Are there differences in lifting technique between those with and without low back pain? A systematic review

Abstract

Background and aimsTo systemically review the literature to compare freestyle lifting technique, by muscle activity and kinematics, between people with and without low back pain (LBP).MethodsFive databases were searched along with manual searches of retrieved articles by a single reviewer. Studies were included if they compared a freestyle lifting activity between participants with and without LBP. Data were extracted by two reviewers, and studies were appraised using the CASP tool for case-control studies.ResultsNine studies were eligible. Heterogeneity did not allow for meta-analysis. Most studies (n = 8 studies) reported that people with LBP lift differently to pain-free controls. Specifically, people with LBP lift more slowly (n = 6 studies), use their legs more than their back especially when initiating lifting (n = 3 studies), and jerk less during lifting (n = 1 studies). Furthermore, the four larger studies involving people with more severe LBP also showed that people with LBP lift with less spinal range of motion and greater trunk muscle activity for a longer period.ConclusionsPeople with LBP move slower, stiffer, and with a deeper knee bend than pain-free people during freestyle lifting tasks. Interestingly, such a lifting style mirrors how people, with and without LBP, are often told how to lift during manual handling training. The cross-sectional nature of the comparisons does not allow for causation to be determined.ImplicationsThe changes described may show embodiment of cautious movement, and the drive to protect the back. There may be value in exploring whether adopting a lifting style closer to that of pain-free people could help reduce LBP.

Impact of load expectations on neuromuscular and postural strategies during a freestyle lifting task in individuals with and without chronic low back pain

“…minimizing effort and energetic cost) over others. Pain, fatigue and possible de-conditioning probably had limited impact on our results, compared to the results published by Rudy et al A recent systematic review exploring the differences in kinematics and muscle activity of the trunk and lower limbs in people with and without LBP during freestyle lifting tasks showed that individuals with LBP move differently than healthy individuals [ 40 ]. However, the review showed several inconsistencies across studies and trends toward greater changes in strategies in individuals who present more severe LBP.…”

Changes in physiotherapy students’ beliefs and attitudes about low back pain through pre-registration training

“…• Biomechanical studies do not consistently support that lifting with a straight back is better [46,47] • Epidemiological studies do not support flexion as an independent risk factor for LBP disability [48] • Manual handling training (doing less flexion) has no effect on LBP [51,52] • Patients with LBP move with a more rigid spine (less flexion and more muscle activity) [53][54][55] • Psychological factors are associated with a more rigid movement [16] There is right and wrong ways to move…”

“…• Movement is very variable and there is no right or wrong way to move [54,58,59] • Confidence to move seems more important than how you move [13] • If a movement is painful, you can temporarily adapt it. But in the long term, all movements should be promoted and trained (improving tolerance) [60] The back is vulnerable and needs to be protected • Loading has positive effects on the back [61,62] • Disuse has negative effects on the back [63] • The back can positively adapt to load [64] Bad postures (particularly slumped postures) cause back pain • There is no right or wrong posture [65,66] • Posture is very variable [67] • Lumbar spine posture is not an independent risk factor for LBP [68] • Patients with LBP often show a hyperactivity of trunk muscles [55,69] Core stabilisation exercises are important to treat LBP • Patients with LBP move with a more rigid spine (and naturally adopt more "neutral" postures) [53] • There is no association between transversus abdominus or lumbar multifidus activation and clinical outcomes [70,71] • Stabilisation exercises are not more effective than other types of exercises [72,73] • The idea that the back needs to be stabilized may elevate fear avoidance beliefs [11,72] Important factors that need to be modified during physiotherapy treatment are muscle strength and mobility (physical factors)…”

Movement, posture and low back pain. How do they relate? A replicated single‐case design in 12 people with persistent, disabling low back pain

“…Cross-sectional data demonstrates that, on average, people with back pain move their back slower, with less range of motion (ROM), and increased activity of their lumbar extensor muscles at maximum voluntary flexion (absence of the flexion-relaxation phenomenon; Watson, Booker, Main, & Chen, 1997) compared to people without back pain (Geisser et al, 2005;Gizzi, Röhrle, Petzke, & Falla, 2019;Laird, Gilbert, Kent, & Keating, 2014;Nolan, O'Sullivan, Newton, Singh, & Smith Benjamin, 2019). For posture, however, there does not appear to be a clear difference in standing lumbar lordosis angle or pelvic tilt angle between people with and without LBP (Laird et al, 2014) and differences in lumbar sitting posture or muscle activity were only found between people with and without LBP when types of LBP were subgrouped (Astfalck et al, 2010;Dankaerts, O'Sullivan, Burnett, & Straker, 2006).…”