19 Mar 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.
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.