Back pain is a common issue that affects millions of people worldwide. It can be caused by several factors, including posture, position, and lifestyle choices. As an expert in treating lumbar spine injuries, I have noticed that many people fail to understand how posture and position affect their back health. In this blog post, I will share my insights on the subject and offer tips on how to avoid overstraining specific structures in the spine.
Acute and Chronic Back Pain
Low back pain can be classified into two main categories: acute and chronic. Acute low back pain is often a temporary discomfort, usually lasting for a few days to weeks, whereas chronic pain refers to pain that persists for more than three months. It's important to note that chronic low back pain can vary in intensity and frequency. While some individuals might experience continuous, agonizing pain, others may face intermittent pain that worsens over time. This persistent pain can impede the quality of life, interrupting sleep, and limiting mobility. Understanding the nature and type of your low back pain is the first step towards effective management and treatment. Pain affects every part of life and severe pain can be debilitating so let's understand the different types of low back pain.
Distinguishing Between Different Types of Low Back Pain
The complexity of the lumbar spine means that low back pain can stem from various sources, including spinal nerves, facet joints, discs, and muscles.
Spinal Nerve Pain
Spinal nerve pain is associated with nerve compression or irritation of a nerve root or even the spinal cord itself such is the case with spinal stenosis. This type of pain is usually sharp, radiating, and might be accompanied by numbness or weakness in the legs—a condition often referred to as sciatica.
Facet Joint Pain
Facet joint pain on the other hand, tends to be a dull ache localized to the lower back, and can often be exacerbated by standing or bending backward. Facet joints help stabilize the spine and control its movement, and pain can occur if these joints are over-strained or arthritic.
Discogenic pain results from damage to the spinal discs, often through a condition known as degenerative disc disease. This type of pain typically presents as a constant, central lower back ache that intensifies during sitting or bending forward.
Muscular pain is usually felt across the lower back and can throb or ache. It's often the result of overuse, strain, or injury to the muscles and ligaments that support the spine. Muscular pain tends to improve with rest, heat, and gentle stretches. Muscle pain can be generated from muscle spasms, which can occur when the body is trying to protect an area. This is a common symptom with a variety of different causes of back pain.
Ligamentous Pain represents another potential source of lower back discomfort. The tough, fibrous ligaments that connect our vertebrae together can be subject to strain or sprain if they are stretched or twisted beyond their normal limits, often during abrupt or awkward movements. This type of injury can result in a deep, steady ache in the lower back which could also radiate to other areas depending on the affected ligament. Postural imbalances and chronic overuse can also contribute to weakening these ligaments over time, leading to persistent ligamentous pain. Developing core strength and maintaining good posture are key preventive measures against this type of discomfort.
Understanding the source of your back pain is crucial for determining the most effective treatment strategy. If your pain persists, a healthcare professional should be consulted to accurately diagnose your condition.
The spine is divided into two areas, the anterior and the posterior. The anterior structures include the vertebral bodies and the discs, while the posterior structures include facets, pars interarticularis, and all other posterior vertebral structures. These structures are typically under load in different positions. When someone is sitting or in flexion, the anterior structures are under load, while posterior structures are more under load with standing.
While there are no perfect postures, certain postures are better than others for specific injuries. For instance, someone with a lumbar disc herniation should avoid sitting for prolonged periods in a slouched position as this would typically make your pain worse. On the other hand, someone with facet joint arthritis could have increased pain with standing for prolonged periods. It's crucial to understand that the best practice to avoid overstraining any one structure is to change positions regularly.
One common misconception is that sitting upright or standing at your desk is the best position for back health. While it is true that sitting in a slouched position for prolonged periods can cause back pain, someone who sits upright for a long time can still experience back pain. The key to avoiding overstraining any one structure is to change positions regularly throughout the day. For example, if you're sitting at a desk for an extended period, try standing and doing some stretches every 30 minutes or so it can help with pain relief and prevention of the onset of low back pain in the first place.
In addition to changing positions regularly, maintaining good posture is essential for back health. When you're standing, your shoulders should be back, and your stomach muscles should be slightly tensed. When you're sitting, make sure your feet are flat on the ground, and your lower back is supported. These small adjustments can make a big difference in preventing back pain and injuries.
Physical Therapy For Low Back Pain
Physical therapy can also play a crucial role in treating lumbar spine injuries. A physical therapist can help you identify any muscle imbalances and weaknesses that may be contributing to your back pain. They can also provide you with exercises that can help you improve your posture, increase your strength, and reduce your risk of future injuries.
The key to recovering from low back injuries is to get moving as soon as possible. This doesn't mean you need to go and hike a mountain. A little movement can go a long way. In PT we focus on first reducing pain with light movement, manual therapy, and modalities. Then, we slowly reintegrate movement back into our program to help get you back to normal activity, sport, and life.
Physical therapy can offer a myriad of solutions for back pain relief, particularly through targeted exercises, massage therapy, and modalities such as Transcutaneous Electrical Nerve Stimulation (TENS).
Strengthening the core, particularly the abdominal muscles, can be instrumental in providing support for the lower back. These exercises often include planks, bridging, and abdominal presses, all performed under the guidance of a trained physical therapist. Regular engagement in these exercises can enhance muscular strength, aid in posture correction, and ultimately alleviate back pain.
Strengthening the lumbar extensors, multifidus, and the posterior chain, including the glutes and hamstrings, is crucial for maintaining proper spinal alignment and function. Lumbar extensors and multifidus muscles assist in back extension and bending while providing essential stability to the spine. Weighted hyperextensions and prone back extensions can be effective exercises for these muscles. The posterior chain, encompassing the glutes and hamstrings, is key for hip extension and lower body strength. Exercises such as deadlifts, hip bridges, and hamstring curls can build strength in these areas. It's important to remember to engage these muscles during everyday activities, maintaining proper form to prevent injury. Regular exercise and stretching can help keep these muscles strong and flexible, contributing to overall back health and reduced lower back pain.
TENS, on the other hand, is a popular modality that uses mild electrical impulses to activate the body's natural painkillers, offering a non-invasive and drug-free option for managing chronic back pain. It is important to remember that every individual’s condition and needs are unique, and thus, these interventions should be personalized based on individual assessments and treatment goals.
Common Things to Avoid
As we delve into common actions to avoid, it's crucial to highlight the excessive use of pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs), tylenol, and muscle relaxants. While NSAIDs, like ibuprofen and naproxen, pain relievers can offer temporary relief from back pain, it's unwise to rely heavily on them. Prolonged, excessive use can lead to severe health complications, such as gastrointestinal bleeding, kidney damage, and an increased risk of heart attack or stroke. If you're finding yourself frequently reaching for these over-the-counter remedies, it might be indicative of a more severe back issue that should be evaluated by a healthcare professional.Moreover, instead of merely masking the symptoms, an underlying cause-focused treatment strategy should be adopted for a long-term solution to your back pain.
It's paramount to initially avoid movements that escalate pain in order to prevent exacerbating the condition yet bed rest is not the answer. Bed rest can lead to increased weakness, muscle tightness, and can have many other systemic ramifications. Heightened pain typically signals additional stress on the affected area, which could potentially lead to further sensitivity and damage. However, it's crucial not to avoid these movements indefinitely. Over time, with therapeutic intervention and guided exercise, these movements can be gradually reintroduced. This process helps restore normal function, improves strength and flexibility, and diminishes the fear of movement often associated with chronic low back pain. A tailored physical therapy program can guide this progressive reintroduction of movements, ensuring they are done safely and effectively, thus contributing to a sustainable long-term recovery.
In conclusion, it's essential to understand how posture and position affect your back health. While there are no perfect postures, changing positions regularly and maintaining good posture can help you avoid overstraining any one structure in your spine. If you're experiencing low back pain, consider seeking the help of a PT who can assess your condition and provide you with a personalized treatment plan to help alleviate your pain and prevent future injuries. Physical therapists are specially trained in helping to reduce symptoms and help you avoid further injury.