Low back pain, as common as the common cold.

A recent survey conducted by the federal government indicated that one quarter of  Americans suffer from back pain at any one time. and one eighth of Americans suffer from neck pain. The causes of the symptoms are varied but complications associated with back pain include: missed work days, visits  to the doctors office, inability to perform fundamental daily activities ie… laundry, child care, houshold chores. They can also include intolerance for lifting, decreased capacity for sitting ie.. in a car, pain with walking or standing, altered sleep quality and quantity, pain with movement. dizzyness, nausea,, increased blood pressure, increased blood sugar, short term memory difficulties… the list goes on.

During my course of study in physical therapy school, several of my instructors stated  that back pain was the most common complaint that gets people through the door in a therapy clinic. not long after graduating from therapy school, while attending a continuing education course provided by Ron Hruska of The Hruska Clinic and the Postural Restoration Institute, Ron was overheard to state, “if you are a human being living on planet earth, you will experince some form of back pain  during your lfetime.

The mechanics of Back pain (how to make your back Hurt)

We have established the prevalence of back pain in America, Studies show that in all other developed countries back pain is also a large scale problem with 1 in 3 patients complaining of back pain at some point in their lifetime. In as such, It is a problem that has received a lot of scrutiny and study over the years. The medical model for understanding the mechanics of back pain include: Poor lifting and movement mechanics, Poor posture and alignment, deconditioning, Strain/sprain/spasm and overuse. While the medical model does recognize stress as a contributing factor to the problem of back pain, in My experience, it is rare that clinicians prescribe or educate patients in activities/strategies specifically designed to reduce stress.

I have also observed many patients come into the therapy clinic with a history of problems that can complicate the recovery picture. These include:

  1. A history of chronic back problems that can span up to 10 years and beyond.
  2. Significantly overweight and deconditioned.
  3. Any number of “compensatory” patterns that allow a person to “get through the day”
  4. adaptive changes in the soft and bony tissues due to stress and degerantive processes
  5. Depression, emotional stress due to pain and uncertainty
  6. Lifestyle habits that contribute to a pattern of imbalance and stress on the core structures including the spine and discs.

So what does back pain look and act like?  here is a profile of a typical chronic back pain sufferer.

MALE:

Age: 35-99

Weight: usually over weight even obese. Not allways however, some are younger healthy individuals who may have injured their back during high school or college sports or in a work related event.

posture:  Excessive lumbar curvature, often times due to excessive weight around the midsection. Acquired forward head positioning and large upper back curvature ie.. hunchback appearance.  barrel chested, sloped shoulders.

Mechanics:  May have poor lifting mechanics, often rely heavily on their back to perform job duties. Excessive use of “BLT”( Bending/lifting and twisting), combines Bending Lifting and twisting movements repeatedly stressing the lumbar discs. Often has poor range of motion at knees and hips

Work: Usually involved in a job that requires heavy lifting or lifting light to moderate weight objects multiple times during the workday. They may alternatively  be involved in a job that requires sitting for long periods and long periods of inactivity ( truck driver, toll booth)

Self medicaters: these guys will often have a chronic history of  ibuprofen usage or some other OTC pain management medication.

Body Wisdom: Most of these guys will be completely out of touch with their bodies. “aches and pains are part of life, just ignore em”  ”cowboy up”

Fitness:  ”I get enough activity at my job, I don’t need to exercise.”

Female:

Age: there is a greater variation in age ranges here, however women will tend to seek medical help a little sooner, but not always, some women will suffer quietly for 10 years or more, they might wait until degenerative changes reach a point of no return before seeking help. often in their late 60′s, after medicare benefits kick in.

weight: Again with women, the worst of the chronic pain sufferers are usually overweight and many suffer from other chronic pain issues such as fibromyalgia.  However, with women, weight is not always a primary consideration. I have seen many thin women of small stature in the clinic with complaints of  back pain.

Posture: Chronic back pain sufferers can demonstrate either excessive low back curvature and forward tilted Pelvis or Opposite to that, Very flat back appearance with Rounded shoulders, and pronounced  head  forward position.

Mechanics: Many of these women will be severely out of touch with themselves, leading to low levels of physical activity, These are NOT athletes.  hip Range Of Motion will often be abnormal with restricted hip extension on one or both sides and possibly excessive hip external rotation  and limited hip internal rotation. Many of these women will have weak Abdominals and pelvic stabilizers.

Work: Work poses a different kind of hazard for most of these women, often these women spend 8 or more hours a day on their feet or sitting behind a desk, leading to an overuse and fatigue type of problem which contributes to their low back pain. many of these women are the primary Housekeeper and care givers as well, work doesn’t end at the end of their job day. many of these gals also put in another 3-5 hours of work at home.

Body wisdom: Here is where the root of a lot of these women’s problems lie. many of these women are severely out of touch with themselves. body wisdom for many of them consists of knowing when to to eat and that something hurts somewhere. many of these women have body image issues and are more concerned about their Body “appearance” than about healthy weight management or fitness and conditioning. As stated earlier many of these women have other chronic pain syndromes such as fibromyalgia and have poor stress coping strategies.

Fitness: some of these women may exercise but tend to focus on “spot trimming” activities to get rid of  their hips or their Butt. but many demonstrate poor overall conditioning.

Overall,  the lifestyle picture of the chronic back pain sufferer includes poor conditioning and excessive weight especially around the midsection. Poor work and lifting mechanics including excessive use of BLT strategies. Postural imbalances and adaptive changes in the joints that limit range of motion at the Hips, back and knees. The typical back pain sufferer will often work at a job that encourages excessive loading of the back with heavy lifting or repetitive motion.  These sufferers will also often have a poor mind/body connection and suffer chronically from a low/moderate to moderate amount of stress. many will demonstrate poor stress coping strategies. Many of these people will also have lifestyle habits that contribute to their pain as well, including:

  • Smoking/Drinking
  • Poor diet
  • sedentary
  • Stressful home and/or work life
  • weekend warrior

An Integrated approach

So What then Can we do To avoid this problem that would seem to be predestined to trouble us? There are a lot of competent and helpful professionals out there including: Doctors, Physical therapists, Chiropractors, massage therapists and Personal trainers. Each of these professionals have their strengths and weaknesses. each of them has their specialty and an education in a discipline to provide you with a specific service. Many of my patients in the therapy clinic also use a massage therapist and/or a chiropractor to supplement their physical therapy. So then, what is left for you to do? how can you improve the chances that you’ll never have a serious problem with back pain?

My reason for writing this article as well as for hosting this blog is to not only educate you the reader but to EMPOWER you as well to take charge of your own health and wellness.  Remember that no matter how many letters a health care professional  has behind their name, you are the expert on how your body feels.

Lets take a look at one possible plan to reduce the chances of back pain and serious complication associated with it…..

1. Core and Pelvic stabilizer muscle strength! studies have shown that people with back pain don’t necessarily have a “weak back”  the problem is more likely to be weakened and deconditioned core and pelvic stabilizers including the abdominals and Paraspinal muscles as well as the Glutes and hamstrings and hip adductors.  I highly recommended yoga. But there a large number of activities that can build core strength and stability.

2. Correct any postural imbalances and misalignments. A good chiro can help resolve acute bony misalignments however, long standing chronic Imbalances are multi factorial and often a person’s  movement strategies and muscle imbalances will cause a relapse of misalignment within minutes after leaving the chiropractors office, (sorry) chronic misalignments require a comprehensive postural reintegration and stabilizing program and a good coach to help correct compensatory movement problems as well as a  good mechanical adjustment.

3.  Learn to breath using “natural” or “diaphragmatic”  mechanics to avoid rib and spine dysfunction associated with inefficient breathing strategies/mechanics. The diaphragm has a greater influence on lumbar mechanics than many practitioners had previously realized. A  good yoga or mediation teacher or even a singing coach may be able to help with this.

4. Learn  Stress reduction/relief strategies and techniques.  there are ton of ways to reduce stress and to deal with stressful situations. we will cover some in future posts.

5. FOOD IS MEDICINE! improve your diet, there are any number of reasons to improve your nutritional intake including the most obvious, Weight loss! many of us however also eat diets high in sodium, fats and sugars as well as food additives such as MSG that have been shown to be damaging to our bodies and organ systems. Our diets contribute to a tendency toward chronic inflammation in joints and  organ systems. Research has also recently demonstrated that the average American is actually walking around day to day in a state of mild dehydration. this also has a number of physiological effects on the body that we will go into in another post.  Drink water and remember, only water is water, it can’t be replaced by pop, soda, coffe, tea, juice, beer etc…

6. Adopt a more active lifestyle. While exercise and training of the core and pelvic stabilizers is essential for preventing and reducing the effects of back pain, it’s Not enough. Begin walking, get involved with something that will get you up and moving. Enjoy Life! thats what It’s all about. very seldom do I get people comming to see me in the clinic who are active, happy and fulfilled people, and when i do usually it’s more of an acute type of injury rather than a chronic problem. So get out there and live, laugh and love. your wellness depends on you taking action every day.

Mitakuye Oyasin (we are all related)

Rich is a wellness coach and practitioner with 7 years experience as a clinical physical therapist and is also a certified strength and conditioning coach. To contact rich for consultative purposes or to host a workshop please see our workshop and coaching page for details.