Do not expect “correct lifting posture” or lifting training to prevent back pain; reduce the weight and number of lifts, and exercise regularly

No expense. You do not need to obsess over whether your back bends during lifting or spend money on back-protection classes and belts. Do two things: divide heavy loads, use a trolley, or lift with help, which adds only a few minutes; and make time to exercise several times a week, which requires sustained commitment.

First, training. The 2011 Cochrane systematic review pooled 9 randomized trials involving 20101 employees. Across 7 trials with 19317 participants, later reported back pain was similar among people who received lifting training and those who received no intervention (OR 1.17, 95% CI 0.68–2.02; the confidence interval includes 1). Compared with people who only watched a video, RR was 0.93 (0.69–1.25), also similar. Evidence quality was moderate. The authors concluded that manual-handling advice and training, with or without handling aids, did not prevent back pain or related disability. Next, bending. A 2020 systematic review pooled studies of lumbar bending during lifting; evidence quality was low. In the only follow-up study, the difference in maximum bending angle between those who later developed back pain and those who did not was just 1.5 degrees (−0.7 to 3.7), not statistically significant. Nine of 11 studies found no difference between the groups. Another 7 studies using a different measurement found that people with back pain bent their backs 6.0 degrees less while lifting (−11.2 to −0.9). The authors concluded that there was no evidence that greater lumbar bending causes back pain. Finally, what to do. One meta-analysis pooled 8 follow-up studies: each additional 10 kg per lift was associated with OR 1.11 for back pain (1.05–1.18, about 11% higher). Each additional 10 lifts per day was associated with OR 1.09 (1.03–1.15, about 9% higher). Another pooled 21 randomized trials involving 30850 people. Exercise plus education reduced the risk of back-pain episodes to RR 0.55 (0.41–0.74, about 45% lower), with moderate-quality evidence. Exercise alone had RR 0.65 (0.50–0.86, about 35% lower), with low- to very-low-quality evidence. Education alone, RR 1.03 (0.83–1.27), and back belts, RR 1.01 (0.71–1.44), showed no discernible effect. Official UK Health and Safety Executive (HSE) guidance also states that training alone cannot ensure safe handling, and good handling technique cannot replace handling aids or improvements to tasks and loads.

Verbeek JH, Martimo KP, Karppinen J, Kuijer PP, Viikari-Juntura E, Takala EP. (2011). Manual material handling advice and assistive devices for preventing and treating back pain in workers. Cochrane Database of Systematic Reviews, CD005958. https://doi.org/10.1002/14651858.CD005958.pub3；Saraceni N, Kent P, Ng L, Campbell A, Straker L, O'Sullivan P. (2020). 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. Journal of Orthopaedic & Sports Physical Therapy, 50(3), 121–130. https://doi.org/10.2519/jospt.2020.9218；Coenen P, Gouttebarge V, van der Burght AS, et al. (2014). The effect of lifting during work on low back pain: a health impact assessment based on a meta-analysis. Occupational and Environmental Medicine, 71(12), 871–877. https://doi.org/10.1136/oemed-2014-102346；Steffens D, Maher CG, Pereira LS, et al. (2016). Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Internal Medicine, 176(2), 199–208. https://doi.org/10.1001/jamainternmed.2015.7431；Health and Safety Executive. Manual handling at work: Training; Good handling technique. https://www.hse.gov.uk/msd/manual-handling/training.htm；https://www.hse.gov.uk/msd/manual-handling/good-handling-technique.htm；反方：Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. (2010). Causal assessment of occupational lifting and low back pain: results of a systematic review. The Spine Journal, 10(6), 554–566. https://doi.org/10.1016/j.spinee.2010.03.033

Disputed. Findings on heavier and more frequent lifting differ. A 2010 systematic review found 9 high-quality studies: 4 found an association and 5 did not. The authors considered occupational lifting unlikely to independently cause back pain. Thus “lift fewer heavy loads” is supported only by association evidence, not proof of causation. The bending review had low-quality studies, mostly comparing two groups at one point in time. The training review’s confidence intervals were wide, and it noted that no randomized trials had tested whether training treats existing back pain. HSE still teaches a technique: keep the load close to the waist, stand firmly, avoid twisting, and do not jerk. A slight bend in the back, hips, and knees at the start is preferable to fully bending the back or fully squatting. Following this is reasonable, but do not expect it alone to prevent back pain. Benefit is rated medium: the exercise reductions would qualify as large, but evidence for exercise alone is low quality, exercise plus education did not demonstrably reduce sick leave, and back pain is not fatal. For exercise, see Section 2, Item 16 (30–60 minutes of strength training each week) and Section 2, Item 11 (7000–8000 steps a day). The beneficiary is you.