It happened again. The same story every day when scrolling through my Instagram feed.
More posture and lifting mechanics nonsense.
The perpetual fear-mongering of social media influencers for the sake of likes and product sales create a net negative for people trying to improve their health. The disinformation — intentional misinformation — leads to people training in fear and avoiding activity.
We should be encouraging movement, not discouraging it.
Lifting mechanics is often a source of mis- and disinformation. There is too much emphasis on maintaining a neutral, flat back while lifting (which technically isn’t possible, at least not during deadlifts, kettlebell swings, good mornings, and picking up heavy objects). The message that rounding the back while lifting will lead to injury doesn’t hold up to the scrutiny of research.
Let’s take it a step further.
Studies show a rounded back may be preferred over a straight one when lifting.
Round your back to improve stability and performance
This study is still warm, having been published in May 2021. It has made its rounds on the social media accounts that are working to build people’s resilience, confidence in movement, and activity level. The study has been absent on the accounts promoting the debunked postural model.
Yes, my bias is showing and I will happily change my tune if the research shows ideal postures or lifting mechanics exist.
Ok, back to the study. Twenty-six healthy individuals performed max effort lifting tasks in three different positions — flexed, neutral, and lordotic (extended or arched) low back. The researchers assessed muscle activity of the trunk extensors (big back muscles that look like rods outside the spine) and the obliques (outside abdominals).
Adopting a flexed posture improved neuromuscular recruitment (strength) and efficiency compared to the other two postures. This makes sense from a kinesiology perspective as the flexed posture puts the muscles in a better length-tension relationship for force output.
Many competitive powerlifters and strongmen athletes purposefully flex their backs to decrease the range of motion their legs need to move, thereby improving the length-tension relationship in the legs as well. Keep in mind, the legs are still important. Lifting with a rounded back does not mean keep the legs straight (i.e. a Jefferson curl) as you will lose strength and power. The goal is to maximize the efficiency of all the muscles involved in the lift.
So, lifting with a rounded back may improve strength and performance, but does it increase injury risk?
No.
The only support for flexing increasing injury risk comes from animal models, claiming the shear force and uneven loading will injury the spine. When looking at humans, freestyle and flexed postures may decrease shear and compression forces. Furthermore, when looking at the outcome studies, lifting with a rounded back does not increase the prevalence of low back pain.
How can you apply this information to your life?
What I tell my patients
Lifting mechanics can be viewed in two lights.
The first is injury prevention. Pain and injuries are multifactorial, complex phenomena that cannot be explained with a single event or variable. Your diet, sleep habits, stress levels, training history, and current mood all influence your injury risk. We often fall victim to confirmation and availability biases, attributing injuries to the first and most prevalent information that comes to mind.
Hurt yourself while lifting? It must be the rounded back or shifted hips. As you berate yourself for “poor” form, you ignore the 5 hours of sleep the past few nights, recent stress at work, and aggressive ramp-up in your training program.
“The eye sees only what the mind is prepared to comprehend.” — Robertson Davies, Tempest-Tost
Look at the big picture. How appropriate are your training program and your recovery strategies? This is what I focus on when talking with patients and individuals worried about pain and injury.
If you feel sluggish after training or your back is often sore, you may need an adjustment in your training frequency and intensity or you may need to improve your recovery strategies.
The body is resilient and adapts to the stresses we place on it. Muscles grow and bones thicken with frequent weight-bearing exercise. However, if you train too hard and don’t allow for recovery, muscles can tear and bones can deteriorate.
Form and mechanics still matter, but not as much as they are often credited. If you want to maximize your deadlift, you can tweak your hip angle, your foot position, or certain cues (e.g. try to break the bar or push the ground away with your feet) to improve efficiency, but injury risk will depend more on the training parameters than the spine angle.
Here are a few lifts you can implement to build your resilience. Start with light weight (relative to your training history) and build up the resistance and volume over time, allowing your body to adapt.
Conventional deadlift, sumo deadlift, barbell hack squat, Zercher squat, goblet squat, Jefferson lift, Jefferson curl, suitcase squat, and good mornings. (check out this account for many videos of these lifts and great information on building low back resilience)
I italicized the lifts you will need a barbell to perform. The others can be with a barbell, kettlebells, or dumbbells.
Some may seem odd and even dangerous. If you gradually build up your tolerance, they are safe. Injuries can never be fully prevented and I can’t guarantee you won’t get hurt during them. The same is true for any exercise. You can be injured during biceps curls, running, or going up and down the stairs of your home.
Focus on the big picture and build your body's resilience.
Keep challenging your bias and perspective
“To err is to wander, and wandering is the way we discover the world.” — Kathryn Schulz, Being Wrong: Adventures in the Margin of Error
No one enjoys having their biases challenged. It’s uncomfortable and we search for ways to reject the challenging information.
I have received a ton of kickback from my articles and social media posts on posture and the value of MRIs. The comments in this article were both entertaining and disconcerting. Clinicians and non-clinicians have deep-seated beliefs about health that have been formed over their entire lives.
We have been told to maintain good posture and lift with our legs since childhood. Advanced training in physical therapy and medical school is often 5–10 years behind current research. I was taught incorrect messages about pain and posture which were hard to challenge when I started treating.
I went through my own five stages of grief when updating my understanding of pain and posture over the first few years of my career.
Denial: Bullshit. There is no way pain actually works that way. Why would my school or previous doctors and therapists teach it differently? Are you telling me I was taught wrong my whole life?
Anger: Are you telling me I was taught wrong my whole life?!
Depression: Not only am I six figures in debt for an education riddled with misinformation, but I have also been telling my patients the wrong information all this time. I even told someone his spine was like a jelly donut and therapy would push the jelly back in! (more on this popular analogy and my unfortunate use of it to come)
Bargaining: Perhaps I can blend the two models and it won’t be a total waste. Surely there are some benefits of the previous education I received. It can’t all be a sunk-cost right?
Acceptance: Bring on the pain science. I’m ready to educate the hell out of people.
It is not easy to abandon strongly held beliefs. Previous investments of time and money or conflicts of interest (aforementioned influencers peddling mis- and disinformation) incentivize us to turn a blind eye to new, conflicting data. But if we want to progress in healthcare and improve our health, we need to apply new evidence and keep asking questions.
Nothing is set in stone forever. Science is always evolving. It is not flip-flopping or lacking conviction to change our message. We did not waste time, money, or effort previously if new information shows we were wrong. We learn through application. What is correct now may be wrong in the future.
We work with the best information available.
Currently, that information says lifting with a rounded back is safe and effective.