Don't count on learning a “correct lifting posture” or taking a lifting course to prevent back pain; what to cut is the weight and number of lifts, and exercise regularly

Cost

Free. You no longer have to fuss over whether your back is bent when you lift, and you don't have to spend on back-care classes or back belts. There are two things to do. Split heavy things up, use a cart or get someone to carry with you, which costs only a few more minutes. And set aside time a few times a week to exercise, which has to be kept up long term.

What you get

First, training. The 2011 Cochrane systematic review pooled 9 randomized trials with 20101 employees. In 7 of them, with 19317 people, the result was that those who had lifting training and those who did nothing reported about the same back pain afterward (OR 1.17, 95% CI 0.68–2.02, the plausible range crosses 1). Compared with people who just watched a video, RR 0.93 (0.69–1.25), also about the same. The quality of evidence was moderate. The authors concluded that lifting advice and training, with or without lifting equipment, do not prevent back pain or the disability it causes. Next, bending. A 2020 systematic review pooled studies of how much the back bends when lifting, with low quality of evidence. In the only follow-up study, the maximum angle the back bent when lifting differed by just 1.5 degrees (−0.7 to 3.7) between those who later got back pain and those who didn't, not significant. In 9 of 11 studies, no difference between the two groups was seen. Another 7 studies measured it a different way, and people with back pain actually bent their backs 6.0 degrees less when lifting (−11.2 to −0.9). The authors concluded that there is no evidence that bending the back more brings on back pain. Finally, what to do. One meta-analysis pooled 8 follow-up studies: for every 10 kg of weight per lift, back pain risk OR 1.11 (1.05–1.18, about 11% higher). For every additional 10 lifts a day, OR 1.09 (1.03–1.15, about 9% higher). Another pooled 21 randomized trials with 30850 people. Exercise plus education cut the risk of back pain episodes, RR 0.55 (0.41–0.74, about 45% lower), with moderate quality of evidence. Exercise alone RR 0.65 (0.50–0.86, about 35% lower), with low to very low quality of evidence. Education alone RR 1.03 (0.83–1.27), and back belts RR 1.01 (0.71–1.44); neither showed an effect. The official guidance of the UK Health and Safety Executive (HSE) also states that training alone cannot guarantee safe lifting, and good lifting technique cannot replace providing lifting equipment and improving the task and the load.

Notes

Dispute. On the “lifting heavy, lifting often” side, accounts differ. A 2010 systematic review found 9 high-quality studies, of which 4 saw a link and 5 did not. The authors thought lifting at work is unlikely on its own to cause back pain. So “lift less heavy things” has only association evidence and cannot prove cause. The bending review is of low-quality studies, and most only compared two groups at the same point in time. The training review has a very wide plausible range, and it also says no randomized trial has looked at whether training can treat existing back pain. The HSE still teaches a set of techniques: keep the load close to the waist, set your feet firmly, don't twist your back, don't jerk. Starting the lift with the back, hips and knees all slightly bent is better than bending fully or squatting fully. There is no harm in doing as it says; just don't count on it alone to prevent back pain. The benefit is rated medium because by the size of the reduction exercise could qualify as large, but the evidence for exercise alone is of low quality, exercise plus education also did not show fewer sick days, and back pain is not fatal. For how to exercise, see §2.16 (30–60 minutes of strength training a week) and §2.11 (walk 7000–8000 steps a day). The beneficiary is you.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Verbeek JH, Martimo KP, Karppinen J, Kuijer PP, Viikari-Juntura E, Takala EP. (2011). Manual material handling advice and assistive devices for preventing and treating back pain in workers. Cochrane Database of Systematic Reviews, CD005958. https://doi.org/10.1002/14651858.CD005958.pub3
2. Saraceni N, Kent P, Ng L, Campbell A, Straker L, O'Sullivan P. (2020). To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 50(3), 121–130. https://doi.org/10.2519/jospt.2020.9218
3. Coenen P, Gouttebarge V, van der Burght AS, et al. (2014). The effect of lifting during work on low back pain: a health impact assessment based on a meta-analysis. Occupational and Environmental Medicine, 71(12), 871–877. https://doi.org/10.1136/oemed-2014-102346
4. Steffens D, Maher CG, Pereira LS, et al. (2016). Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Internal Medicine, 176(2), 199–208. https://doi.org/10.1001/jamainternmed.2015.7431
5. Health and Safety Executive. Manual handling at work: Training; Good handling technique. https://www.hse.gov.uk/msd/manual-handling/training.htm
6. https://www.hse.gov.uk/msd/manual-handling/good-handling-technique.htm
7. 反方：Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. (2010). Causal assessment of occupational lifting and low back pain: results of a systematic review. The Spine Journal, 10(6), 554–566. https://doi.org/10.1016/j.spinee.2010.03.033

Translated from the Chinese original. Original book, section 6, tip 29. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer