The Lost Art of Loading: How Other Cultures Build Robust Spines

Recently I saw an article regarding the prevalence of low back pain in other cultures outside of north America and the author suggests that somehow the relevance of the way people bend is the main factor.

You can read the full article here: https://www.npr.org/sections/health-shots/2018/02/26/587735283/lost-art-of-bending-over-how-other-cultures-spare-their-spines?sc=17&f=1001

Low back rounding around the world

The article goes on to discuss that because people in U.S. bend through their low backs, causing a sideways “C” shape that this is the cause of the high rates of back pain as opposed to a flat back as they showed in pictures. They have some hand picked images of people bending with relatively flat backs, with most of the motion going through their hips. Although this was probably a catchy headline and article, the truth is not that cut and dry with many other factors to consider (1) on top of the fact that the way you bend may not necessarily be relevant.

Firstly bending through the hips is what many would call a “hip hinge”. This keeps the low back in a relative mid range while the motion goes mainly through the hips. The back still moves to some extent in this case as shown in research, even when one may try to prevent motion in their spine. So that means that the article would have to state that: a little bending is ok, but a lot is not. This still isn’t completely factual based on the current understanding of research. There is evidence that this bending of the spine can strengthen the muscles of the low back while the hip hinge not as much(2). Does a stronger spine wound like a negative thing?

In fact there is a chance that the explanation of “your back hurts because you bend it when you bend over” can actually cause or increase the severity of symptoms. This is evident with a study that look at Australian Aboriginals that had chronic low back pain. There was a relation between their level of disability and their beliefs on the cause of their pain, with higher levels attributed to those with a structural beliefs and radiological imaging(3).

Low back rounding in U.S.

So why are some cultures bending their backs, having back pain and still going on with their daily lives? Part of it is that they communicate their pain less often (4). They tend to simply associate that with day to day physical labour and rightfully so. Having back pain on occasion is relatively normal, to be debilitated by it is not.

Another part is general physical activity. Typically people in those countries and cultures are that of a relative lower socioeconomic status which has shown to be correlated with higher activity levels (5). There are other studies that show that walking can be very beneficial for back pain, even over physical therapy and specific core exercises (6). Considering that many of these cultures walk a lot more it’s almost no surprise that they have less incidence of back pain and disability from back pain. So what does being more active mean on top of not verbalizing your pain when it does occur? You keep moving and staying active, and research shows that exercise can be just as effective for pain management as analgesics(6).

Along with being more active, they are also loading their tissues more. Much like your muscles get bigger and stronger when stressed with resistance, your ligaments, joints and tendons can thicken and become more robust. An example of this is the thickening of back ligaments with age (7). It is important to note that structures such as bone, ligaments etc take a longer time to adapt than muscle for a few reasons including lower blood supply. So in a culture where they are constantly moving regardless of how they are moving, their bodies are adapting to this over time. A child slouching all day in their seat, will have different adaptive effects than a kid who walks at least a few miles a day and bends and twists every which way. The research that suggests repetitive bending of the spine has negative consequences is often done on cadaver animal spines that obviously will not adapt over time. I am of the belief that the amount of load one can carry in a given position is not an inherent generalization but more so the product of what loads and positions that person has been exposed to over time.

Another article on NPR suggested that the shape of the spine may be a significant factor: https://www.npr.org/sections/goatsandsoda/2015/06/08/412314701/lost-posture-why-indigenous-cultures-dont-have-back-pain . Again the research does not back that up. A analysis of the literature found that there was no strong evidence to link the shape of a spine to general health or spinal pain (8).

Another thing to consider is variety. Does one bend their backs every time they move? Do they sometimes hinge trough the hips. The variety of movement will load the back and tissues in a variety of ways and positions. Variety of movement and positions is a great way to encourage a more robust body through adaptation as mentioned above.

So the take homes for back pain from this post:

-Move often in a variety of ways

-Don’t be afraid to bend your back

-Be more active in general especially walking

-Your body is robust and can adapt to various stressors over time

Thanks for reading, Vitas

1-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633330/ Tousignant-Laflamme Y, Martel M, et al. “Rehabilitation management of low back pain – it’s time to pull it all together!” J Pain Res. 2017.

2- Fisher J, Stewart B, et al. “A randomized trial to consider the effect of Romanian deadlift exercise on the development of lumbar extension strength” Phys Ther in Sport. 2012.

3- Lin I, O’Sullivan P, et al. “Disabling chronic low back pain as an iatrogenic disorder: a qualitative study in Aboriginal Australians” BMJ Open. 2013.

4- Had back pain but culturally kept it private. Honeyman PT, Jacobs EA. “Effects of culture on back pain in Australian aboriginals.” Spine. 1996.

5- Larouche R. “Physical inactivity in developing countries” CMAJ. 2014.

6- Shnayderman, I. Katz-Leurer, M. “An aerobic walking program versus muscle strengthening programme for chronic low back pain: a randomized controlled trial.” Clin Rehabil. 2013.