reckless with heavy loads. And obviously technique does not for extreme loads — the kind of loads no one would ever be expected to deal with at work. Strain hard enough and you will get a muscle strain (a tear), or worse. And although disc herniations may be less common and less serious and less related to lifting than people think, that doesn’t mean you want one.
But training for lifting technique is probably not important because heavy lifting itself probably does not actually increase the risk of back pain significantly in the first place — and so there’s no problem to solve with better technique. Doubtless heavy lifting is at least a little bit of a factor in back pain, just not a major one — not the kind of factor that generates a nice clear statistical signal.
Back pain that starts with a lifting trauma probably occurs less than most people think, and isn’t as severe, and when it does occur it probably often seems worse than it is due to the common problem of trigger points in back pain.
I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.
— A couple minor changes to make sure it’s completely clear that the article is not arguing that technique doesn’t matter in powerlifting. It does. This article is about occupational lifting, and powerlifting is raised only for an interesting perspective on that topic.
— Completed major revision and modernization. (After languishing in obscurity for the last eight years — almost never visited by anyone! And forgotten by me.)
To determine how much a back brace really braces, German researchers used “telemeterized” implants — steel fixation rods with meters on them! so cyborgy! — to measure the effect of common braces on spinal forces. This is a good experiment. If you have implants stabilizing your spine internally, measuring the stresses on them directly is a pretty clever way of checking to see if an external brace is doing anything.
Three types of braces were examined: Boston overlap brace, reclination brace, and a lumbotrain harness. Unsurprisingly, they found that “none of the braces studied were able to markedly reduce the loads” on the implants. There was some reduction — just not “marked,” nothing to write home about.
More surprisingly, some of their measurements showed that bracing increased loading on the implants! That does seem possible. The spine is an extraordinarily dynamic structure. Somewhat like slouching into a comfortable chair, a brace may actually cause some sloppiness of spinal function, resulting in “resting” on the fixations, rather than using muscle to support and control the spine. That’s just a guess, but it seems like a reasonable one to me.BACK TO TEXT