Low Back pain is one of, if not, the most common workplace injury in Australia every year. It has been shown to cost around $4.8 billion per year for health care and cause 25% of sufferers in the 18-55 age bracket to miss 10 or more days of work each year. The prevalence of this injury misleads a lot of people to perceive the lower back as a fragile structure. This is not the case, the lumbar spine is actually a very strong area of the body, it just has to be treated right.
We will not go into too much detail about structure, mobility and stability of the lumbar spine today, instead just give you a few tips on how to lift right to look after your back.
The most important thing to remember when lifting or picking an object up off the ground is to maintain a neutral spine with good muscular control. The lumbar spine naturally has a slight curve towards the stomach, this curve is called a lordosis. A neutral spine is the natural position your spine adopts at rest with no external or internal forces acting on it, therefore, a neutral spine remains slightly lordotic. In this position forces on the spine are relatively balanced and symmetrical.
Everyone has heard the term 'lift with your knees', this advice has been around for a long time to help protect your back when lifting. Unfortunately however, this has caused a lot of people to over focus on using their legs and keeping an upright body. People are scared to lean when they lift! This can lead to awkward postures and movement patterns with a lack of focus on spinal control, possibly even contributing to injuries! Where people have stiff knees, arthritic hips, tight hamstrings or poor balance, this negative effect is further amplified.
Rather than thinking of 'using the legs to lift', think of correct lifting technique as the method that allows you to maintain a neutral spine posture with good control, whilst employing movement of your legs to transfer the load. It is ok to lean forward at your hips to lift something (hip hinge) if you can maintain a neutral and braced spinal posture! In other words it is important not to bend or extend your back during the movement of lifting or picking up an object. Avoiding bending or extending under load helps to avoid excessive shear and compression forces between the vertebra, which are the damaging forces.
In light of the above points, a commonly taught lifting technique is the 'semi-squat' or weightlifters technique. This is a good lift for transferring heavy loads, such as in jobs requiring manual lifting. This technique involves a starting position comprising bending forward at the hips while maintaining a neutral spine (hip hinge) and a semi squat position (knees and hips slightly bent). The lifting movement involves driving upwards with the hips and knees in a smooth fashion until upright, employing the strong gluteal and hamstring muscles. Focusing on keeping your body weight through your heels and your chest upright will assist with a smooth movement and a braced posture.
In the above lifting technique, it is the concept of hip hinging that most people struggle to apply. The coordination between the hips and spine is very important so you can selectively control your posture when lifting, and a hip hinge allows us to control our posture under heavy loads and keep a neutral spine. The videos below show techniques you can use to learn how to perfect the hip hinge movement.
Branching off from techniques involving heavy loads or large items to lift, another effective way to pick something up off the ground is using a golfers lift. This form of lift utilizes a hip hinge movement and the strong gluteal muscles to control the lift. As you can see in the video below, lifting this way places your spine into a horizontal position however a neutral spine is maintained throughout therefore minimizing any shear forces between the vertebra. This can be useful for those small items around the house or yard, particularly if you are recovering from back pain or a back injury.
In finishing, there are a number of ways to lift, this obviously has to change with different objects and positions you are lifting from - everything depends on the context. The most important thing to remember is to maintain a neutral spine and hinge at your hips to avoid moving your back during a lift. The back is an incredibly strong and resilient structure - just think of what Olympic weightlifters can do with their backs! Lifting need not be feared, just strengthened and movement patterns improved - but this is a conversation for another day.
Lift better, live better!
The Gap Physio