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.

Your Journey to a Better Back: Part 5- Back strengthening exercises

Once you’re feeling better and don’t have particular pain, you can try these two exercises that target the deep back muscles.  They shouldn’t be painful, but rather just challenging for your muscles to do several repetitions or hold for awhile.  If either exercise is creating pain, check with your Physiotherapist to make sure they are appropriate exercises for you!  Enjoy!

Your Journey to a Better Back: Part 4- Your back muscles are not that weak

It is surprising to many people to learn that your back muscles are likely not the cause or driver behind back pain.  Your brain recognizes that pain is not normal and can go into “protective” mode and the muscles can spasm or not work normally as a result, but they are not often the cause of the issue.  Check out this video below to explain more:

Your Journey to a Better Back: Part 3- The “Sloppy” Push Up

We all know that there isn’t likely one movement or exercise that is appropriate for everyone, but the “sloppy” push up can be helpful for many people.  People tend to sit slouched and spend WAY too much time with their spine rounded forward, so this is a nice movement to get out of that, and nothing you happen to do in your day puts your back near there unless you make a point of it!

Remember, the “sloppy” push up should not be painful.  If it is, it’s best to consult with your Physiotherapist to see if this exercise is appropriate for you at the moment.

 

Say “Yes” to Exercise for Back Pain

An interesting article where I both wholeheartedly agree and don’t agree: the researchers report that “the best form of exercise is the one that you are going to stick with”. Exercise in the form of general movement is generally fantastic, but often there are specific directions/ movements that could actually help repair the problem– read more 

If this interests you, you will find the blog from July to be a great read.

View original article:  www.scientificamerican.com

 

A Very Cool Study: Directional Preference in Action

In a previous blog, I was mentioning the McKenzie System of Mechanical Diagnosis and Therapy (MDT) and outlined what a “directional preference” is: the assessor is trying to determine if the person with back pain has one direction of movement that they can do repeatedly that will consistently decrease their pain or increase their movement.

There is a huge and growing area of research dedicated to the McKenzie system, and I want to outline perhaps my favourite study of back pain of all time! Audrey Long is the lead researcher for this study, and she is a Physiotherapist and McKenzie Faculty in Alberta, Canada. She and her team examined over 300 people with lower back pain, and was able to categorize 230 people who demonstrated a directional preference into flexion (bending forward), extension (bending backward) or lateral (sideways)—performing repeated movements into their direction of preference would lessen their pain consistently. These people were then randomized to continue, as homework for 2 weeks, repeated movements several times per day into their 1) direction of preference, or 2) the movement opposite to their direction of preference, or 3) the control group, which was assigned general stretches and strengthening of the back and hips.

People worked on this consistently, and after 2 weeks, the >90% of the group that worked into their direction of preference reported being improved or resolved. That is HUGE! It’s not often in research that you get such dramatic results. This group also reported having to take much less medication than initially, and their level of function had significantly improved.

Interestingly, 23% of the group that worked into the direction of movement opposite to their direction of preference showed improvement, and 15% of that group and the control group reported being worse. You don’t start doing exercises that make you worse as the days go on!

This study really demonstrates how important it is to determine if you have a direction of movement preference that consistently lessens pain or increases movement, as that can really allow back pain to move along quickly!

The study is called:  Does It Matter What Exercise? A randomized contol trial of exercises for low back pain. (2004) Spine. 29(23): 2593-2602 by Long, A., Donelson, R., Fung, T

Flexion Inspection

Most back problems are not really muscular.  It sounds weird to say, but so many people’s pain actually starts for no obvious reason, without any trauma. They might wake up with pain, or it might just start in their back after they’ve been sitting for awhile.  It is really common to hear that back pain starts when someone stands up again after bending forward to pick something up.

In life, we all spend WAY too much time bending forward. That forward bending movement is called flexion, and think about it– whenever you sit, are you slouching much?  Do you sit to get to and from work in a car or on transit?  Do you sit at work?  You certainly sit to eat your meals, and when you have a chance to relax you will likely sit more in front of the TV, or reading, or out for dinner or the movies.  Pretty much all our entertainment is in back flexion. Then if you sleep on your sides, your hips and knees are bent, allowing your pelvis to tip backward, and hey, more flexion. Then you bend forward to brush your teeth, sit on the toilet, tie up your shoes, reach into the fridge, etc.  You see my point: we live life in a flexed, rounded forward position.  It is no wonder that eventually your back can have enough and freak out a little.

It is important to make sure you get out of this back flexion quite regularly:  you can try sitting with a lumbar support, change your position at your desk often, get up and move around if even for short periods, and some will find that moving your back into extension (arching) is helpful relief.