Work-related movement and lumbar spine direction: a systematic review of lifting, posture, and pain risk

Low back pain (LBP) is a prevalent musculoskeletal condition of occupational and socioeconomic importance. The main biomechanical exposures related to LBP among workers include repetitive lifting, non-neutral trunk postures, and long-duration static trunk positions. This systematic review aimed to evaluate the role of lumbar spine movement direction during work-related lifting and posture in relation to spinal loading and the risk of LBP. PubMed, Scopus, and Web of Science were searched for articles published in January 2015 - June 2025. Eligible studies included adult workers performing occupational lifting or posture activities and reported direction of lumbar spine movement, biomechanical loading measures, or LBP outcomes. Ten studies met the eligibility criteria, including experimental, modeling, and field-based research. Biomechanical evidence showed that squat lifting reduced shear forces at lower vertebral levels but increased overall musculoskeletal effort, while stoop lifting produced higher shear loads at L5/S1. Lifting with a lordotic spine curvature elevated both compressive and shear forces. Individuals with LBP exhibited altered neuromechanical strategies such as reduced lumbar flexion and increased pelvic compensation. Field studies linked repetitive manual handling and constrained postures to higher LBP prevalence. Asymmetrical movement, inadequate strength, and fatigue also contributed to injury risk. The direction and quality of lumbar spine motion during lifting and other posture-dependent activities is an important modifiable risk factor for LBP. Through environmental design changes and behavioral training programs employees can learn and apply ergonomically suitable movement patterns and postures to prevent LBP and decrease spinal loading in their workplaces. Int J Occup Med Environ Health. 2026;39(4):348-62.