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

Review written by Dr Sarah Haag info

Key Points

  • This review found that lumbar flexion is not associated with an increase in low back pain, or a greater risk of low back pain.
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Low back pain is the leading cause of disability globally and has become a much larger issue in low and middle-income countries in particular (1). With back pain being a world-wide issue, it is also an issue for workplace safety and health. Very often, to prevent or reduce ‘workplace injuries’ to the low back, ‘proper lifting techniques’ are advised by healthcare providers and workplace safety personnel. The purpose of this review was to evaluate whether lumbar spine flexion during lifting is a risk factor for low back pain onset/persistence, or a differentiator of people with and without low back pain.

Low back pain is the leading cause of disability globally.
This review suggests that flexion of the spine is not a predisposition to low back pain or injury.


The review protocol was prospectively registered in PROSPERO, and a meta-analysis was added to the protocol after the data were found to be suitable for meta-analysis. Eligibility criteria was clearly defined, and a search was commenced. ProQuest, CINAHL, MEDLINE and

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