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J Orthop Sports Phys Ther. 2019 Nov 28:1-50. doi: 10.2519/jospt.2020.9218. [Epub ahead of print]

To Flex or Not to Flex? Is There a Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-Analysis.

Author information

1
School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia.
2
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark.
3
Body Logic Physiotherapy Clinic, Shenton Park, Western Australia, Australia.

Abstract

STUDY DESIGN:

Prognosis systematic review with meta-analysis.

OBJECTIVE:

To evaluate whether lumbar spine flexion during lifting is a risk factor for low back pain (LBP) onset/persistence, or a differentiator of people with and without LBP.

LITERATURE SEARCH:

Database search of Proquest, CINAHL, Medline and EMBASE until August 2018.

STUDY SELECTION CRITERIA:

We included peer-reviewed articles, investigating lumbar spine position during lifting as a risk factor for LBP onset or persistence, or as a differentiator of people with and without LBP.

DATA SYNTHESIS:

Lifting task comparison data were tabulated and summarised. For meta-analysis, we calculated an n-weighted pooled mean (SD) of the results for each of the LBP and no LBP groups. Where a study contained multiple comparisons (i.e. different lifting tasks that used various weights or directions), only one result for each study was included in the meta-analysis.

RESULTS:

Four studies (one longitudinal study and three cross-sectional studies) measured lumbar flexion with intra-lumbar angles and found no differences in peak lumbar spine flexion when lifting (longitudinal 1.5 degree (95%CI -0.7 to 3.7), p=0.19 and cross-sectional -0.9 (95%CI -2.5 to 0.7), p=0.29). Seven cross-sectional studies measured lumbar flexion with thoraco-pelvic angles and found people with LBP lifted with 6.0 degrees less lumbar flexion than people without LBP (95%CI -11.2 to -.89, p<0.01). Most (9 of 11) studies reported no between-group differences in lumbar flexion during lifting. The included studies were low quality.

CONCLUSION:

There was low quality evidence that greater lumbar spine flexion during lifting was not a risk factor for LBP onset/persistence, nor a differentiator of people with and without LBP. J Orthop Sports Phys Ther, Epub 28 Nov 2019. doi:10.2519/jospt.2020.9218.

KEYWORDS:

lift; manual handling; posture

PMID:
31775556
DOI:
10.2519/jospt.2020.9218

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