Quick answer: Bending your back while lifting is less risky than many people think. A 2020 review found low quality evidence that rounding the lower back when lifting does not raise the risk of back pain starting or lasting. Lift loads you are ready for, add weight gradually and stop any exercise that hurts. If you have osteoporosis, get advice first, because bending and twisting at the waist can raise the risk of spinal fractures.
What is spinal flexion?
Spinal flexion simply means bending your spine forward, as you do when you pick something up from the floor, tie your shoes or round your back at the bottom of a deadlift. It is a normal movement that your spine is built to do.
What does the research say?
For years, people were taught that a rounded back when lifting causes back injuries. The evidence is more reassuring:
- A 2020 systematic review in the Journal of Orthopaedic and Sports Physical Therapy found low quality evidence that greater lower back flexion during lifting was not a risk factor for back pain starting or lasting. Only one of the studies followed people over time. People with back pain did not bend their backs more when lifting than people without it.
- A Cochrane review found that training workers to lift with a particular technique, on its own, did not prevent back pain.
That doesn’t mean technique is irrelevant. Good technique still matters, so learn each lift properly before adding weight. But there is no single “perfect” form that protects you from back pain.
What matters more than back angle
- Load you are ready for: problems are more likely when you lift much more, or much more often, than your body is used to.
- Gradual progression: start with lighter weights, learn the movement, and increase the load slowly.
- Pain as a guide: stop any exercise that causes pain, and ease back in with lighter loads.
- Staying active: regular exercise, including strength training, is good for your back.
A caution if you have osteoporosis
If you have osteoporosis, take extra care. Bending forward and twisting at the waist can raise the risk of spinal fractures, so avoid exercises such as toe touches and sit ups, and get advice before lifting.
When to see a doctor or physiotherapist
See a doctor or physiotherapist if back pain isn’t improving after a few weeks, stops you doing everyday things or is worse at night. See one too if you have leg pain with numbness or weakness, have lost weight without trying, or have a lump or swelling in your back. See a doctor the same day if you feel hot, shivery or generally unwell, or the pain is severe and came on suddenly or is getting worse quickly. Go to A&E or call 999 if back pain comes with numbness around your genitals or bottom, new bladder or bowel problems, weakness or numbness in both legs, or chest pain, or if it started after a serious accident.
Frequently asked questions
Is it bad to round your back when deadlifting?
Research on lifting in general hasn’t shown that a rounded back causes back pain. But only a few low quality studies have looked at this, and only one followed people over time. Learn the lift with light weights and add load gradually.
Does lifting with a straight back prevent back pain?
Not on its own. A Cochrane review found that teaching workers lifting techniques didn’t prevent back pain.
Should I stop lifting if my back hurts?
Stop any exercise that causes pain, but stay as active as you can. Ease back in with lighter loads, and see a doctor or physiotherapist if it isn’t improving after a few weeks.
Is bending safe if I have osteoporosis?
Take extra care. Bending forward and twisting can raise the risk of spinal fractures, so get advice before lifting.
Sources
- Saraceni et al. 2020, JOSPT: To flex or not to flex? Lumbar flexion during lifting and low back pain
- Cochrane: Lifting advice and devices to prevent back pain in workers
- Mayo Clinic: Weight training, do’s and don’ts of proper technique
- Mayo Clinic: Exercising with osteoporosis
- NHS: Back pain
Need help with this? Our lower back pain physiotherapy team at Total Health by Hong Kong Sports Clinic can assess you and start treatment in your first session, in Central, Kai Tak or Tin Hau. Message us on WhatsApp to book.
