The Evidence is In: Slouching IS the Culprit!

Lower back pain is prevalent and patients frequently seek help to deal with the pain and functional limitations that arise.  It sounds oversimplified, but commonly lower back pain begins without any trauma, but more due to the cumulative effect of too much lumbar flexion each and every day—sitting in slouched posture at the computer, sitting to eat all meals, brushing teeth, washing feet, doing laundry etc.  We don’t get out of that position very much and over time, the back can become aggravated as a result.

A recent study provided information about the type of movements of the lumbar spine performed by 208 pain-free individuals over a 24-hour period, and the proportion of time spent in flexion and extension.

 Main Results:

The median total number of movements with a change in the lordosis angle greater than 5° was approximately 4,400 within the 24 hour period. Most of these occurred within a small range of movement.

On average, full flexion was achieved 50 times within the 24 hour period, whereas full extension was achieved 0 times.

94% of the day was spent in the 0-50 degree range of flexion and 2% of the day (24 minutes) was spent in any extension relative to the standing position.

Conclusions: The data illustrated the spine mainly moves through a small range of movement during normal daily activities, the minimal amount of time spent in any lumbar extension, and the majority of time spent in flexion.

A huge 66% of the movements occurred within a very small range – only 5 to 10 degrees of movement. It appears that those movements are occurring within the flexion range, but of course may not be at full end-range. It is good to finally have some evidence about the number of movements and the type of movements that an individual without symptoms performs in a normal 24 hour period. What this research does not tell us is if individuals with lower back pain have a different movement pattern.

Physiotherapy for people with lower back pain often involves education on correcting sitting posture using a lumbar support in chairs to prevent slouching, and various spinal mobilizations and exercise into lumbar extension to lessen or abolish the pain and functional limitations due to living in flexed positions!  Back pain can often be completely abolished when lumbar flexion positions can be avoided for a short time, and repeating lumbar extension movements.

Prostate Issues are Not Just for your Grandpa

Prostate Issues are Not just for your Grandpa

Prostate cancer is often diagnosed in men in their 50s and 60s, but younger men can experience this as well.  About 40% of men diagnosed with cancer are low-risk, and will have “active surveillance” over time, but it should start with a blood test to see the PSA (prostate-specific antigen) level.  If this is at all concerning, then it can be followed up with an MRI to see if a biopsy is even needed.

Often men will first have their PSA tested at age 50, but it is now recommended that a man has his first test in his mid-40s.  If the PSA level is low, then it needs to be repeated only every 5 years until about age 60.  Doctors are suggesting that healthy lifestyle choices might help to lessen the chance of developing prostate cancer—regular exercise, maintain a healthy weight and eating less animal fat.

For those who develop prostate cancer, it needs to be treated aggressively.  If a man has to have the prostate removed, better surgical techniques have been developed that allow sparing of the nerves that control the bladder for urination, as well as erection and ejaculation.  For several months after the surgery, almost every man will experience urinary incontinence and erectile dysfunction, but pelvic floor physiotherapy can be helpful to return to a much better quality of life.

The pelvic floor is a group of muscles that sling under the pelvis, and act as support and stability, as well as assisting as a sphincter.  These muscles work collectively, and are generally ignored by all until there is a problem with leaking urine.  Your pelvic physiotherapist can help you to make sure that you are engaging these muscles correctly and effectively, as well as teaching you how to manage the abdominal pressure changes that come with coughing, sneezing laughing or moving around.

There is much that can be done, and seeing a physiotherapist who practices pelvic health can get you back on the road to full function quickly.