Understanding Lower Back Pain at Work: Is bending our spines bad for us?

This Backcare Awareness Week our National Clinical Education Lead, Ash James, discusses the impact posture and manual handling can have on our backs and highlights some common misconceptions about best practice.

Understanding Lower Back Pain at Work: Is bending our spines bad for us?

Low back pain (LBP) is common, and according to a series of research papers in the Lancet in 2018, 80% of the world’s population will experience LBP at some point in their life, it is also the leading cause of disability and the number one reason for musculoskeletal work absence in the UK.

As a result, several workplace interventions have been developed largely based on the notion that bending of the spine should be avoided.

Postural Corrections: Avoid flexion in sitting

Most people associate the term posture with an upright sitting position and a belief that sitting in a slouched position is bad for your spine. In keeping with this, a recent study found that the majority of people experiencing LBP thought that an upright sitting position was important.

However, if we ask the question, ‘Does sitting in a certain way cause pain?’, consistent findings in the research would suggest it does not. Two such large reviews, performed ten years apart (2008 and 2019), found no consensus that sitting position was a reason for causing LBP.

Straight Back and Bent Knees; Avoid flexion when lifting

Another common intervention in the workplace is manual handling training. This is frequently based on the idea that bending forward should be avoided. However, the research tells us that manual handling training is ineffective at reducing LBP and work absence. Moreover, recent evidence suggests that that lifting less than 12kg with a flexed spine does not increase the risk of LBP and there was no evidence as to whether or not flexion and lifting over 12kg is associated with LBP or not. Research has also found that people who perform lots of spine flexion under load (e.g., rowing athletes) did not get more LBP later in life, compared to people who only perform usual daily tasks.

We do know however, that there is 3-4% increased risk of developing LBP if you lift 25kg or lift 25 times or more per day when compared to people who do not lift at all at work. This has less to do with the position of the spine and more to do with your individual capacity to tolerate a specific load.

Differentiating between lifting in a way to maximise the performance of a task compared to lifting in a way to prevent injury is an important distinction to make. There is a more efficient way to lift something that seems heavy to you, however there is no evidence to suggest that this is more or less likely to stop you from becoming injured or experience pain.

In summary, it would seem that interventions in the workplace focus on avoiding flexion and this seems to also be viewed as important by people with LBP, however, this is not effective in reducing LBP.  LBP is a combination of biological, psychological and social factors, so it is no surprise that interventions focusing predominantly or only on the biological factors have not been successful. Workplace interventions should incorporate all these factors.

Sitting in any one position for short periods is not the problem, staying in one position for a long time is potentially problematic.

When it comes to lifting, we need to be mindful of our individual lifting capabilities and although there might be a lifting technique that makes moving an object easier it does not seem to be important for the prevention of LBP.

So, going forwards, if you are lifting things below 12kg do not worry about avoiding flexion. If you are lifting something heavy, consider utilising a technique that makes it easier to move, and if some bending of the spine occurs during this, don’t worry! It’s not likely to cause an injury.


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