Understanding and Preventing Your Low Back Pain
About 80% of Americans suffer low back pain at some point in their life. This statistic is staggering, yet it doesn’t have to be this way. The key to staying out of this group low back pain sufferers comes down to one word: Prevention. If we had to choose one common problem amongst all low back pain sufferers, it would be poor low back position during common activities such as bending over, picking up a small child, exercising and sitting.
The lumbar spine, which is the lower part of the spine, is meant to have a natural curve to it that compensates for the forces of gravity, weight, etc. evenly and minimally. When this natural curve is straightened, or reduced, the forces on the discs, muscles, and ligaments of the low back are significantly increased. For example, sitting without maintaining the natural curve increases the forces on those structures by 30-40%!
There are many conditions under the umbrella of low back pain, but in this article, we will cover the following key points on low back pain for the sake of this informational handout.
Understand your symptoms and risk factors
Proper Activities of Daily Living
Common Low Back Conditions
Lumbar strains and sprains
A lumbar strain is when an injury occurs to the muscles of the low back. A sprain, on the other hand, is an injury to the ligaments or joints; both, however, have similar pain and symptom patterns. When these muscles or ligaments become injured, it can lead to dysfunctional movements, and cause instability in the spine. Patients suffering from this diagnosis often have pain when attempting to walk, sit, exercise and can even occur during sleep.
The main physical causes of this condition are:
Poor movement mechanics
However, with proper education, you can protect yourself from many of these causes. The primary sufferers of this condition, especially chronic cases, often are those in poor physical condition with weak stabilizing muscles. A comorbid factor of this condition is often a desk job that involves sitting for most of the day. This type of patient usually has poor sitting posture, which can lead to a weakening of your lower spinal muscles and destabilize the spine, contributing to the condition. The importance of a strong core and training your spinal muscles cannot be overstated.
In cases where the injury stems from a problem related to overuse, poor posture or improper from while exercising, there are steps that can be taken to help avoid these injuries from happening. Proper instruction about your postural habits can reduce the negative effects of sitting on the spine, and education about correct lifting form can reduce these episodes of low back pain and help you build a healthy spine.
This condition occurs when there is a narrowing of the spinal canal in the lumbar spine (the lower back). Often this results in compression of the spinal cord, which can lead to symptoms such as: pain, numbness, discomfort and radiating symptoms. The mechanism behind how stenosis happens is usually caused by the degenerative changes of aging. However, there are other causes.
The main physical causes of this condition are:
Degeneration of the lumbar spine
Lumbar disc herniation putting pressure on the spinal cord
Degeneration of the spinal column is inevitable with aging and may reflect normal changes in an aging spine. It won't necessarily always result in lumbar stenosis but is often the most common cause.
While it is difficult or borderline impossible to combat normal aging of the spine, there are some habits and tips you can use to reduce this condition related to the other causes. Reduce your chances of a lumbar disc herniations by learning proper bending and lifting biomechanics is the first place to start. You can do this by utilizing your lifting power from your legs and not your back. In relation to osteoporosis, making sure you meet the recommended calcium and Vitamin D intake, as well as incorporating weight bearing activities into your exercise routine (lifting weights) have been shown to significantly help. Post-menopausal women tend to be more susceptible to this condition and should ensure they are doing everything they can to prevent osteoporosis.
Lumbar Disc Disorders
The lumbar spine is made up of five bone segments called vertebrae. In between each vertebra are flexible intervertebral lumbar discs, which act as shock absorbers for the spine. The intervertebral discs are designed to be a tough outer ring of fibrous tissue called the annulus fibrosis, and a jelly-like center of the disc called the nucleus pulposus. The disc is then held together by ligaments on both the front and the back of the vertebrae. Additional support is provided by your trunk and core muscles.
In most cases, lumbar disc disease is the result of a normal aging process called disc degeneration which results in structural changes in the normal disc. As we age, the disc begins to lose fluid and dries out, causing the disc to compress. This then leads to the breakdown and degeneration of the tough outer ring of the disc (the annulus fibrosis) allowing the jelly-like center (the nucleus pulposus), to bulge out. This is considered a bulged disc or many people know it as a herniated disc. This bulged disc puts pressure on the outer ring of the disc, which may lead to low back pain. As degeneration of the disc continues, or with continued stress on the lumbar spine, the inner jelly-like core may eventually rupture out from the outer ring causing a ruptured disc. Once the inner nucleus herniates through the outer ring, pain in the lower back may temporarily improve.
However, the fragmented disc material can inflame or put pressure on the spinal nerves leading to an increase in sciatica-like leg pain, weakness, numbness, or changes in sensation in one or both legs. Most disc herniations occur at the lower lumbar spine at the adjacent spinal levels, most often the L4-L5, L5-S1 levels. Occasionally, severe trauma can cause a normal disc to herniate or may cause an already herniated disk to worsen.
Risk Factors of Lumbar Disc Disorders
Age and Gender - the highest incidence is in men between the ages of 30 and 50.
Obesity - being overweight puts added stress on lumbar discs.
Sedentary lifestyle - lack of exercise and poor core body strength.
Smoking - Smoking decreases oxygen supply to the discs causing more rapid degeneration.
Improper lifting - using your back muscles instead of your legs to lift heavy objects. Twisting while lifting
Posture - hyperlordotic lumbar curvature, anterior pelvic tilt (lower cross syndrome).
Repetitive activities that strain your spine - jobs that require constant lifting, pulling, bending, or twisting.
Frequent driving - staying seated for long periods and the vibration from the car can put pressure on your discs.
History and Symptoms of Lumbar Disc Disorders
Lumbar disc disorders may include one or a combination of the following symptoms:
Intermittent or constant lower back pain and pain in the buttock,
leg and foot pain, numbness or a tingling sensation in the leg and foot,
Weakness in the leg and foot
Decreased reflexes in the knee or ankle
Changes in bowel or bladder function.
The symptoms will vary depending on if and where the disc has herniated, and what spinal nerve root is affected. Leg pain is usually greater than low back pain with disc herniations and nerve root involvement. However, if there are only annular tears without herniation, the pain will be localized to the low back and buttock. The onset of pain can be sudden or gradual after an injury. Pain may follow heavy lifting, twisting, or straining activities or repetitive stress trauma. However, patients may not recall a prior injury or a precise time the condition began because it is often preceded by frequent episodes of less severe low back pain that usually resolved. Pain is usually characterized by sharp, shooting, or electrical pain that may be aggravated by movement, changing positions, sneezing, coughing, or prolonged sitting and standing. The pain is usually relieved with rest and a recumbent position.
Treatment of Lumbar Disc Disorders
Conservative care should be your first course of treatment to manage lumbar disc disorders, but treatment will depend on the clinical presentation, your age, overall health, and tolerance to therapies. With disc herniations, the first few days of care will focus on centralizing (reducing) leg pain, decreasing inflammation, and preventing further neurological loss by decompressing nerve root impingement and reducing the disc herniation. Osseous mobilization and manipulation and soft tissue therapy may be administered as tolerated. Home care will consist of pain-relief repetitive positional exercises and lumbar stabilization exercises. We will also educate you on ways to protect your lower back, positions to avoid, and how to manage activity. In most cases, bed rest will not be recommended as the sooner you are up and moving, the better the prognosis. Once pain and inflammation have decreased, we will continue working on lumbar stabilization and progress into proprioceptive training. We will evaluate muscle imbalances using posture and movement patterns with the goal of restoring good biomechanics and core body strength. Your home care will emphasize the progression of stabilization protocols and corrective exercises. If you fail to respond to conservative treatment, or in cases of severe neurological loss, a referral for a surgical consultation will be recommended.
Over half of facet syndrome cases occur in the neck (cervical spine), and a third occurs in the low back (lumbar spine). Facet joints are the small joints in the back of the spine that are responsible for much of rotational movement and limits side-to-side movement. The pain is often worst when moving from a sitting position to a standing position or moving from a bent-over position back to an upright standing position.
The main physical causes of this condition are:
Overuse (sports or labor)
Whiplash/motor vehicle accident
Sitting for long periods of time
However, with the proper education, you can protect yourself from many of these causes. The primary sufferers of this condition, especially chronic cases, often are in poor physical condition with weak stabilizing paraspinal muscles. A comorbid factor of this condition is often a desk job that involves sitting for most of the day. This type of patient usually has poor sitting posture, which can lead to a weakening of your spinal erectors and destabilize the spine, contributing to the condition. The importance of a strong core and training your spinal muscles cannot be overstated.
In cases where the injury stems from a problem related to overuse, poor posture or improper exercise, there are steps that can be taken to help avoid these injuries from happening. Proper instruction about your postural habits can reduce the detrimental effects of sitting on the spine, as well as education about correct lifting form can reduce these episodes of low back pain and help you build a healthy spine.
Lower Crossed Syndrome
The abdominal muscles are inactive and not supporting the spine, while the spinal erectors are pulling the lumbar spine forward, resulting in something called hyperlordosis. This means that the spine in the lower back has an exaggerated curve, which can result in accelerated degeneration of the joints of the spine.
At the same time, the hip flexors are facilitated and are chronically tight while the gluteus muscles are inhibited and have reduced activation. This leaves the back muscles to do most of the work to extend the spine instead of the gluteus muscles keeping the pelvis level.
Body Preparation and Positioning
Sternum Up- Keeping the sternum up automatically sets the body into the good posture and maintains:
Neutral Spine: Maintaining good spinal alignment decreases the stress placed on the spine and discs.
Hip Hinging: Bending at the hips, and not the low back, decreases the stress placed on the low back and increases strength & power.
Power Zone- The zone that will optimize lifting strength and injury reduction.
a. Bend your elbows at a 90-degree angle, and you are in the “Primary Power Zone.”
b. The area up to the shoulders and down to the hips is acceptable.
c. The more you can work in the “power zone” the less fatigue on your body
Abdominal Bracing- When all of your core muscles work together, a "Super Stiffness" occurs, and all three layers of the abdominal wall are activated to protect and stabilize the spine and discs.
Without bending forward, contract the abdominal muscles (like you are about the get punched in your gut - feel them tighten with one hand) and the buttock muscles (as if you are holding in a bowel movement). You will feel the lower back muscles contract (with the other hand) when you contract your abs and buttocks. Activities of Daily Living
Optimal Activities of Daily Living Considerations
The below images and descriptions were resourced from The Journal of Bodywork and Movement Therapies (2004) 8, 85–87 written by Craig Liebenson, DC
These are a sampling of some daily activities that you may encounter. We encourage you to practice and apply the body preparation and positioning described above. The Sternum Up, Power Zone and Abdominal Bracing should be utilized to protect and spare the spine.
Keep the spine upright by hinging from the hips as you bend your knees
Maintain all three points of contact as you move to an upright position
Going from Sit-to-Stand
Start in a seated position at the edge of your chair with your feet under your thighs before sitting up
To initiate movement begin upward movement by using your hips and knees
To avoid strain to your back, keep your torso upright when rising from the chair.
Picking objects from ground
When lowering to pick up the object, bend from the knees and keep your chest lifted.
When lifting keep your spine upright by hinging from the hips and knees.
If the object is not directly in front of you, it is important to keep your chest lifted in front of you while keeping your lower back’s natural curve.
Avoid lifting immediately after sitting for a prolonged period.