To compare freestyle lifting technique 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.
9 studies were eligible. Heterogeneity did not allow for meta-analysis. Most studies (n= 8 studies) reported that people with LBP lift differently to painfree 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 ROM and greater trunk muscle activity that is active sooner and for longer than pain-free controls.
People with LBP move more cautiously (slower, stiffer, 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. However, there may be value in exploring whether adopting a lifting style closer to that of pain-free people could help reduce LBP.
Common beliefs among physiotherapists and manual handling advisors are that you need to lift with a straight back, and a squat style lift is safer. This review shows that those with back pain are more likely to lift in a way deemed safest by the majority of physiotherapist and manual handling advisors.
However, there is a reasoned argument, that these changes may be unhelpful, and this cautious, slow, guarded lifting style is an inappropriate protection strategy and a target for treatment. This may help explain why there is no evidence that teaching people to lift prevents back pain.
A critical question, that needs further research, is whether teaching people with significant pain and a fear of lifting to lift less cautiously, and more like pain-free controls, is helpful to them.
This work was not funded.