Should I stop bending over
People often blame bending as the trigger for their back pain, we are told from a young age that if you don’t lift correctly it will likely damage your back, or lift with your knees outs less strain on the spine?
But is this true, is there a correct way to lift, does lifting “stress” or “damage your spine”… Let’s find out.
Firstly can you hurt your back from bending over, certainly you can. In the same way, you can hurt your shoulder from throwing or ankle from running, but does that mean the activity is the problem or damaging? Certainly not.
Could the way you bend & lift have triggered your back pain, again, possibly but does that mean that lifting is a problem and you should stop ding it, likely not. After all, if you hurt your back having Sex, would you never have sex again.
This episode come about after I saw a patient aged 65 who was told aged 18 never to lift anything heavier than a bag of shopping… so for the last 45 years, this had been the case. She said she didn’t even lift her child once she got much older than 1. This is awful and inspired us to do a whole show on this topic, to stop this awful fear-mongering information from spreading further. Thankfully we have come a long way in the last 40 years, but I still hear this very regularly.
So how did this come about? This is likely through a post hoc fallacy, ie because an event happened (back pain) after another event, the result can often just be blamed on that even when there are often many other factors at play. Combine back pain after lifting what you thought was incorrect, with an understanding that that back is weak and fragile, easily damaged, and has to be corrected you can see how lifting is so often solely blamed on the pain.
So is lifting bad for your back, no, Lifting is not bad for your back any more than lifting is bad for your arms! Is there a correct way to lift? No, whilst some positions may be more optimal at a competitive lifting level in sports such as Olympics lifting or powerlifting, this is in terms of power and force production as opposed to reducing the chance of injury.
The reason people get injured is often through what we can the rule of Toos, lifting Too Much, Too Often after lifting Too Little for Too long. Ie doing something you are not prepared to do. What the body doesn’t really like is a sudden change, whist our spines and other joints are incredible at adapting to stresses, (it’s how we get better and stronger) if this too much and we can easily overload our structures. The analogy I use most recently is running a marathon, Most people know even if they haven’t run a marathon, that when training for one, you don’t go out on day one and run 42km, you gradually build up over a period of time to reduce the chance of overloading your tissues and getting injured.
Lifting and bending is no different to this, if you never bend and lift, you cant expect to be great at bending and lifting. You have to prepare yourselves for doing this. If for 6 months after an injury you stop bending as you think that’s a cause for your previous episode of back pain, then have to bend over to mow the lawn, it may exceed your current tolerance. Which makes sense.
Does bending forward place more stress on your spine? Yes, is this a bad thing, no. Remember stress is how the body grows and adapts… it responds to stressors and becomes stronger. Same as it would from stressors placed on the body in the gym, or walking/running.
So why does it hurt every time I bend over? Often once a movement hurts or triggered an episode of pain, the brain perceives this movement as a threat. After all, our brain still thinks we are cave people. So when a threat is discovered is wants us to retreat to a dark cave and not move much. So it triggers pain (You’ll notice we used the phrase “trigger” for pain a lot here, as opposed to a cause) often from movements when it shouldn’t remember pain doesn’t equal damage, so just because a movement may trigger pain it doesn’t mean you are damaging anything, this is often something that people are afraid of.
So how can you introduce bending? If we are currently worried about doing it, or it’s a trigger for pain? I can use the lady I saw above as an example. She was very fearful about bending, thinking that her spine was weak and bending forwards would cause not only pain but damage. Slowly we unpacked these beliefs. It came back to ultimately that she felt spines aren’t meant to bend and the knees/hips should do the work. So how did we get her to reduce her fear of bending…
We started by educating her, using what we spoke about above regarding the spine being designed to bend, twist and lift. We then started promoting some bending in normal pain-free positions, such as lying down, or sitting and bending forwards. Now initially these were uncomfortable, not because the movements were bad, but because they weren’t often done (This lady even bought a device to put her shoes & socks on for her). What she soon came to realise was that by repeating this movement not much happened, ie it didn’t feel that comfortable, but nothing bad happens ie it didn’t cause significant pain, trigger something to slip out of place. So simply her homework for the first few weeks was to work towards touching her toes in a sitting position. Building up to doing this every few hours. Within about a week, she could comfortably touch her toes 10 times with no issues. We then added weight, starting with a handbag, and going up from there and doing the same movements from a standing position. We are still a long week off from her lifting heavy stuff as it’s a slow and graded approach, plus some other healthcare issues at hand, but she can now put her socks on and tie up her shoes without worrying that she is damaging her back. She described it as a load has been lifted from her shoulders.
So does this mean that manual handling training is pants?? We may make some enemies, but often yes, if they are telling you to avoid bending when lifting, or trying to avoid using your back, then I wouldn’t pay much attention, point them in the direction of us, or sit quietly and then find another musculoskeletal clinician who will be able to give you some more up to date advice.
So I hope that’s answered your questions about bending and lifting. As always if you have any questions you can reach out to us on social media, or via email hello@thebackpainpodcast and we will be happy to answer any questions. Or pop a comment below!
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