Are there differences in lifting technique between those with and without low back pain? A systematic review

David Nolan 1 , Kieran O’Sullivan 2 , 3 , 4 , Chris Newton 5 , 6 , Gurpreet Singh 5  and Benjamin E. Smith 6 , 7
  • 1 Sheffield Teaching Hospitals NHS Foundation Trust, PhysioWorks, Firth Park Clinic, North Quadrant, Sheffield, UK
  • 2 Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  • 3 School of Allied Health, University of Limerick, Limerick, Ireland
  • 4 Health Research Institute, University of Limerick, Limerick, Ireland
  • 5 Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester, UK
  • 6 Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
  • 7 University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
David Nolan
  • Corresponding author
  • Sheffield Teaching Hospitals NHS Foundation Trust, PhysioWorks, Firth Park Clinic, North Quadrant, Sheffield, UK
  • Email
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, Kieran O’Sullivan
  • Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  • School of Allied Health, University of Limerick, Limerick, Ireland
  • Health Research Institute, University of Limerick, Limerick, Ireland
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, Chris Newton
  • Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester, UK
  • Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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  • degruyter.comGoogle Scholar
, Gurpreet Singh
  • Physiotherapy Department, University Hospitals of Leicester NHS Trust, Leicester, UK
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  • degruyter.comGoogle Scholar
and Benjamin E. Smith
  • Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
  • University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
  • Search for other articles:
  • degruyter.comGoogle Scholar

Abstract

Background and aims

To systemically review the literature to compare freestyle lifting technique, by muscle activity and kinematics, between people with and without low back pain (LBP).

Methods

Five databases were searched along with manual searches of retrieved articles by a single reviewer. Studies were included if they compared a freestyle lifting activity between participants with and without LBP. Data were extracted by two reviewers, and studies were appraised using the CASP tool for case-control studies.

Results

Nine studies were eligible. Heterogeneity did not allow for meta-analysis. Most studies (n = 8 studies) reported that people with LBP lift differently to pain-free controls. Specifically, people with LBP lift more slowly (n = 6 studies), use their legs more than their back especially when initiating lifting (n = 3 studies), and jerk less during lifting (n = 1 studies). Furthermore, the four larger studies involving people with more severe LBP also showed that people with LBP lift with less spinal range of motion and greater trunk muscle activity for a longer period.

Conclusions

People with LBP move slower, stiffer, and with a deeper knee bend than pain-free people during freestyle lifting tasks. Interestingly, such a lifting style mirrors how people, with and without LBP, are often told how to lift during manual handling training. The cross-sectional nature of the comparisons does not allow for causation to be determined.

Implications

The changes described may show embodiment of cautious movement, and the drive to protect the back. There may be value in exploring whether adopting a lifting style closer to that of pain-free people could help reduce LBP.

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