The hidden danger of spinal rotation – how does twisting impact your lower back?

tl;dr Is twisting bad for your spine?

Twisting, in itself, isn’t necessarily a problem. But frequent exposure to flexed and rotated spinal positions will increase your risk, particularly under load. Especially when posture, duration, and lifting forces aren’t managed well.

Understanding your own movement patterns - through assessment rather than guesswork, gives you the information you need to make smarter decisions about how you move, work and train.

How does twisting impact your lower back?

Spinal rotation, or twisting, is a natural movement – if we think about it we probably do it numerous times during the day. And usually without incident.

But under load, twisting can become one of the most damaging mechanisms for the lower back. That’s why, in the video tutorial above I wanted to get into the science behind rotational stress and how it affects the discs, ligaments, and joints of the spine.

Drawing on research by Lehman (2019) and Coenen et al. (2013) I discuss how different movements and postures affect the lower back. focussed on flexion under load, as well as rotation, and ultimately showed that combined rotation, flexion, and compression greatly increased injury risk to the lower back, especially during lifting and sports.

So if you’ve been trying to understand why your lower back keeps flaring up despite your best efforts, this article will help you learn how to move more efficiently, build rotational strength safely and protect your back from overuse.

The limitations of research studies into low back pain

One of the challenges with scientific studies is that they’re usually done in controlled environments. This allows researchers to remove other variables and focus on one or two specific factors.

Which is, of course, how it should be, but the downside is that it’s hard to replicate how we move in the real world.

On the other hand, studies of real life are tricky too. Once research is taken fully into real-world conditions, there are suddenly too many variables to control - posture, fatigue, load, frequency, environment and more. That makes it difficult to draw meaningful conclusions.

So there are limitations on both sides, but these researchers tried to bridge that gap by adding rotation alongside flexion, to better reflect how people actually move.

What happens when you add rotation to a flexed spine

What the studies found was fairly clear:

• Loaded spinal flexion, when done frequently, increases risk to the lower back
• When rotation is added on top of that, the risk increases even further.

In simple terms, a spine that is flexed, rotated, and loaded - especially when this happens often - is placed under greater stress. The more frequently that stress occurs, the greater the potential risk.

This doesn’t mean that movement is bad. It means that how often, how much, and in what position the movement happens all matter.

How to reduce the risk the low back being damaged by twisting

To reduce risk to the lower back, the study highlighted four key factors that should be considered. These were posture, lifting forces, duration and exposure.

They asked the questions:

• What positions are you spending time in?
• How much weight are you lifting?
• How long are you doing it for?
• How often are you exposed to those positions and loads?

And these are pretty similar to the questions that come up again and again when I’m working with clients to try to understand their persistent back pain.

Why you’ll get better answers from proper assessment

Rather than guessing, if you’re looking to understand your lower back issues, the best course of action is to go through a structured assessment.

A proper low back assessment doesn’t just look at the lower back itself. It also includes the hips, the muscles around the spine as well as an assessment of core endurance and core stability.

Going through this process will help you identify patterns - perhaps the way you’re sitting at work, repeated movements, or regular tasks that maybe be adding load.

Once you understand where the issue is coming from, you can start making specific changes:

That might involve adjusting your posture, or at least spending less time in certain positions. Plus modifying how you’re lifting weight and learning to spread the load more effectively.