When you hear or read the term “back pain,” what comes to mind? How do you answer questions like:
What is this pain?
What caused this pain?
What will this pain mean for me?
How can I control this pain?
How long will it last?
Your responses likely draw from personal experiences, articles you've read, or even reels on social media. Yet, when we talk about back pain—especially lower back pain—our beliefs about it can profoundly affect both how we experience it and how we recover.
The Power of Beliefs in Shaping Back Pain
Research shows that certain beliefs about back pain can shape how we respond to it. If you believe that your pain is due to damage or weakness in the spine, you might start avoiding certain movements or activities, thinking you're protecting yourself. Unfortunately, this mindset can prevent you from engaging in beneficial treatments and may even worsen your condition over time.
People with negative beliefs about their backs are more likely to develop chronic, high-intensity pain and disability in the future. Overly cautious behaviors can hold you back from finding relief through effective care.
The Myth of Avoiding Back Rounding
A common piece of advice many of us have heard is to avoid rounding or flexing our backs, especially when lifting. But is this advice helpful—or harmful?
Contrary to what you might think, research indicates that lifting with a rounded lower back does not increase the risk of injury or pain. In fact, studies show that rounding the back is safe, and avoiding it can even create more problems.
For example, a 2021 study published in Pain looked at how fear-avoidance beliefs—such as fearing certain movements because they might cause pain—affected spinal motion during lifting. The results were eye-opening. Participants who had higher fear-avoidance beliefs tended to restrict their back movements, but those who flexed their spines more often did not experience increased pain.
So, the age-old advice to "lift with your legs, not your back" isn’t supported by modern research. Your back is strong and resilient, designed to bend and lift, as long as you build up gradually and train properly.
Rounding Your Back Can Be Safe
Yes, it’s safe to lift with a rounded back, and I know this from both research and professional experience. As a certified orthopedic physical therapist and former residency program director, I’ve seen the evidence firsthand. One great example is the Jefferson curl, an exercise that maximally rounds the back and strengthens the spine over time.
Of course, like any exercise, the key to safety is gradual progression. You wouldn’t try to max out on a Jefferson curl without building up to it. The same principle applies to daily activities like picking up groceries or lifting your kids. The more you train and expose your back to these movements, the more resilient it becomes.
Addressing Common Fears About Back Pain
Many of us are conditioned to think that back pain comes from improper lifting form or a weak core, but that’s not the whole story. Research has yet to show a direct connection between loading the spine and non-specific low back pain (NSLBP). The main issue is often overloading the body without enough preparation or recovery, much like overdoing any other exercise.
It’s important to recognize that back pain is common and often temporary. Staying active and building up your tolerance to physical demands is the best way to manage it. If you're concerned, consulting a physical therapist can help guide your recovery and address any lingering doubts.
The Internet and Misinformation
Be cautious about the messages you hear online or even from some healthcare providers. Misinformation about back pain can lead to frustration and fear. That’s why it’s crucial to seek out up-to-date, evidence-based advice. Look for clinical guidelines and research-backed content to avoid falling into the trap of outdated beliefs.
Your Back is Strong and Resilient
Remember, your spine is designed to bend, lift, and withstand pressure. Back pain is a normal part of life, but it doesn’t have to limit you. With the right mindset and gradual progression, you can build strength and resilience in your back, making it less vulnerable to future injury.
So, feel free to round your back when lifting. The evidence supports it—and your back will thank you.
For a deeper dive, check out my Medium article on the topic (free article link)
References
Grøn S, Bülow K, Jonsson TD, Degn J, Kongsted A. What do people believe to be the cause of low back pain? A scoping review. Braz J Phys Ther. 2023 Nov-Dec;27(6):100562. doi: 10.1016/j.bjpt.2023.100562. Epub 2023 Nov 7. PMID: 37972538; PMCID: PMC10679815.
Knechtle D, Schmid S, Suter M, Riner F, Moschini G, Senteler M, Schweinhardt P, Meier ML. Fear-avoidance beliefs are associated with reduced lumbar spine flexion during object lifting in pain-free adults. Pain. 2021 Jun 1;162(6):1621-1631. doi: 10.1097/j.pain.0000000000002170. PMID: 33323888; PMCID: PMC8120682.
de Bruin LJE, Hoegh M, Greve C, Reneman MF. Insufficient Evidence for Load as the Primary Cause of Nonspecific (Chronic) Low Back Pain. A Scoping Review. J Orthop Sports Phys Ther. 2024 Mar;54(3):176-189. doi: 10.2519/jospt.2024.11314. PMID: 38270054.
Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. J Sport Health Sci. 2021 Sep;10(5):513-522. doi: 10.1016/j.jshs.2021.04.001. Epub 2021 Apr 20. PMID: 33862272; PMCID: PMC8500811.
Saraceni N, Kent P, Ng L, Campbell A, Straker L, O'Sullivan P. 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. J Orthop Sports Phys Ther. 2020 Mar;50(3):121-130. doi: 10.2519/jospt.2020.9218. Epub 2019 Nov 28. PMID: 31775556.
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