🏋️‍♂️ Bending the Truth: Does Lifting with a Rounded Back Really Cause Back Pain?

“Lift with your legs, not your back!”

It’s advice we’ve all heard; plastered across workplace posters, shouted in manual handling courses, echoed by well-meaning clinicians.

The logic seems sound: bending your spine = bad. Keep it straight = safe.

But what if that’s not entirely true?

Let’s take a closer look at what the science actually says about lifting with a flexed (rounded) spine and its link to low back pain.

The truth about bending is often upside down

🔬 The Science: What the 2020 Systematic Review Found

A landmark review by Saraceni et al. (2020), published in the Journal of Orthopaedic & Sports Physical Therapy, asked a bold question:

Does bending your back when lifting increase your risk of low back pain?

Their findings?

👉 No strong evidence supports the idea that lifting with a flexed spine causes or worsens low back pain.

Here’s a breakdown of what they discovered:

• 🧾 Meta-analysis included 12 studies (697 participants).

• 📐 Studies measured spinal movement with sensors and motion capture during real-world lifting tasks.

• 🧪 No significant difference in lumbar spine flexion between people with and without low back pain.

• 🔁 In fact, some studies found people with back pain used less spinal flexion, likely due to fear or previous advice.

The studies were varied in quality, and only one was longitudinal. Still, the consistency of findings is striking.

🤯 Busting the Myth: Why “Bend = Bad” Doesn’t Hold Up

The widespread advice to avoid spinal flexion during lifting often stems from cadaver studies - lab-based research on spinal tissues that aren’t alive.

But here’s the problem:

• 🧟 Dead tissues don’t adapt like living ones.

• 🚫 These studies didn’t measure real-world lifting, or pain experience.

• ⚠️ The advice became dogma, despite a lack of human-based, in vivo evidence.

This has led to unnecessary fear and rigidity in movement which are, ironically, both risk factors for chronic pain.

🧘‍♂️ The Mind-Body Connection: Beliefs Matter

Research shows that fear of movement and negative beliefs about the back are powerful contributors to pain persistence.

When people believe their back is fragile:

• They move less.

• They brace and avoid bending.

• Their nervous system becomes more sensitive.

This fear of movement, known as kinesiophobia, can keep people trapped in pain cycles.

🧰 Practical Takeaways

✅ For the General Public:

• Backs are strong, adaptable structures

• It’s okay to bend your back when lifting

• Lift in a way that is comfortable for you

  
  

✅ For Healthcare Professionals:

• Avoid reinforcing unhelpful beliefs about spinal fragility

• Teach patients to explore movement variability and confidence, not rigid technique

• Encourage safe, graded exposure to spinal flexion as part of rehabilitation

🧵 Let’s Rethink “Safe” Lifting

It’s time to shift the narrative around our spines. They are robust, adaptable and can be trusted to move in a variety of ways.

💡 Stop pretending safe lifting means avoiding bending.

💡 The body thrives on variability.

💡 The spine is built to bend.

Let’s start helping people feel safe to move again.

💬 People with back pain—what have you been told about bending your back?

Join the discussion below.

References

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. The Journal of orthopaedic and sports physical therapy, 50(3), 121–130. https://doi.org/10.2519/jospt.2020.9218