TLDR: It depends (classic, right?)
For my inaugural blog post, I couldn't resist diving into one of the most hotly debated topics in the realm of rehab and training: lifting with a rounded lower back. If you're anything like me, your social media feed is flooded with bodybuilders, trainers, physios, and chiros sharing countless conflicting opinions on the matter. From @SquatUniversity preaching the gospel of maintaining a perfectly straight lower back and hammering spinal stability exercises to others advocating for Jefferson curls like they're going out of style, the confusion is real. This mountain of conflicting advice has left many of my patients (and me, frankly) scratching our heads. So, this prompted me to take a deeper dive into the literature and hopefully come out with an unbiased opinion that I can share with all of you.
Part 1: Does It Cause Pain or Lead to More Injuries?
Let's tackle the number one argument head-on: Does lifting with a rounded lower back lead to more injuries or pain? In my decade-plus journey in the bodybuilding world, I've lost count of how many times fellow gym bros warned me that anything less than a neutral back while lifting would result in blowing every disc out of my back. Even I have been guilty of this mindset before - looking over to the deadlift area and seeing a guy looking like a cat while maxing out and telling my friends how I would never do that. But was I right?
"Never Skip Spine Day"
So, let’s check out the literature looking into this exact question. Luckily, there are a couple of journal articles that can help us out a bit in determining if this is true. The first of which - a systematic review, a culmination of a lot of evidence - looked at seeing whether lumbar spine flexion during lifting is a risk factor for low back pain onset/persistence in people with and without low back pain. Overall, they found that it wasn’t a major predictor of low back pain or the persistence of low back pain. Although this was found, one major limitation I noted when trying to extrapolate this to the gym population was that not one of the included studies (12 total) incorporated lifts larger than 12kg (~26lbs), which is unfortunate because I think most people do a bit more than that when deadlifting or squatting (the damn bar by itself weighs 45lbs :/ ) (PMID: 31775556).
There are a lot more studies echoing the sentiment that lumbar flexion is relatively safe, but the most disappointing aspect is that most are done with pretty light loads that don’t really carry over to gym-like conditions (some did repetitive lifts with 200g lol) (PMID: 34288926, PMID: 34805121). Therefore, it’s pretty safe to say that for the general population, it’s not that big of a deal, but for the lifting population, the data could be a bit murkier (we’ll touch more on this at the end).
Part 2: Is It Even Possible to Lift With a Neutral Spine? And Is It Actually Better for Power?
"The Spine Literally Exploding Due To The Slightest Bend"
When your trainer or rehab professional is teaching you how to lift and they are yelling keep your spine neutral - is it actually even neutral under the skin (weird visual, I know). Again, luckily for us, there has been a multitude of studies looking at the variability of lumbar spine motion. In a study analyzing powerlifters and weightlifters, it was pretty clear that there is a lot of variability in all 3 planes of motion in the lumbar spine during lifts - even with submaximal loads (PMID: 36237649). In a lifting context, this partial lumbar flexion has been noted to actually increase the effectiveness of the back extensors and reduce the external moment arm (PMID: 33799053). Again, don’t take this as gospel because from my research it seems like this hasn’t been extensively studied on different populations or big groups of people.
My Opinion
So, where do I stand on all of this? If you know me, you won't be shocked to hear I'm taking a middle-of-the-road approach - because, hey, it depends ;). Generally speaking, it's probably safe for most individuals and might even confer some advantages in a weightlifting setting. The key lies in understanding the context of spinal flexion: how far you're bending, how quickly, whether it's within your typical range of motion, and the overall load relative to your capabilities.
Throwing 405lbs on the bar and attempting your first deadlift? Not the brightest idea and a sure-fire recipe for injury. But if you gradually build up over time with proper load management, nutrition, and programming, it's likely okay. Take strongmen tackling atlas stone lifts, for example. They often find themselves in some serious spinal flexion with wicked heavy loads, but they've put in the work to build up their tolerance to such positions. This mindset guides my approach in the clinical setting as well. If I have a patient who keeps injuring themselves while bending down, I might incorporate targeted movement training in similar positions to build their back tolerance rather than fear-mongering them into thinking their back is made of glass and will explode with the slightest bend.
Of course, this isn't a one-size-fits-all solution (and we haven't even scratched the surface of other factors that can contribute to pain or injury). Anatomical differences, past injuries, individual limitations - everyone's unique, and that's damn okay. I think @mikestella_atc (my favourite insta account currently) sums this up perfectly in this video:
So, where do you stand? Are you firmly on one side of the fence, or are you a fence-sitter like me? Let me know your thoughts!
Is It Safe To Lift With A Rounded Lower Back?
No Way
Yup
It Depends?
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