5 Ways To Beat Back Pain
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Research shows that low back pain (LBP) affects 90% of the population at some time in their lives, and that 80% of these people will suffer a repeat episode at a later time.
5 Ways To Beat Back Pain
The lumbar spine consists of 5 lumbar intervertebral segments or bones.
Each segment consists of:
- discs (the “shock absorber” of the spine)
- facet joints (control movement)
- nerves (they exit the spinal cord from between the vertebra of your spine, travelling the length of each leg to send messages from your brain to your skin and muscles)
- and ligaments (support your disc and facet joints by providing stability)
Low back pain is a common and disabling condition that affects 85% of the population at some point in their lives, with 80% of these people suffering a repeat episode later in life. In fact, it is in the top five reasons that people will book in to see their GP. When you experience low back pain, it affects every aspect of your daily activities – work, social, home, sleep, not to mention sports and exercise. Often enough, this flows on to put a strain on our mental and emotional state.
To understand how you can effectively manage and prevent low back pain, it is important to understand what causes it. When the cause is known, that is when the problem can be solved and protected for the future.
Unfortunately, there is no universal answer to low back pain – the reasons why a football player, a truck driver, or a desk worker experience low back pain are often very different. The spine is one of the most complex structures in the body – it is the pillar of our body and the foundation upon which all our movements start. That is why it is important to look at the body as an interconnected chain when assessing a low back pain condition. While low back pain can be caused by local problems with the structure of the spine (i.e. the joints, the discs, the ligaments), there is also mounting evidence that problems elsewhere in the body (i.e. upper back, arms, legs, neck) can be the cause of low back pain just as frequently.
Individual assessment of your body and the activities you take part in is vital to understanding the cause of your pain.
FACTORS THAT CONTRIBUTE TO LOW BACK PAIN
1. POOR POSTURE OR TECHNIQUE
Everybody’s spine has a S-shaped curve that is designed to spread weight bearing forces evenly and reduce overloading on individual segments. The lumbar spine naturally curves slightly (lordosis), however the exact degree of this curve can vary. Each person has a posture that is considered neutral for their spine – a posture where all the nerves, muscles, and joints are aligned well and able to support you with minimal effort. Generally, postures that do not have a lordosis (i.e. slouching) will increase pressure on your discs, and postures that increase the lordosis (i.e. hyperextending) will increase pressure on your facet joints – either extreme will lead to pain and injury over time.
Your tendency to do either often comes down to habits reinforced by your lifestyle and activity, so it is vital to become aware of the positions you assume during the day and during your sleep at night. Once you have identified the positions that are causing problems for you, the next step is to correct them.
Common positions that lead to slouching: slouching on the couch/in the car, sitting in bed, lifting with a curved back, “butt wink” while exercising at the gym (squats), foetal position sleeping.
Common positions that lead to hyperextending: trying to sit too upright, sitting in a straight-backed chair, chest too high while squatting, stomach sleeping.
2. REPETITIVE OR HEAVY LIFTING
Lifting is a safe activity for your spine. When done with the correct technique, the muscles in our trunk will adequately support the discs and joints of our spine and protect them from injury. The risk of injury increases when 1) we attempt to lift objects heavier than our muscle strength can support, 2) when we lift repetitively to the point where our muscles become fatigued and begin to lose strength, and/or 3) when we lift with an excessively extended, curved or rotated spine, as these are not optimal positions for our muscles to work in.
When our muscles are not able to support our spine adequately, the load is placed on our spinal discs instead. For example, the pressure placed on the discs when the spine is excessively curved can rise up to 2.5 times your body weight. At worst, this can lead to tearing of the disc fibres and/or disc bulges and, when severe, compress the nerves nearby.
3. PROLONGED POSTURES
Our bodies were made to move so when we stay in one position for prolonged periods, strain and tension can build up in our nerves, muscles, joints, and discs. This can feel like increasing stiffness, tightness, or discomfort in the body. When we ignore these warning signs, this strain can build to a high level, eventually leading to pain and injury. Sitting, standing, driving, gardening… all these activities can cause strain to build up if we do them excessively, regardless of how good our posture is.
4. MUSCLE WEAKNESS OR INACTIVITY
There has been much research on the role of the deep core muscles of the spine and their role in preventing injury. The main core muscles consist of the transversus abdominis (over the front of your abdomen), multifidus (on either side of your spine), pelvic floor (forming a sling in your pelvic bones), and diaphragm (forming a ceiling at the bottom of your ribs). Together they form a cylinder of muscle that covers your trunk region and act as a natural brace for the spine, much like guy-ropes would hold up the mast of a ship.
When these muscles are weak, our body will rely on the discs and joints of the spine to take the load and pressure instead, which leads to wear and tear of these structures and eventually pain. These muscles can be weak due to lack of use or be inhibited due to pain. When this is the case, strengthening them again requires specific exercise and conscious practice so they can do the job they are meant to – taking the load off the spine to prevent injury.
As our bodies age, natural wear and tear develop in the spine, joints, tissues, and organs. In the spine, this is known as spondylosis, which involves loss of disc height and degeneration of the cartilage in the facet joints. Boney spurs, called osteophytes, may also develop as the vertebra of the spine try to adapt to the pressures put on the spine over our lifetime.
In some cases, these spurs can grow to significant size and reduce the space in the intervertebral foramen (the exit holes for nerves from our spine) causing irritation of the spinal nerves.
How significantly this contributes to an individual’s experience of pain, however, can vary despite the severity of the degeneration. More research is showing that the damage found on scans such as lumbar spine MRIs may not always be the cause of back pain.
Healthy individuals with no pain whatsoever will also have signs of degeneration as they age, so its best to consider the results of a scan as a factor to your back pain, not the complete answer.
6. TRAUMATIC INJURY.
Trauma can potentially lead to damage to ligaments, discs, facet joints, and/or muscles of the spine. When the body suffers a traumatic injury, be it a fall, motor vehicle accident, lifting injury, or sports injury, the brain’s initial response is to trigger the protective mechanism.
This often feels like a locked-up movement, muscle spasm, and, of course, pain. This response is generated by the brain to prevent further injury from any source, however, when this protective response remains unaddressed, it can lead to unhelpful reactions such as increased sensitivity to pain and avoiding certain movements due to fear.
Due to the variable nature of the traumatic injury, it is always best to work with a team of dedicated health professionals to help you manage these reactions and get you on the path to recovery.
5 WAYS TO BEAT BACK PAIN
1. MAINTAIN AND BE AWARE OF GOOD POSTURE.
Maintain a neutral spine during all your daily activities. When sitting, a rolled-up towel or firm posture support pillow behind your back in your office chair or car can assist with this. When standing, think about gently drawing in your deep abdominal muscles to lift your pelvis and support your spine – for some, this may feel easier when you distribute your weight evenly through the centre of your foot as you stand.
If you are a side sleeper, put a pillow between your knees to support your hips and prevent them from rotating during the night. If you are a back sleeper, a pillow under your knees can also offload pressure from the spine. Avoid stomach sleeping, as this exaggerates the curve in your lower back, leading to increased pressure on the facet joints during the night. Lastly, make sure your bed is supportive of the natural curves of your spine – if the bed is old (usually >15 years old) and sagging in places, then it is time for a new one!
You may have an increased or decreased lumbar lordosis and different exercises will apply for each. If you are unsure of the type of posture you have and how this can be improved, your physiotherapist can assess this and properly advise you.
2. APPLY CORRECT LIFTING PRINCIPLES.
Whenever you are lifting/pushing/pulling:
- Bend at both your knees and your hips to get close to the object
- Maintain a neutral posture in your spine
- Be aware of the weight beforehand by rocking it side to side before you lift it
- Keep the weight close to your body when you lift it – holding the weight further away from you will increase forces on your spine
- Brace your back by drawing in your deep abdominal muscles and maintain this tension during the whole lift
- Do not twist your spine as you lift, but rather use your feet to turn once you have the weight safely at waist level
3. TAKE REST BREAKS FROM SEDENTARY POSTURES
Avoid sitting for longer than 45 minutes before standing up and moving around. If you work sitting down, set up a timer on your computer that will remind you to take a break. Walking to the water fountain, or toilet, or simply doing a few stretches can prevent tension, pain, and fatigue from building in your muscles over a day. If you have a standing desk or occupation, do not stand for longer than 45 minutes in the same spot before walking or sitting.
If you can switch between standing and sitting, make sure you alternate between the two positions every few hours. If you are gardening or working on the floor with a bent posture, make sure you stand and walk every 20-30 minutes, as a sustained curved posture builds up strain the quickest.
4. CONTROL YOUR WEIGHT, STAY ACTIVE AND BUILD DEEP MUSCLE STRENGTH.
This strategy is essential to achieve back pain relief for the long term. Your body weight will directly affect the pressure on the spine and increase your risk of back pain. The best way to keep your weight under control is through regular cardiovascular exercise.
The Heart Foundation recommends at least 30 minutes of continuous activity that raises your heart rate daily. This may be walking, cycling, swimming, or taking a group fitness class. Of course, eating a healthy, well-balanced diet is also very important.
Working with a personal trainer and dietitian can help you get started. Incidental exercise like taking the stairs instead of the lift or walking to the cafe rather than driving can also play its part in building a more active lifestyle. Specific core exercises have been proven to assist with low back pain. These may include exercises on a Fitball, Pilates exercises, or floor exercises involving combined movements. Sit-ups are generally not the preferred exercise for those suffering low back pain as they increase the load on the spine.
There are countless exercises available to build strength in your spine, however, not all may be suitable for you.
Building your deep muscle strength is best done with guidance from your physiotherapist or an experienced exercise physiologist when you are starting out.
5. MANUAL THERAPY COMBINED WITH SPECIFIC EXERCISE
Joint mobilization, muscle release, massage, and specific strengthening/stretching exercises have been shown to reduce low back pain when prescribed appropriately. A course of treatment with your physiotherapy can get you out of pain and moving better sooner than waiting for your back to settle.
Once you are moving pain-free, then it is important to correct your posture and habits to prevent a recurrence. Finally, developing an ongoing routine to build strength and flexibility in your back is vital because a stronger body means it can tolerate more activity and loading without a problem.
This report provides some basic guidelines for managing and preventing back pain, but each case is different.
Your back pain will be different to your friends, family, or your colleagues so what other people have done may not be suitable for you.
Our experienced physiotherapists can help you resolve these problems by finding the cause of your pain. They have over 50 years of combined experience in dealing with back pain with a range of strategies that have helped thousands of people like you.
Call our rooms at Essendon on 9370 5654, or book online through our website for your initial consultation. Your satisfaction with our professional, caring, and thorough service is guaranteed.
You can look forward to years of increased energy and enjoyment doing the things you love to do!
Linda R. Van Dillen , Barbara J. Norton et al: Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial. Manual Therapy 24 (2016) 52-64.