Dealing with low back pain
Along with neck/shoulder pain, low back pain is right at the top of the list of conditions I see most frequently. Before we begin delving into this expansive topic, let’s start with a few stats:
- Low back pain is the single leading cause of disability worldwide, according to the Global Burden of Disease 2010.
- One-half of all working Americans admit to having back pain symptoms each year.1
- Back pain is one of the most common reasons for missed work. In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.
- Most cases of back pain are mechanical or non-organic—meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer.
- Americans spend at least $50 billion each year on back pain—and that’s just for the more easily identified costs.2
- Experts estimate that as many as 80% of the population will experience a back problem at some time in our lives.3
The potential causes for back pain are too numerous to address in a blog article, so I will pick just a few.
Correct posture is a simple but very important way to keep the many intricate structures in the back and spine healthy. It is much more than cosmetic – good posture and back support are critical to reducing the incidence and levels of back pain and neck pain. Back support is especially important for patients who spend many hours sitting in an office chair or standing throughout the day.
Not maintaining good posture and adequate back support can add strain to muscles and put stress on the spine. Over time, the stress of poor posture can change the anatomical characteristics of the spine, leading to the possibility of constricted blood vessels and nerves, as well as problems with muscles, discs, and joints. All of these can be major contributors to back and neck pain, as well as headaches, fatigue, and possibly even concerns with major organs and breathing.
Our core is generally defined as the muscles that stabilize and support the spine, pelvis and hips. Having these muscles strong and functioning properly is crucial to proper movement, support and distribution of forces around the body. Due to posture, compensation and general deconditioning, most lack fully functioning core musculature. Among the muscles most responsible for back pain are the muscles of the inner core. These include the deep abdominals, pelvic floor muscles, the muscles or respiration and the deep muscles of the spine. As mentioned in a previous blog entry of mine, dysfunctional breathing plays a huge role in the poor performance of these muscles and what’s more, back pain. With poor breathing mechanics, the body is unable to generate adequate intra-abdominal pressure to stabilize the trunk. Increased lumbar spine compression is a frequent result.
As a popular new saying goes, “Sitting is the new smoking”. This isn’t far from the truth. We sit more than just about any other culture and our rates of low back pain reflect this. Our bodies are configured in such a way that the tensional elements of our bodies (muscles, ligaments, tendons, fascia, etc) offset compression to the rigid structures of our bodies (our skeletons). This is a concept known as tensegrity. When we sit, we lose the tensional support of our lower halves and compression to our spinal column increases as a results. In fact, the mere act of sitting increases lumbar compression by approximately 60%. In addition to the compression element, with extended sitting we tended to tighten through the low back and hips, which further lends to this compression.
PUTTING IT ALL TOGETHER
Long term resolution of back pain requires that all these issues be addressed. Proper posture (or as close to it as possible) should be achieved and maintained. Compensations and dysfunctions of the core musculature must be addressed as well as learning and practicing proper breathing technique. And of course, ones lifestyle must be addressed. Repetitive motions and poor ergonomics can be the undoing of even the best of therapies. A comprehensive treatment plan will include things such as corrective exercises or stretches, breaks taken at the appropriate intervals and implementing proper ergonomics. A skilled therapist or trainer should be able to help you get out of pain and stay there.
- Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.
- This total represents only the more readily identifiable costs for medical care, workers compensation payments and time lost from work. It does not include costs associated with lost personal income due to acquired physical limitation resulting from a back problem and lost employer productivity due to employee medical absence. In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville.
- In Vallfors B, previously cited.