Focus on Pain: The Low Back

by Dr. Christopher on November 8, 2010

Why do you have low back pain?  Why does everyone seem to have low back pain if not all of the time, at least at one point in their lifetime?  Why do the same people continue to see healthcare practitioners without a complete resolution of their issue? 

I’ve explored some lifestyle causes of low back pain and how the choices you make in everyday like can increase your risk of injury.  

Here, I’d like to get into the specifics, physiologically speaking, of what is going on with low back pain and offer some theories as to what causes it to be so prevalent. 

Culturally, what are we doing wrong?

Courtesy of t-nation.com

As I’ve mentioned before, we are hunters and gatherers.  The standup hominid as we know it split from the ape species approximately 7 millions years ago.  Homo erectus?  2 million years ago.  Homo sapiens as we are today?  150,ooo years ago.  

Genetically speaking, there has not been enough selective pressure to cause us to evolve further.  Let me explain.  Selective pressure exposes genetic weakness that causes an individual to die before he can reproduce.  It may be an inability to outrun a predator, a compromised immune system leading to infection, or a tolerance of mutations in our DNA that leads to organ malfunction.  These are all things that previously would allow us as a species to evolve, where the weak die before being able to reproduce, so “survival of the fittest” holds true. 

In today’s world, we prolong life through any means possible.  There is widespread overuse of antibiotics to keep us alive, allowing bacteria to evolve at much quicker rates than we can to fight the infection.  We operate on those with organ dysfunction, finding anyway to squeeze days, months, or years out of our lives, as unpleasant as they may be.  We vaccinate with dozens of chemical concoctions to prevent even the slightest possibility of disease, as minimal a risk as it may be.  All of these actions we take allow the weakest of humans to make it to reproductive age so that today, our genetic code is the same as it was 10,000 years ago, or even weaker. 

With the same DNA as our hunter-gatherer ancestors, we spent our days hunting, gatherering, running, playing, cleaning, working, etc.  The key to this lifestyle is that we were always moving and using our bodies (or more specifically, our musculoskeletal systems).  We didn’t begin life as a child in first grade, where we’d sit in our desks for 6 hours a day, well into high school and college, where we’d continue to sit.  Then, we’d get a 9-to-5 job, where we’d sit some more.  Finally, we’d come home and plop our butts in front of the television, to sit our lives away. 

Sitting is the bane of our existence and a primary cause of obesity, depression, and musculoskeletal pain today.  Following the ‘use it or lose it’ principle, it allows us to lose muscular strength, endurance, and flexibility through inactivity.  Why would we need these necessary components of health when we’ve resigned our bodies to sitting so much of our time? 

On an anatomical level, here’s what happens…

Your upper extremities (aka your shoulders, elbows, and ultimately, your hands) were designed by nature to grab things in space and alter your environment.  You can grab fruit off of a tree, pick up a child off of the floor, or build shelter.  Because of this need to get work done, your upper extremities were designed for mobility.  Your shoulder consists of a ball and socket joint (the glenohumoral joint), which allows for 360 degrees of motion as long as you don’t lose it

Your lower extremities (aka your hips, knees, and ultimately, your feet) were designed by nature to move your body through your environment.  You can move yourself to safety, to get your body closer to food, or to any physical location that you desire.  Because of this need to move through space, your lower extremities were designed for mobility.  Your hip consists of a ball and socket joint (the femora-acetabular joint), which again allows fo r360 degrees of motino as long you don’t lose it.  

If the upper extremities and lower extremities were generally designed for mobility, what was your spine designed for?  The answer is stability, or keeping the spine in it’s neutral posture throughout ALL of life’s daily movements.

And if you’re a manual therapist and one of your patient’s core muscles, ligaments, or tendons as an adhesion, you can guarantee that the core stabilizing muscles are not going to be functioning at 100%.  So you should be able to treat all of these structures: lumbar semispinalis, multifidus, rotatores, psoas, facet capsules, and interspinous/supraspinous ligaments.  It wouldn’t hurt to work on all hip musculature as well.

How to Prevent Low Back Pain and Ensure Long Term Spinal Health

Now, I say spinal health.  But this isn’t just about spinal health.  Really, when we work on core stability and hip mobility, we’re talking about long-term musculoskeletal health.  We’re talking about being able to use your body when you’re 60, 70, 80, 90, dare I say, into your centennial years?  We’re talking about having a body that functions at its optimum, allowing you to do the things that you love, whether that’s playing tennis, taking care of your grandchildren, or cleaning the streets like my Babci

Conventional wisdom can still be seen in gyms world wide today, as people continue to “work their core” by doing ridiculous amounts of situps, curlups, crunches, etc.  By doing so, we are overloading an already overworked hip flexor complex (from all of the sitting) further reducing hip mobility and increasing the risk of low back injury.   With this observation, guidance is needed. 

Here  are 4 essential tips. 

  1. Perform all exercise and everyday life activities by bracing your abdomen: The purpose of “bracing” is to prevent lumbar spine movement.  You do this by activating ALL relevant core musculature so that each muscle is holding the spine tight, pulling from every direction, like guidelines on a tower.  You can practice this yourself by simply pretending that someone is going to punch you in the stomach, you want to prevent them from damaging you.  You will naturally tighten all relevant core muscles.  You do NOT want to bring your belly button closer to your spine (as this preferentially overactivates the transversus abdominus).  If you’re known to have a hyperlordosis, also known as “J-Lo booty), you also want to think about tucking your sacrum underneath you by squeezing your gluteal (butt) muscles.
  2. Courtesy of robertsontrainingsystems.com

    Always (or as often as possible), maintain a neutral spine (“1” in the image to the right): Perform exercises that stress preventing lumbar movement (plank, side-plank), not emphasizing it (sit-up).  When you can hold the plank and side-plank for a good three minute count, you can then progress to more complex movements that will address other parameters of your musculoskeletal health and fitness, like these.

  3. Work on hip flexibility on a daily basis: Perform 360 degree circles with your hips on a daily basis.  Practice your squats, lunges, and other movements that emphasize moving the hips while keeping the spine stable as often as possible.
  4. Sit properly: If you have a choice, sit as little as possible.  But when you must, ensure that entire low back and upper back are in contact with the back of the chair (Sitting on physioballs as seen in the tv show, “The Office,” is a bad idea).  Also, use a chair or lumbar roll that allows you to stay in a neutral posture rather than flattening the low back.

Resources

For those who’d like to delve further, below are some fantastic resources by a couple of the best strength coaches around the country, Mike Robertson and Eric Cressey

  • Understanding your Abs Pt. I – Information about the rectus abdominus, or the “6-pack” muscle, Pt. II – Examples of beneficial core exercises(Mike Robertson)
  • Lower back Savers Pt. I, Pt. II, – Pts. I & II give excellent information on the low back Pt. III – Examples of beneficial core exercises (Eric Cressey)
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{ 7 comments… read them below or add one }

Dawn November 8, 2010 at 7:23 pm

Great article on why we get pain in our lower back. When compared to our earlier evolutionary state you can see just how “off course” we have got. I spend most of my day at the computer. I do try to get up regularly and walk about but it certainly is not what man – or woman’s – body was designed to do.
Dawn recently posted..Nov 7- Femanol – Does It Work

Christopher November 8, 2010 at 10:06 pm

Happy you enjoyed it Dawn. Given our working circumstances, all we can do is to make the best of the situation. Hopefully, it’s good enough.

Dany Morin November 26, 2010 at 12:01 am

Hi Christopher. I just have one question. What is your reasoning for not recommending sitting on physioballs? Thanks. 🙂
Dany Morin recently posted..Quand survient une hernie discale…

Christopher November 26, 2010 at 1:02 pm

Hi Dany…great question.

What is the alleged purpose of sitting on a physioball? to increase the endurance of the core stabilizing musculature of the lumbar spine (the transversospinalis muscles, external obliques, internal obliques, rectus abdominus or the “6-pack muscle”, and the psoas).

I agree that this is a valuable component of health and fitness, in theory.

The problem is that it is not practical when it comes to our desired outcome, for a couple of reasons.

1. PSOAS overload: Our core works best when the muscles named above work at 100% of their maximum efficiency. Due to prolonged sitting, the psoas, which is also a primary hip flexor (the act of bringing your knee closer to your chest), tends to do more work. More work = less blood flow = more toxin build up (because traffic is congested and the garbage men can’t get through) = scar tissue accumulation. Whenever there is a large amount of toxins, the body thinks “Damage…must repair” and that’s why scar tissue is so common.

By sitting upright on a physioball or any chair without a back, we are increasing the load that core musculature needs to be able to handle. The problem is that we’re asking more of the psoas when we sit. Because it attaches to each lumbar vertebra, when “tight”, it will increase the pressure on the discs. In a normal human, the discs can handle 100% of the load put on them. When the psoas are “tight,” usually from scar tissue, it is being overloaded, say with 120% (an arbitrary number is chosen) of the normal load.

Unless we’re striving to be sit-up champion of the world, the majority of us do not need to be preferentially exercising the psoas.

2. Not FUNCTIONAL movement: The best strategy to increase core stability so it translates to daily life is to do it movements that resemble everyday life movements. Makes sense, right? So doing exercises like planks, squats, deadlifts, standing presses will be maximally efficient at making each of us healthier, especially in our core.

MORAL of the story: Sitting is NOT good for our whole body, and especially, our low back. When possible, we should avoid the act. However, it’s a given that at times, we must sit. Our best bet is to weather this storm by decreasing the stress (or work) on our low back by sitting with a good chair, with a back that supports a neutral alignment). Then we should get our core musculature stronger by choosing exercises that increase core muscle load, but decrease psoas load.

Please let me know if this doesn’t make sense. I hope it is helpful.

Christopher November 26, 2010 at 1:05 pm

Also, please look up the “Nachemson Chart” for loads put on the lubmar spine and Dr. Stuart McGill for further reading.

Dany Morin November 27, 2010 at 3:26 am

Thanks you very much Chris. I’ll keep that in mind.

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