The basic message:
- It is safe to bend with back pain.
- Lifting and carrying light objects is not injurious to the spine.
- The degree to which you can safely lift heavier objects depends on your general condition, strength, fitness and how much you are accustomed to normally lifting (your lifting fitness).
So, what is all the hoopla about? The concern, the admonition, and warnings you may hear about these activities?
Often patients are advised to avoid bending as a part of a generally strategy to avoid activities that might cause pain. You will “protect” the spine. However, bending is part of the normal range of motion of the spine. Some bending is a necessary activity of the spine, so completely avoiding bending is irrational and counterproductive.
Bending may be uncomfortable when there is stiffness and spasm. Flexion activities should be taken on gradually, starting with slow forward bending in standing or seated positions. Some pain may occur with stretching of the back muscles, but this is normal.
Slowly resume bending and lifting.
Lifting, like bending, is also an activity that should be taken on gradually. It may be aided by performing back extension progressive resistance exercises (see strength training). Most empirical evidence suggests that lifting of moderate weights is not harmful to the spine.
Studies comparing the experiences of identical twins have supported the notion that normal lifting and bending does not cause harm to the spine. Twins may have completely different occupations, one being sedentary and the other involving repetitive lifting but surprisingly their spinal MRI’s were nearly identical.
Most important, bending and lifting must be performed without excessive “fear of movement”. There is also empirical evidence that “kinesiophobia”, or the fear of movement is a cause of back pain. Excessive apprehension can lead to voluntary or involuntary guarding (tensing of back muscles) during the action of a lift. This may cause pain and in some cases back spasm.
There are a few specific scenarios where lifting may pose some risk. The first was noted in Olympic power lifters. These individual engage in supernormal weight lifting as a lifestyle. The second is the repetitive lifting that involves constant twisting. In these cases there appears to be a significant risk of acute (not chronic) back pain attributed to disc herniation.
The third is older individuals with significant spinal osteoporosis. Here there is a significant concern for spinal compression fracture (but not disc injury). But this will reviewed in more detail in a separate section.
- Bending is a natural activity in the range of motion of the spine.
- Lifting of moderate weights is not harmful to the spine.
- Restoring bending as a natural activity should be a goal in recovering from back pain.
- The bending motion is best done in a smooth, gradual, natural fashion.
- Attempting to hold the spine in a rigid or flat position while bending and lifting creates muscle tension that may actually cause back pain. It will not allow you to strengthen your back muscles properly.
- Forward bending requires the elongation of the posterior back muscles and hamstrings.
- Tight hamstrings will actually restrict the ability of the spine to bend.
When lifting you should use common sense and follow the suggestions below:
- Plan ahead before lifting.
- Keep the object in front of you and lift close to the body. This will improve the power of your lift.
- Make sure you have a firm grip on the object.
- Your feet should be a shoulder width apart to provide a solid base.
- Bend your knees using the strengths and power of your legs during the lift.