Prone to lower back pain? Bending, lifting and twisting won’t cause permanent damage, study finds
Although the researchers found that certain movements increased the risk of developing a flare-up within 24 hours, these movements and temporary bouts of pain did not predict whether people would have worse back-related physical function a year later.
The findings reinforce long-standing indications that staying active is generally helpful for lower back pain, although certain movements may temporarily worsen symptoms, the authors wrote.
“The important thing to remember here is that the movement may sting your back today, but it won’t ruin you for tomorrow,says Nick Shamie, MD, a spin surgeon and professor of orthopedic surgery and neurosurgery at UCLA School of Medicine in California, who was not involved in the study.
Does lifting, twisting or sitting increase lower back pain?
To learn more about physical activities related to short-term (less than 24 hours) low back pain and long-term disability, investigators followed more than 400 people who had recently had an appointment at a Veterans Affairs health clinic for their back pain. Participants were on average 47 years old and 75 percent were men.
Over the course of a full year, the group conducted nearly ten thousand daily surveys to determine whether they were experiencing a flare-up of low back pain and how many hours they spent doing 10 common activities, including bending, lifting, twisting, pushing or pulling, squatting, sitting, standing, walking, climbing and crawling.
The researchers looked at the data in two ways:
- If more time spent in any of the above activities increased the likelihood of a flare-up within 24 hours
- If these same activities predicted worse back-related function one year later
This design allowed the team to assess both short-term symptom triggers and long-term outcomes in the same group (something previous studies had not done).
Movements that increased flare risk did not lead to worse functioning one year later
Study data associated several daily activities with a slight increase in the risk of experiencing a flare the next day, including:
- Folding
- Twist
- Squat
- Push or pull
- Lift more than 10 pounds
Each additional hour spent bending, twisting, pushing or pulling increased the risk of a rash by about 6 percent. An hour spent lifting or squatting increased it by about 5 percent.
These patterns match what many people with back pain notice in daily life: Certain movements can cause short-term pain, Dr. Shamie says.
But researchers discovered no evidence that any of the movements caused a deterioration of back-related functions a year later.
“Pain flare-ups reflect temporary irritability rather than structural damage or disease progression. This is why movement can hurt but still be recommended,” Shamie says.
Why back pain flare-ups occur
Low back pain flare-ups generally do not come from a single cause. Instead, research shows that these phenomena often occur when multiple factors accumulate at the same time.
Everyday movements – especially if performed with poor posture, sudden force or higher intensity than usual – can irritate the muscles, joints or ligaments of the lower back and cause sharp lower back pain.
- Muscle fatigue, stiffness from sitting for too long, or lifting in a way that overloads the back
- Muscle spasms or overly tense muscles
- Facet joints (joints along the spine) become irritated and nerves become tender when nearby tissues become inflamed
- Fascia, the thin layer of connective tissue covering muscles, is irritated by micro-injuries, which can also increase sensitivity to pain.
- Myofascial trigger points (tight knots in muscles) flare up after exercise or overuse
Physical stress is only part of the lower back pain equation. Sleep problems, stress, excess weight and low activity levels can all make the back more reactive.
Limitations of the study
The authors note some limitations. Because participants estimated their daily activities, the data may not be perfectly accurate. The study did not use motion sensors, so actual movements might differ from what people remembered. Since most participants were middle-aged veterans, results may not reflect young adults or women.
Nevertheless, the overall message remains consistent with current understanding: Pain during movement often reflects tenderness and not damage.
How to prevent back pain flare-ups
“In practice, these results reinforce current recommendations: stay active, use stimulation and gradual exposure rather than avoidance. Movement remains beneficial for long-term results even if it is painful in the short term,” says Shamie. He recommends:
- Warm before the activity; gentle stretching reduces tension.
- Rhythm activities that involve bending or lifting and don’t try to do too much at once.
- Use good lifting form: Bend your knees, keep objects close, tighten your body and avoid twisting.
- Exercise through activities like walking, swimming and Pilates, which will support your spine by strengthening the muscles of your core, hips and back.
- Avoid sitting or standing for long periods of time. Change positions often and take short movement breaks.
- Maintain a healthy weight; Excess weight increases pressure on the lower back.
