Low Back Pain CoachHome / What helps low back pain
Lifting Technique and Low Back Pain Research
Verbeek (Cochrane, 2011) included nine randomized trials (20,101 employees) in workers and found moderate-quality evidence that manual-handling advice and training, with or without assistive devices, does not prevent back pain or back pain-related disability in workers versus no intervention or alternative interventions. van Dieën (1999) found the biomechanical literature does not provide support for advocating the squat technique as a means of preventing low back pain. Saraceni (2020) found low-quality evidence that greater lumbar flexion during lifting was not a risk factor for low back pain onset or persistence and was not a differentiator of people with and without low back pain. Hayden (Cochrane, 2021) found moderate-certainty evidence that exercise is probably effective for pain at earliest follow-up versus no treatment, usual care or placebo in adults with chronic non-specific low back pain lasting more than 12 weeks.
Once your back hurts, Verbeek (Cochrane, 2011) found no randomized-trial evidence that manual-handling advice or assistive devices treat back pain already present in workers. For chronic non-specific low back pain lasting more than 12 weeks, Hayden (Cochrane, 2021) found moderate-certainty evidence that exercise is probably effective for pain at earliest follow-up versus no treatment, usual care or placebo.
I had low back pain for about ten years and have no medical credentials. Every research figure below comes from a source listed at the end of the page.
What the research and guidelines found
| Review | Comparison | Finding |
|---|---|---|
| Verbeek 2011, Cochrane | Workers | Nine randomized trials (20,101 employees) were included on prevention in workers. Moderate-quality evidence showed that manual-handling advice and training, with or without assistive devices, does not prevent back pain or back pain-related disability versus no intervention or alternative interventions. |
| van Dieën 1999 | Stoop versus squat | Spinal compression, as indicated by intra-discal pressure and spinal shrinkage, appeared not significantly different between stoop and squat lifting. The biomechanical literature does not provide support for advocating the squat technique as a means of preventing low back pain. |
| Saraceni 2020, JOSPT | Lumbar flexion | Low-quality evidence showed that greater lumbar flexion during lifting was not a risk factor for low back pain onset or persistence and was not a differentiator of people with and without low back pain. |
| Hayden 2021, Cochrane | Versus no treatment | In a review of 249 trials, moderate-certainty evidence showed that exercise is probably effective for pain at earliest follow-up in adults with chronic non-specific low back pain lasting more than 12 weeks, versus no treatment, usual care or placebo. For that same comparison, the effect on function was small and did not meet the review's threshold for a minimal clinically important difference, also at moderate certainty. |
| Steffens 2016 | Exercise plus education | Steffens 2016 included 21 randomized trials of prevention strategies for nonspecific low back pain. The review found moderate-quality evidence that exercise combined with education reduces the risk of an episode of nonspecific low back pain. |
What to do in practice
- Training in the Verbeek (Cochrane, 2011) prevention trials in workers ran from a single educational session to very extensive personal biofeedback.
- From seven trials (19,317 employees), Verbeek (Cochrane, 2011) found moderate-quality evidence that workers given manual-handling training reported back pain levels similar to no intervention or minor advice in a video.
- In adults with chronic non-specific low back pain lasting more than 12 weeks, Hayden (Cochrane, 2021) found that exercise versus other conservative treatments had small effects that were not clinically important on pain (low-certainty evidence) and on function (moderate-certainty evidence), when considering all comparisons together.
- Twelve studies of adults with chronic non-specific low back pain lasting more than 12 weeks measured adverse effects systematically, and harms in the exercise groups were mostly minor, such as muscle soreness (Hayden, Cochrane, 2021).
- In prevention trials, education alone had no effect on nonspecific low back pain episodes, on moderate- to very low-quality evidence (Steffens, 2016).
- Prevention trials found low- to very low-quality evidence that exercise alone may reduce the risk of a nonspecific low back pain episode (Steffens, 2016).
- Low- to very low-quality evidence from Steffens (2016) showed that back belts do not reduce the risk of nonspecific low back pain episodes in prevention trials.
For people aged 16 and over with low back pain, with or without sciatica, NICE NG59 (2016) tells clinicians to include encouragement to continue with normal activities and to promote and facilitate return to work or normal activities of daily living. For people aged 16 and over with low back pain, with or without sciatica, NICE NG59 (2016) says consider a group exercise programme within the NHS for a specific episode or flare-up, taking needs, preferences and capabilities into account when choosing the type of exercise, and do not offer belts or corsets.
WHO's 2023 news release lists exercise programs among the non-surgical interventions it recommends for adults with chronic primary low back pain (pain lasting more than 3 months that is not due to an underlying disease or other condition). It also says lumbar braces, belts and supports should not be routinely offered for most people in most contexts, because potential harms likely outweigh benefits.
Where the program in the app fits
Low Back Pain Coach runs guided sessions on a 45-degree back-extension bench. The bench is required. It is for people with chronic pain who have been cleared to exercise. Floor Foundations is floor work only until you have a bench, not an equipment-free version of the program. Recent workouts and pain logs help set the next session. The first guided session is free, as are the pain log, calendar, 30-day graph, CSV export, lessons and flare help. Later guided sessions require a plan. The app does not diagnose. The next-morning rule is a pacing rule, not a diagnostic test. The exact bench progression has not been tested in a trial. The program is not written for a vertical 90-degree Roman chair. Details are on the app page.
When to get care
Go to emergency care now for any of these:
- New numbness, tingling or change in feeling in the saddle area: around the groin, inner thighs, genitals or anus, or when you wipe
- New trouble getting or keeping an erection, not being able to orgasm, or a change in feeling during sex
- New bladder or bowel changes: trouble starting or stopping pee, a weak stream, not feeling when you need to go, or leaking pee or poo
- New pain, tingling, numbness or weakness in both legs
- Leg or foot weakness that is getting worse (tripping, a foot that slaps down)
- Back pain that started after a recent serious accident, like a car crash or a bad fall
See a clinician today (urgent care if no appointment today) for any of these:
- Other new weakness or numbness in one leg or foot
- Fever or chills alongside the back pain
- New pain after a recent smaller fall or knock
- Unexplained weight loss, or a history of cancer
- Pain that is rapidly getting worse
- Pain that is constant at rest and worse at night, not tied to movement
Common questions
Does lifting with your back rounded cause low back pain?
Saraceni (JOSPT, 2020) found low-quality evidence that greater lumbar flexion during lifting was not a risk factor for low back pain onset or persistence and was not a differentiator of people with and without low back pain.
Is a squat safer for your back than stooping to lift?
van Dieën (Clinical Biomechanics, 1999) found model-estimated net moments and compression forces equal or somewhat higher in squat lifting than in stoop lifting. Shear force and bending moments appeared lower in squat lifting. The review does not provide support for advocating the squat technique as a means of preventing low back pain.
Will a class on lifting technique prevent back pain?
Verbeek (Cochrane, 2011) found moderate-quality evidence from seven trials (19,317 employees) that workers given manual-handling training reported back pain levels similar to no intervention or minor advice in a video.
Should I stop lifting if my back already hurts?
NICE NG59 (2016) tells clinicians to include encouragement to continue with normal activities, and promote and facilitate return to work or normal daily activities, for people aged 16 and over with low back pain, with or without sciatica. That is not advice to keep lifts that aggravate your back. Verbeek (Cochrane, 2011) found no randomized-trial evidence on manual-handling advice or assistive devices for treating back pain already present in workers.
When should I stop and see a doctor?
Go to emergency care now for any of these: New numbness, tingling or change in feeling in the saddle area: around the groin, inner thighs, genitals or anus, or when you wipe; New trouble getting or keeping an erection, not being able to orgasm, or a change in feeling during sex; New bladder or bowel changes: trouble starting or stopping pee, a weak stream, not feeling when you need to go, or leaking pee or poo; New pain, tingling, numbness or weakness in both legs; Leg or foot weakness that is getting worse (tripping, a foot that slaps down); Back pain that started after a recent serious accident, like a car crash or a bad fall. See a clinician today (urgent care if no appointment today) for any of these: Other new weakness or numbness in one leg or foot; Fever or chills alongside the back pain; New pain after a recent smaller fall or knock; Unexplained weight loss, or a history of cancer; Pain that is rapidly getting worse; Pain that is constant at rest and worse at night, not tied to movement.
Sources
- Verbeek JH, Martimo KP, Karppinen J, Kuijer PP, Viikari-Juntura E, Takala EP. Manual material handling advice and assistive devices for preventing and treating back pain in workers. Cochrane Database Syst Rev. 2011 Jun 15;2011(6):CD005958. link
- van Dieën JH, Hoozemans MJ, Toussaint HM. Stoop or squat: a review of biomechanical studies on lifting technique. Clin Biomech (Bristol). 1999 Dec;14(10):685-696. link
- 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. link
- Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021 Sep 28;9(9):CD009790. link
- Steffens D, Maher CG, Pereira LS, Stevens ML, Oliveira VC, Chapple M, Teixeira-Salmela LF, Hancock MJ. Prevention of low back pain: a systematic review and meta-analysis. JAMA Intern Med. 2016;176(2):199-208. link
- National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59. Published 30 November 2016, last updated 29 July 2026. link
- National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. NICE guideline NG59. Overview. Published 30 November 2016, last updated 29 July 2026. link
- World Health Organization. WHO releases guidelines on chronic low back pain. Departmental update, 7 December 2023. link
The app
Low Back Pain Coach runs a guided strength program on a 45-degree back-extension bench: floor work until you have a bench, then four stages from short holds to weighted reps. You log your pain the next morning, and that log sets the next session. A voice counts the holds, reps and rest.
Your first guided session is free. Then $59.99 a year or $9.99 a month, renewing until you cancel, with a 7-day free trial for eligible new subscribers. US prices. iPhone and Android. The 45-degree bench is required. What the app does.
The program on one page
The printable program card has the four stages, the next-morning rule, and the stop signs on one sheet.
If you want an email when the program or the app changes, leave your address. A few emails a year at most, and a reply to any of them takes you off the list.