Is It Safe To Bend Your Back?

7 Reasons Why it's Ok to Bend Over


You can add your own 8th reason (if that’s the way your dirty mind is heading!) but the 7 reasons given here focus on why you don’t need to worry about bending your back.

Your spine is there to support your body and connect different parts of your musculoskeletal system to each other so you can move easily.

One of your back’s main jobs is to help you bend. Yet you may have been told that flexing/bending your back is bad for it; that you should always keep a ‘neutral’ spine or something of that sort.

Of course, it’s helpful to spend most of your time with a neutral spine because it places the least amount of strain on your back and neck. Good posture and positioning can help prevent back pain so do make sure you’re not spending large amounts of time sitting hunched over your desk or staring down at your phone.

But, unless you’re surrounded by servants who’ll pick up after you, you can’t spend the whole day in a neutral position. You might need to bend down to pick up your toddler, unpack your moving boxes or lift things into your car boot.


So, here are 7 evidence-based reasons to reassure you that it’s OK to bend over:

1. Spinal flexion doesn't cause lower back pain. There’s very very little prospective evidence that spinal flexion is an independent risk factor for low back pain.

Prospective evidence is gathered by selecting a group of people, following their progress (for months to decades), observing their behaviour and noting who develops the condition being studied. It’s a strong form of evidence that’s helped us understand the causes of heart disease and stroke and proved that smoking causes lung cancer and other diseases.

Prospective studies have not shown us that bending over hurts your lower back. Swain et al’s recent review of 4285 research studies published from 1990-2018 concluded that there was no consensus about the role that bending, twisting and other movements played in causing lower back pain. The available evidence does not allow us to conclude that bending over causes lower back pain. 

Coenen et al 2014 showed that regularly lifting heavy loads in physically demanding jobs could be a small risk factor for lower back pain through an accumulation of microdamage or fatigue. But that’s not about bending or flexion, it’s about load.


2. A different lifting technique doesn't prevent lower back pain. You may have been encouraged to lift with your knees, not your back. The idea is that if you bend at the knees and keep your back straight when lifting, you’re less likely to hurt your back because you’re relying on your strong thigh muscles instead.

This idea is now being debunked. Training people to avoid spinal flexion when lifting doesn’t prevent lower back pain developing. WorkSafe Qld now says that:

There is strong evidence that teaching people how to lift, or using programs that include lifting techniques such as keeping a neutral spine and bending your knees or bracing your abdominals, are ineffective and are wasting employers' time and money.

When it comes to heavy lifting, the best option is to redesign the task or use a mechanical aid to lighten the load.


3. Spinal flexion is functional. Your spine is built for flexibility. Indeed, you use that flexibility constantly, whether you’re riding a bike, rowing or bowling in a game of backyard cricket. Flexing your spine is part of kinematic sequencing, the efficient transfer of energy from large, strong muscles to smaller ones. It’s why we believe that sit-ups are not a dangerous exercise if they’re done correctly.


4. Spinal flexion is unavoidable. Try doing anything without bending your spine! Basic resistance training movements like squats, deadlifts and kettlebell swings involve a degree of spinal flexion. 


5. Evidence from dead animals is not a terribly good guide for live humans. A lot of evidence for avoiding flexing your back comes from studies on animal spines taken from dead pigs (Thoresen et al 2017, Callaghan and McGill 2001) and cows!

Relying on results from animal models is problematic because: 

  • An animal's spine is different from ours in so many ways, particularly for  a 4-legged creature (duh!)
  • Dead tissue doesn’t adapt to load like living tissue (Li et al 2013)
  • Cadaver models show conflicting findings, such as that staying in a neutral position isn’t any more protective than flexed positions (Veres et al 2010)
  • The studies did not use representative loading patterns. McGill et al did 86,000 spinal flexion moments one after another with no rest which then caused a herniation. We don’t move like that in real life.
  • The animal models used ~35-70% max flexion. That degree of flexion is literally unavoidable in normal humans. It's akin to saying breathing is a risk factor for back pain.
  • Live animal modelling conflicts with dead animal modelling (Fearing et al 2018). See the point above about live tissue’s ability to adapt to load.


6. Avoid extreme postures. Khoddam-Khorasani et al 2020 studied whether it was best to curve your lower spine inwards (lordotic posture) or outwards (kyphotic posture) when lifting. They concluded that current results support a free posture (in between the extreme kyphotic and lordotic postures). This gives you moderate contributions from the active and passive structures in your back when you’re bending over to lift something. They also show that your discs adapt well to loads.



7. Bending now doesn't risk your future. Foss et al 2012 examined whether endurance athletes in sports that involved repetitive backloading like rowing, skiing and orienteering were more likely to have back pain in later years than non-athletes. The results of this 10-year cohort study ‘indicate that years of prolonged and repetitive flexion or extension loading in endurance sports does not lead to more lower back pain’.


Should you ever avoid excessively bending your back?

It's probably a good idea to try to remain in a neutral range if:

  • You're pregnant
  • Your sporting performance is better when you don't flex your back
  • Flexing your back hurts - stop bending for a bit to let it desensitise.

How can Sycamore Health help? 

If you’re dealing with lower back pain, we’re here to help. We’ll chat to you about symptoms, assess your movements and develop an evidence-based treatment plan to help things improve. Give us a call today on (07) 3046 1700 or book online.


Disclaimer

All information is general in nature. Patients should consider their own personal circumstances and seek a second opinion.



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