Written By Tricia D. Lish PT, DPT – Back in Action Physical Therapy
Is back pain preventing you from doing your everyday tasks? Is it also affecting your ability to do your job? Keep reading and consider the steps you should take in order to not let back pain control you.
What causes low back pain?
As a physical therapist every single day I treat someone who suffers from low back pain. It is a common complaint and has a significant impact on everyday life. There are many possible causes of low back pain and the main ones will be discussed throughout this article.
When considering issues of the back there is a phenomenon that needs to be addressed. It is called referred pain. You may say that you do not actually have back pain, but experience pain in other places including the hip or buttock or even down the leg extending into the foot. When I have someone come into my office with a report of hip pain without traumatic incident, I never focus my examination on the hip alone because more often than not, it is spine pathology that is masking itself as hip pain. This hip pain is referred pain that is actually coming from the back. I understand this can be misleading but the science behind it relates to how your nervous system developed during early fetal life.
Sometimes pain isn’t the only symptom you might feel, but other possible sensations include numbness, tingling, burning and even muscle spasms. These symptoms are more associated with radicular pain, which relates to compression of the nerves as they leave your spine, and will typically follow a certain pattern that corresponds to what level of nerve being affected. Typically the more peripheral or further down the leg the symptoms are, the more severe the condition.
There are different types of pain including chemical and mechanical pain. Chemical pain often occurs right after injury when the body is going through the inflammatory process and the chemical make up associated with injury is stimulating your nerves thereby creating pain. When you are in this state, pain medications can help control your pain. However, I often hear from patients that when they take pain medication it does not seem to help their pain. In this case they may be experiencing more mechanical pain. The structures in your back are being stressed in a mechanical way that is generating pain. For many people they have had on and off back pain for many years. Your condition may be in more of a chronic state. In this case the actual structural properties of the related tissue have changed and are now in a more abnormal state. Normal motion with healthy tissue is not painful; however, normal motion with abnormal tissue is painful. Continue reading to understand the effects certain motion may have on your back pain.
How does sitting affect my back pain?
As a society our lives are very sitting oriented. Most everything we do is down and in front of us. When thinking about the impact sitting has on the spine, I need to provide you with an overview of the spine structure. The spine consists of 33 bones called vertebrae and in between each of these bones there is an intervertebral disc, which consists of an inner gel like substance surrounded by fibrous discs. Within the canal of the vertebrae sits your spinal cord, and at each segment of the spine your nerves exit and extend out into your body.
There are natural curves, which make up a neutral spine. Neutral for the low back is a slight forward curve called lordosis. When we bend forward the spine is moving into flexion and when we bend backwards the spine segments are extending. The spine also moves into rotation and side bending. The problem with sitting is it is difficult to maintain the spine in a neutral posture, and often times we find ourselves in a more comfortable leaned back or slumped posture. In this posture there is more flexion and the lordosis of the neutral spine is no longer maintained. If you work at a desk all day or your job requires you to do a lot of travel, you are at more risk for back pain. Lets consider two structural effects of sitting and how it relates to the anatomy of the spine.
One pain generator of the spine is the intervertebral disc. One analogy I like to use when I am educating my patients is that the disc is like a jelly donut. If the donut was to receive too much forward pressure, which happens with sitting, then the jelly will start to bulge backwards and can even squirt out. With the spine, you can get a disc bulge. This means that excess pressure from bad posture pushes the gel like substance out of its normal position. This can press against the nerves as they leave your spine, causing pain, numbness or tingling.
Another pain generator is the facet joints, or areas where each of the vertebrae touch. Each bone segment articulates with the segment above and below through the facet joints. There is one on each side of the spine process, which is the bone you feel when touching each individual segment of your spine. The analogy I like to use, is if you were to take your finger and bend it backwards and hold it there for several minutes, initially, the position would be ok, but if you held it there long enough you would start to experience pain in that position due to the prolonged stress on the joint capsule. If your spine is in a non-neutral position for a prolonged time, which can happen with a poor sitting posture, then the joint capsule and surrounding connective tissue of the spine are being stressed, and like with the finger analogy, can generate pain.
Adding another analogy, the fibrous part of the intervertebral disc and the connective tissue of the facet joints are like a rubber band. You can stretch the rubber band within a range and it will return back to its original length. The more the band gets stretched and the wider you stretch the rubber band it begins to weaken, and with enough stress, the rubber band will break. This correlates to micro-tearing and even possible full rupture of the disc structure.
Sitting is not the only factor causing low back pain; there are a number of mechanical positions that create injury to the tissue of your spine. Other potential incidents that lead to low back pain include repetitive lifting or lifting too heavy of an object without proper mechanics. Repetitive rotation of the spine is another activity that can excessively stress the spine. As an example, a grocer all day is constantly rotating through the spine by grabbing items from the conveyer, scanning the items and then rotating to bag it. It is important to consider the demands of your job and what potential compromising positions the tasks place on your spine. Sometimes injury can happen with one event and sometimes back pain results from the cumulative effect of poor positioning and abnormal stress over time.
What should I do to treat my back pain?
1. Activity modification: quit doing the activities that cause pain.
With abnormal stress to the structures of the spine you can cause injury. Consider your finger and imagine you have a cut on the back of your finger. Every time you bend your finger you run the risk of tearing the cut open. This is the same with your back. Essentially there is a cut or micro tearing occurring in the structures of your spine and doing a lot of flexion based activity or bending forward will aggravate your condition. This includes sitting. It is a good idea to limit how much you have to sit. For many people they have a desk job and it requires a lot of sitting and in this case it will be important for you to improve your sitting posture. You will need a chair that provides good lumbar support or use an external device like a support pillow to help maintain the spine in neutral position. See this video tutorial on proper sitting posture and the use of a support pillow. It is also important that you take a break and stand up every 20-30 minutes to reduce excessive stress on your back. Avoid excessive bending over and do not perform stretches like bringing your knees to your chest because they create flexion in your spine.
2. Activity addition: perform activities that promote extension.
I have already mentioned that most of what we do is down and in front of us, which leads to excessive flexion of the spine. However, the spine is meant to bend both forward and backwards. When someone comes to see me for back pain I look at the range of motion in the spine and generally there is an associated loss of mobility into extension. You will want to promote more extension throughout your day. Two exercises to start working on are a standing extension and prone press up. Follow the link to the video tutorials to start working on improving your spine mobility.
The two previous suggestions seem simple enough to start trying on your own; however, I am a physical therapist and I want to relay to you how physical therapy can play an important role in your recovery. Every person is different and it is a good idea to see a musculoskeletal expert that can create a plan of care that is right for you. A physical therapist will help make you accountable and will help push you further and faster than you can push yourself with your recovery.
If you are suffering from back pain and need treatment, contact us today!