One article on PainSci cites Nachemson 1981: Don’t Worry About Lifting Technique
PainSci notes on Nachemson 1981:
Alf Nachemson is a legend in back pain research, and unfortunately it also one of the most misinterpreted and abused studies in the history of the field. This diagram from it specifically was widely used to demonize flexion:
Many years later, shortly before his death, Dr. Nachemson expressed his regrets (see The Back Letter):
This experiment has been misinterpreted as evidence that the disc is a significant pain generator and that increasing the biomechanical load leads to greater pain. But this study merely showed how the lumbar spine responds to normal physiologic loading in various positions of the body. It does not give any indication as to where the pain actually comes from.
Also, some key findings were contradicted by later studies (see Wilke).
Also from Nachemson’s interview:
One of the main goals of my career has been to determine the cause of non-specific back pain. And in this I have failed. I didn’t know the origin of back pain in those days, and I don’t know now.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
By measurement of intradiscal pressure in vitro, the hydrostatic properties of the nucleus pulposus of normal lumbar intervertebral disc were proven. The hydrodynamic properties seem to exist also in the somewhat degenerated disc, but not in the more severely deranged ones. Intravitally-performed measurements of disc pressure over the last 20 years in more than 100 individuals have demonstrated how the load on the lumbar disc varies with the position of the subject's body and during the performance of various tasks, both in standing and in sitting. Compared with the pressure of load in the upright standing position, reclining reduces the pressure by 50-80%, while unsupported sitting increases the load by 40%, forward leaning and weight lifting by more than 100%, and the position of forward flexion and rotation by 400%. Large augmentations in pressure were also observed in subject performing various commonly prescribed strengthening exercises.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.