{"id":16914,"date":"2023-07-11T18:39:50","date_gmt":"2023-07-11T16:39:50","guid":{"rendered":"https:\/\/www.physiotutors.com\/?p=16914"},"modified":"2023-07-11T18:43:46","modified_gmt":"2023-07-11T16:43:46","slug":"lifting-with-a-flexed-lumbar-spine-safe-and-possibly-even-beneficial","status":"publish","type":"post","link":"https:\/\/www.physiotutors.com\/lifting-with-a-flexed-lumbar-spine-safe-and-possibly-even-beneficial\/","title":{"rendered":"Lifting with a flexed lumbar spine &#8211; Safe and possibly even beneficial?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Whether it be in the classroom, clinic, at work, or in the gym, for decades people have argued that lifting with a flexed spine is inherently bad for the health of someone\u2019s back. You\u2019ve seen the pictograms (see below) and models showing what\u2019s supposed to be the safest and best way to lift an object but is that really the case? <\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" width=\"1902\" height=\"953\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2023\/07\/Advice-on-lifting.jpg\" alt=\"Advice on lifting\" class=\"wp-image-16916\" title=\"sadFDSAFS\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">In this blog, we want to take a look at recent research examining this topic.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Prefer watching instead of reading? Then check out our video here:<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Lifting with a Flexed Spine - Harmful or beneficial?!\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/C5nG7G8e8EY?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Spinal flexion in animal models<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most of the research that is used as the argument against lifting with a flexed spine comes from animal models that showed a higher potential of injury and \u201cdegeneration\u201d when loading a spinal segment in a flexed versus neutral position (<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24503692\/\" target=\"_blank\" rel=\"noreferrer noopener\">Wade et al. 2014<\/a>, <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28785999\/\" target=\"_blank\" rel=\"noreferrer noopener\">Wade et al. 2017<\/a>, <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27187053\/\" target=\"_blank\" rel=\"noreferrer noopener\">Berger-Roscher et al. 2017<\/a>). We can argue that these observations don\u2019t translate to a living and breathing human being whose tissues are able to adapt to loads they are exposed to. Also, as discussed in <a href=\"https:\/\/www.physiotutors.com\/6-facts-every-healthcare-professional-needs-to-know-about-lumbar-disc-herniations\/\">another blog article<\/a>, lumbar disc degeneration is an inevitable and normal process of aging and the correlation to pain is poor. <\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Lifting with a flexed lumbar spine &#8211; unavoidable?<\/h2>\n\n\n<div class=\"quote-with-background\" style=\"\">\n    <div class=\"quote-with-background__in\">\n\n        <svg width=\"30px\" height=\"25px\" viewBox=\"0 0 30 25\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\">\n            <g id=\"Design\" stroke=\"none\" stroke-width=\"1\" fill=\"none\" fill-rule=\"evenodd\">\n                <g id=\"08-blog-redesign\" transform=\"translate(-191.000000, -2974.000000)\" fill=\"#7973FF\" fill-rule=\"nonzero\">\n                    <g id=\"Group-7\" transform=\"translate(80.000000, 2893.000000)\">\n                        <g id=\"\u201c\" transform=\"translate(111.000000, 81.000000)\">\n                            <path d=\"M6.4,25 C4.42666667,25 2.86666667,24.3743344 1.72,23.1230032 C0.573333333,21.871672 0,20.2609159 0,18.2907348 C0,17.2790202 0.173333333,16.2539936 0.52,15.215655 C0.866666667,14.1773163 1.49333333,12.513312 2.4,10.2236422 L6.48,0 L12.8,0 L10,12.5399361 C11.9733333,14.0841321 12.96,16.001065 12.96,18.2907348 C12.96,20.2076677 12.3466667,21.8051118 11.12,23.0830671 C9.89333333,24.3610224 8.32,25 6.4,25 Z M23.44,25 C21.4666667,25 19.9066667,24.3743344 18.76,23.1230032 C17.6133333,21.871672 17.04,20.2609159 17.04,18.2907348 C17.04,17.2790202 17.2133333,16.2539936 17.56,15.215655 C17.9066667,14.1773163 18.5333333,12.513312 19.44,10.2236422 L23.52,0 L29.84,0 L27.04,12.5399361 C29.0133333,14.0841321 30,16.001065 30,18.2907348 C30,20.2076677 29.3866667,21.8051118 28.16,23.0830671 C26.9333333,24.3610224 25.36,25 23.44,25 Z\" id=\"Shape\"><\/path>\n                        <\/g>\n                    <\/g>\n                <\/g>\n            <\/g>\n        <\/svg>\n       <div class=\"quote-with-background__content heading-three\">\n            <p class=\"heading-four\">More than 20\u00b0 of lumbar flexion occurs in movements with a straight or neutral spine<\/p>\n       <\/div>\n       <div class=\"quote-with-background__info\">\n                   <\/div>\n    <\/div>\n<!--    <div class=\"quote-with-background__background\">-->\n<!--        <svg width=\"100%\" height=\"100%\" viewBox=\"0 0 849 447\" version=\"1.1\" preserveAspectRatio=none xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\">-->\n<!--            <g id=\"Design\" stroke=\"none\" stroke-width=\"1\" fill=\"none\" fill-rule=\"evenodd\">-->\n<!--                <g id=\"08-blog-redesign\" transform=\"translate(-80.000000, -2893.000000)\" fill=\"#F1F5FD\">-->\n<!--                    <g id=\"Group-7\" transform=\"translate(80.000000, 2893.000000)\">-->\n<!--                        <polygon id=\"Rectangle\" transform=\"translate(424.500000, 223.500000) scale(-1, 1) translate(-424.500000, -223.500000) \" points=\"0 99.703192 849 -4.43831367e-13 849 347.296808 0 447\"><\/polygon>-->\n<!--                    <\/g>-->\n<!--                <\/g>-->\n<!--            <\/g>-->\n<!--        <\/svg>-->\n<!--    <\/div>-->\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Secondly, while the backs in all those pictograms may appear to be straight, research has actually demonstrated that even when we try to perform lifts such as a Deadlift or Good Mornings with seemingly neutral spines, there is a substantial amount of flexion. More than 20\u00b0 of flexion actually (<a href=\"https:\/\/openrepository.aut.ac.nz\/items\/1ebabad0-cd1c-401b-903b-2baf3081cc3e\" target=\"_blank\" rel=\"noreferrer noopener\">Holder 2013<\/a>, <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25653899\/\" target=\"_blank\" rel=\"noreferrer noopener\">Vigotsky et al. 2015<\/a>)<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" width=\"907\" height=\"557\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2023\/07\/image.png\" alt=\"Image\" class=\"wp-image-16917\"\/><figcaption class=\"wp-element-caption\"><a href=\"https:\/\/openrepository.aut.ac.nz\/items\/1ebabad0-cd1c-401b-903b-2baf3081cc3e\" target=\"_blank\" rel=\"noreferrer noopener\">Holder et al. (2013)<\/a><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><br>When we compare that to spinal flexion ranges from in-vitro models that were labeled as injurious (around 15-18\u00b0) then it seems impossible to avoid risking a back injury despite our best efforts to stay neutral during lifting.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Lifting with a flexed spine &#8211; is it beneficial?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Recently, <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33799053\/\" target=\"_blank\" rel=\"noreferrer noopener\">Mawston et al. (2021)<\/a> wondered how differences in lumbar spine postures influence trunk extensor strength, muscle activity, and neuromuscular efficiency during maximal lifting. In their study, they assessed 26 young healthy pain-free subjects. Their task was to generate maximal isometric force from a lifting position in three lumbar postures: extended, mid-range, and flexed as seen in the pictures here.<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" width=\"878\" height=\"374\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2023\/07\/image-1.png\" alt=\"Image 1\" class=\"wp-image-16918\"\/><figcaption class=\"wp-element-caption\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33799053\/\" target=\"_blank\" rel=\"noreferrer noopener\">Mawston et al. (2021)<\/a><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">What they found was that lifting with a flexed lumbar spine resulted in significantly higher trunk extensor muscle moments as well as lower surface EMG activity compared to the extended and mid-range spine postures. Overall, the neuromuscular efficiency was highest in the flexed position, which according to the authors further questions why we are advocating so much against lifting with a flexed spine. <\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" width=\"600\" height=\"414\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2023\/07\/image-2.png\" alt=\"Image 2\" class=\"wp-image-16919\"\/><figcaption class=\"wp-element-caption\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33799053\/\" target=\"_blank\" rel=\"noreferrer noopener\">Mawston et al. (2021)<\/a><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">However, Greg Lehman posted valid criticism about those conclusions on Twitter&nbsp;as comparing measured EMG amplitude across different muscle positions is flawed as this heavily influences EMG accuracy, especially as all trials required maximal effort by the participants, which you\u2019d expect to result in maximal EMG readings.<\/p>\n\n\n<div class=\"cta\" style=\"\">\n    <div class=\"cta__in\">\n        <div class=\"left\">\n            <div class=\"cta__content text-color-light\">\n\t\t\t\t\t\t\t\t\t<h2 class=\"own-size\">Orthopedic Physiotherapy of the Spine<\/h2>\n\t\t\t\t\t                <p>Master Treating the Most Common Spinal Conditions in Just 40 Hours<\/p>\n                                        <div class=\"cta__button\">\n                                <a href=\"https:\/\/study.physiotutors.com\/course\/orthopedic-physiotherapy-of-the-spine\/\" class=\"button button-five\" target=\"_self\">\n                                    Enroll Now                                <\/a>\n                            <\/div>\n                                    <\/div>\n        <\/div>\n                        <div class=\"right\">\n                    <img decoding=\"async\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2023\/01\/Spine-online-course.png\" alt=\"\"\/>\n                <\/div>\n                <\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Mawston and colleagues reason that lifting with a flexed spine improves the length-tension relationship of the erector spinae and benefits from the elasticity of passive structures such as the posterior longitudinal ligament. Increased load on passive structures is often mentioned as an argument against lifting with a flexed lumbar spine as it may result in increased shearing forces and tissue creep. However, the authors reason that judging from the relatively small difference in EMG activity of the upper and lower erector spinae, the reliance on passive structures and risk of shear is most likely minimal.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So does this study add to the evidence that lifting with a flexed spine should not be discouraged and avoided at all costs? Yes, we admit the subjects in the study were young, healthy, and pain-free, and lumbar flexion is often painful in patients with low back pain. But avoiding flexion entirely is thus A) anatomically not possible and B) apparently not efficient either. If spinal flexion hurts then we can modify those symptoms by temporarily moving differently and as always we should gradually build up our tolerance to any repetitive movement giving our body and tissues time to adapt. If you want to get some ideas on how you can reintroduce spinal flexion in patients hesitant to move into flexion, check out the following video<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Graded Exposure Exercises for low back pain\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/WVhWMbEm6_o?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Also, the way we move differs between individuals and is only one piece of the pain puzzle.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Alright, thanks a lot for reading!  <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Andreas<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a id=\"_msocom_1\"><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">References<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27187053\/\" target=\"_blank\" rel=\"noreferrer noopener\">Berger-Roscher, N., Casaroli, G., Rasche, V., Villa, T., Galbusera, F., &amp; Wilke, H. J. (2017). Influence of complex loading conditions on intervertebral disc failure.&nbsp;<em>Spine<\/em>,&nbsp;<em>42<\/em>(2), E78-E85.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/openrepository.aut.ac.nz\/items\/1ebabad0-cd1c-401b-903b-2baf3081cc3e\" target=\"_blank\" rel=\"noreferrer noopener\">Holder, L. (2013).&nbsp;<em>The effect of lumbar posture and pelvis fixation on back extensor torque and paravertebral muscle activation<\/em>&nbsp;(Doctoral dissertation, Auckland University of Technology).<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33799053\/\" target=\"_blank\" rel=\"noreferrer noopener\">Mawston, G., Holder, L., O\u2019Sullivan, P., &amp; Boocock, M. (2021). Flexed lumbar spine postures are associated with greater strength and efficiency than lordotic postures during a maximal lift in pain-free individuals.&nbsp;<em>Gait &amp; Posture<\/em>,&nbsp;<em>86<\/em>, 245-250.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29579012\/\" target=\"_blank\" rel=\"noreferrer noopener\">Schollum, M. L., Wade, K. R., Shan, Z., Robertson, P. A., Thambyah, A., &amp; Broom, N. D. (2018). The influence of concordant complex posture and loading rate on motion segment failure: a mechanical and microstructural investigation.&nbsp;<em>Spine<\/em>,&nbsp;<em>43<\/em>(19), E1116-E1126.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25653899\/\" target=\"_blank\" rel=\"noreferrer noopener\">Vigotsky, A. D., Harper, E. N., Ryan, D. R., &amp; Contreras, B. (2015). Effects of load on good morning kinematics and EMG activity.&nbsp;<em>PeerJ<\/em>,&nbsp;<em>3<\/em>, e708.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24503692\/\" target=\"_blank\" rel=\"noreferrer noopener\">Wade, K. R., Robertson, P. A., Thambyah, A., &amp; Broom, N. D. (2014). How healthy discs herniate: a biomechanical and microstructural study investigating the combined effects of compression rate and flexion.&nbsp;<em>Spine<\/em>,&nbsp;<em>39<\/em>(13), 1018-1028.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28785999\/\" target=\"_blank\" rel=\"noreferrer noopener\">Wade, K. R., Schollum, M. L., Robertson, P. A., Thambyah, A., &amp; Broom, N. D. (2017). A more realistic disc herniation model incorporating compression, flexion and facet-constrained shear: a mechanical and microstructural analysis. Part I: low rate loading.&nbsp;<em>European spine journal<\/em>,&nbsp;<em>26<\/em>, 2616-2628.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":36,"featured_media":16920,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"5136,12036,9910,5108,8188,6444","_relevanssi_noindex_reason":"","footnotes":""},"categories":[195],"tags":[2154,2155,176,177,2156],"tracking_tag":[],"class_list":["post-16914","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lumbar-sij","tag-lifting-technique","tag-lifting-with-lumbar-spinal-flexion","tag-low-back-pain","tag-myth-busting","tag-spinal-flexion"],"acf":{"sections":[{"acf_fc_layout":"featured-related","heading":"Related blog posts","subheading":"","content_editor":"","featured_or_related":"related","posts":null,"button_type":"internal_link","button_label":"","button_style":"button-one","button_internal_link":"","button_anchor":"","button_url":"","button_file":null}]},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Lifting with a flexed lumbar spine - safe and possibly beneficial?<\/title>\n<meta name=\"description\" content=\"For decades healthcare providers have argued that lifting with a flexed lumbar spine is dangerous. 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