Evidence that “lifting with your back” is … fine?

For decades, we’ve been warned to “lift with your knees, not your back” — and most people still believe it.

Even physical therapists believe it (in droves), despite plentiful evidence that it’s just not that simple. It might be going too far to say that it’s a “myth” that you shouldn’t lift with your back, but it’s definitely more nuanced than the traditional, one-size-fits-all demonization of stooping.

A new study in the European Journal of Pain emphasizes the nuances, and adds to the case that stooping probably isn’t much of a problem. But it goes even further: the results actually imply that lifting with your back can be a good thing. Because, clearly, “it depends.”

The hazard of “lifting with your back” is gospel — but it has probably been exaggerated quite a bit.

Au et al. in Australia followed five people with chronic low back pain triggered by lifting. Over four months, they tracked every bend and grunt with wearable motion sensors, while the participants went through several sessions of Cognitive Functional Therapy (CFT), which I have written plenty about lately. But this was not a test of CFT; the point was just to use a prominent feature of CFT — encouraging people to move more freely and bravely, despite the pain — to study how changes in movement and lifting technique related to their back pain.

And the participants tended to feel better — less pain, less functional limitation — when they shifted away from the textbook “safe” squat lift and towards quicker, looser, stoopier techniques. On a spectrum of technique from the squattiest of squats to the stoopiest of stoops, some of them moved stoopward and felt better. They didn’t all move that way, and they didn’t all improve, but the goal was not to show that stooping was curative or therapeutic, but rather just that it’s not an inevitable disaster for their lifting-related back pain. The authors write:

“Contrary to conventional clinical and ergonomic advice promoting ‘safe’ squat lifting techniques, our findings suggest… stoop-like lifting often corresponds with reductions in pain and functional limitation.”

This is a little more evidence-based rebellion against the conventional wisdom. With only five subjects, it’s obviously not a lot to go on. As the authors caution, “within-person changes in lifting technique varied among individuals.” Some improvements began during the baseline phase, possibly just from practicing the lifts every week. But, as far as it goes, the experiment does reinforce the claim that lifting safely is more about confidence and adaptability than rigid posture rules. It also highlights how little science exists to support the “don’t lift with your back” mantra.

A conflict-of-interest note: co-author Peter O’Sullivan disclosed that he receives honoraria for teaching CFT workshops.

Next? Read my full review of this topic: Don’t Worry About Lifting Technique: The importance of “lift with your legs, not your back” to prevent back pain and injury has been exaggerated.