Author: Adrian Ong
Introduction
As physiotherapists, our principal objective is to support workers to move with confidence and to minimise pain while meeting the demands of their roles. Conventional manual handling guidance has long promoted a rigid “safe squat lift” (knees bent, back straight). Recent evidence from Curtin University suggests this approach, applied uniformly, may not be optimal for individuals with lifting-related chronic low back pain. This paper summarises key findings from a replicated single-case design study and outlines practical implications for workplaces.
Study Overview
Researchers observed five adults with chronic low back pain who regularly experienced symptom flares during lifting tasks. Participants completed Cognitive Functional Therapy (CFT), a programme designed to address movement patterns and beliefs about pain. Wearable sensors captured back, hip and knee kinematics while lifting boxes to quantify technique changes over time.
Key Findings
Across cases, shifting away from a squat-style lift (greater knee flexion, rigid spine) towards a semi-squat or stoop-style lift (greater trunk flexion, reduced knee flexion, quicker movement) was frequently associated with improvements in pain and self-reported functional limitation. Participants demonstrated increased tolerance for spinal flexion and a reduction in protective, guarded movement patterns.
Clinical and Workplace Implications
In environments where lifting is unavoidable, enforcing a single “correct” technique may perpetuate stiffness and fear-driven behaviour in some workers. Allowing technique variation within safe parameters—together with confidence-building and graded exposure—can support symptom reduction and task performance. Onsite physiotherapists are well placed to assess individual movement patterns, de-catastrophise pain responses, and tailor coaching at the workstation in collaboration with key stakeholders.
Practical Guidance
The following guidance can be incorporated into early intervention and routine coaching, with appropriate consideration of load, environment and worker capability:
- Permit spinal flexion within tolerable ranges; the lumbar spine is designed to move.
- Vary lifting technique (semi-squat or stoop) where it feels natural and compatible with the task.
- Encourage a steady pace—neither jerky nor excessively slow—to reduce guarding.
- Prioritise individual assessment; if a style reduces symptoms and improves control, it can be preferentially used.
- Retain standard controls for higher-risk tasks: team lifts, mechanical aids, and load management.
- Where available, integrate principles from Cognitive Functional Therapy (CFT) to address beliefs and movement habits.
Study Limitations
Findings derive from a small cohort (n=5) within a replicated single-case design and therefore are not generalisable to all workers. Improvements reflect both technique variation and participation in CFT; the study excluded individuals with specific conditions (e.g., sciatica or significant hip/knee pathology), which constrains applicability. Further research with larger samples is required before revising organisational lifting policies wholesale.
Conclusion
A balanced, sustainable approach to manual handling recognises that confident, natural movement—including controlled spinal flexion—can benefit some workers with lifting-related low back pain. Embedding onsite physiotherapy into routine operations enables early intervention, task-specific coaching, and collaborative risk management, supporting both worker wellbeing and productivity.
Reference
Au, I. P. H., Saraceni, N., Smith, A., O’Sullivan, P., Ng, L., & Campbell, A. (2025). 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. European Journal of Pain, 29(1), e70071. https://doi.org/10.1002/ejp.70071
