03/07/2025
Just published 🔥
Is Lifting Technique🏋️♀️ Related to Pain and Functional Limitation? A Replicated Single-Case Design Study of Five People With Lifting-Related Chronic Low Back Pain
👉 Chronic low back pain (CLBP) is a leading cause of disability and is frequently exacerbated by lifting tasks (Stevens et al., 2016). Conventional clinical and occupational ergonomics guidelines advocate for squat-like lifting as the “safe” standard, emphasizing minimal lumbar flexion through increased knee flexion (Caneiro et al., 2018; Nolan et al., 2018; von Arx et al., 2021). However, empirical evidence supporting this approach is weak (Martimo et al., 2008; Verbeek et al., 2012). Cross-sectional studies have even shown that individuals with CLBP tend to use more rigid, squat-dominant techniques than those without back pain, potentially reinforcing maladaptive motor control strategies (Nolan et al., 2020; Saraceni et al., 2022).
👉 Recent literature has emphasized the need for individual-level analysis in CLBP to capture the heterogeneity in presentation and response to intervention (Wernli et al., 2020; Christe et al., 2024). Cognitive Functional Therapy (CFT), a multidimensional behavioral intervention, has shown promise in improving function and reducing pain in CLBP (O’Sullivan et al., 2018; Kent et al., 2023). However, the relationship between movement change and symptom relief in lifting-specific contexts remains underexplored.
📘 A brand-new study by Au and colleagues aimed to fill that gap using a replicated single-case design (SCD) to examine within-person associations between changes in lifting kinematics and clinical outcomes. (https://pubmed.ncbi.nlm.nih.gov/40596778/)
🧍♂️Methods
Five individuals with lifting-related CLBP participated in a replicated SCD with baseline (4–6 weeks), intervention (12 weeks), and follow-up (3 months) phases. Kinematic data were collected weekly using wearable inertial sensors (Noraxon myoMOTION) during a 20-repetition lifting task. Pain (NRS) and lifting-specific functional limitation (PSFS) were collected concurrently. The intervention consisted of up to 10 CFT sessions per participant. Cross-correlation analysis and baseline-corrected Tau statistics were used to evaluate the temporal and directional relationships between biomechanical and clinical changes.
📊 Results
🏋️♀️ All participants demonstrated changes in lifting technique, though direction and magnitude varied. The most common pattern of improvement was a transition from squat-like to semi-squat or stoop-like lifting. This was characterized by:
▶️ Increased trunk range of motion (ROM) and velocity
▶️ Decreased knee ROM and velocity
▶️ Faster lift duration
✅ Statistically significant relationships were found in:
▶️72% (18/25) of lifting kinematics–functional limitation associations
▶️ 52% (13/25) of lifting kinematics–pain associations
▶️ Temporal analysis revealed that 67% of significant associations occurred with a lag of 0, indicating contemporaneous changes.
💡 Discussion
This study questions the universal application of squat-like lifting advice. Contrary to prevailing belief, transitioning toward more stoop-like techniques—often deemed “unsafe”—was frequently associated with clinical improvement. These findings support CFT’s emphasis on unguarded, relaxed movement strategies and individualized rehabilitation (O’Sullivan et al., 2018; Caneiro et al., 2019). The findings align with earlier single-case and longitudinal studies (Wernli et al., 2020; Chang et al., 2024) that also identified increased trunk motion as beneficial in CLBP. Importantly, these benefits were observed despite participants having unique baseline movement patterns and intervention targets.
Furthermore, improvements noted during the baseline phase suggest that even unguided repeated exposure to lifting may have therapeutic effects, aligning with principles of graded exposure (Vlaeyen et al., 2001).
📌 Conclusions
In people with lifting-related CLBP, changes in lifting technique were frequently associated with reductions in functional limitation and, to a lesser extent, pain. Improvements typically occurred during transitions from squat-like to more stoop-like techniques, characterized by greater trunk motion and velocity. These findings challenge traditional ergonomic recommendations and underscore the importance of individualized, multidimensional care approaches.
📒 References
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