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Licensed Unlicensed Requires Authentication Published by De Gruyter November 14, 2019

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

  • David Nolan EMAIL logo , Kieran O’Sullivan , Chris Newton , Gurpreet Singh and Benjamin E. Smith


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).


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.


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.


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.


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.

  1. Authors’ statements

  2. Research funding: Authors state no funding involved.

  3. Conflict of interest: KOS receives income from workshops promoting the biopsychosocial management of low back pain.

  4. Informed consent: Not required for this systematic review.

  5. Ethical approval: No ethical approval was required.


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Received: 2019-06-26
Revised: 2019-10-11
Accepted: 2019-10-17
Published Online: 2019-11-14
Published in Print: 2020-04-28

©2020 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.

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