Low back pain is one of the biggest causes of sick leave in the Western world but in most cases, it’s entirely preventable. It’s one of my favourite things to treat but the fun part is working out the different factors that led to it and putting in a plan to prevent it happening again.
Here’s the thing: unless you have had an actual injury ( a fall or a knock), there is no ONE cause for your low back pain. While some event might have been the catalyst, there are usually 3 or 4 other factors mooching around in the background and adding to the likelihood of getting pain before something sets it all off. The key to backpain prevention is taking a good look at the numerous interacting factors and reducing those. See how many of the factors below that you can pick out that pertain to you and you then have the basis for your action plan.
Let’s look at some of the outside factors first, and then we will get to things specifically involving your back:
OUTSIDE FACTORS
1) Occupation
If you sit a lot at a desk this puts your discs under significant strain. Discs are like the sandwich fillers between your vertebrae ( back bones) and they don’t like getting squished all the time. Sitting squishes discs much more than standing or lying. Getting your desk and chair at the correct height is a massive help. USING THE BACKREST is helpful, people! How many people spend a fortune on an office chair and then perch on the edge?….you might as well be sitting on a stool….Backrests support your back in its upright-against-gravity job, and takes the strain off your discs. If you only use it for 30% of the time, it’s better than 0%....AND you are vindicating that large sum you paid for the chair….just saying!! Take frequent breaks during the day to stand up and move. Better still, get a standing desk or one that can move between sitting and standing, so you can vary your position during the day.
If you bend or lift a lot in your job, you need to know that this is asking a lot of your back and that you need to offset this with stretches or exercise. Tradespeople do a lot of bending in their jobs and this is like everyday micro-trauma to your back. It chinks away at the structures of your back, and then one day your back might just ‘give’. But it’s the sustained micro-trauma that is the cause, not the job you were doing at the time of injury. Fatigue is a huge factor in overuse injuries like this, so beware the rush up to Christmas to get the jobs done. Keeping fit aerobically is a real protector against micro-trauma so make sure you are not working so hard that you don’t have time for self-care exercise.
Driving for a living is very hard on your discs too. Not only has you the sedentary aspect of it ( see below) but the prolonged sitting combined with the stretch on your sciatic nerve that occurs during braking and clutching, makes it the all-round bad guy for backs. Make sure you keep fit to mitigate this.
2) Stress
Yep, same old story: stress is not in your head, it is a hormonal and biochemical event in your body. It fills our body with adrenalin and cortisol and if sustained over a long period of time, then it tightens our muscles and plays havoc on our joints. Nearly every time I examine someone for low back pain, there is at least one life/stress factor lurking about for the previous few months. We can’t always avoid stress, life being life, but learning to manage it is important. So you need a relaxation plan to stimulate the opposite chemicals ( feelgood, relaxation ones like endorphins) …you can read my blog on relaxation here.
3) Fatigue
I’m sounding like an old clanging bell on the effects of fatigue, but the simple truth is that being tired predisposes you to injury: long distance travel, holidays (yes!), emotional distress ( family worries, I-hate-my-job feelings), too much work or indeed too much exercise drain our body’s resources to be resilient to the daily grind that it places on our back. Your back has to hold you up against gravity for all of your waking hours…when YOU get tired, IT does too. Read my blog on fatigue if frequent tiredness is a problem for you.
4) Genetics
We can sometimes blame the parents! WE have no control over what we inherit, but it’s safe to say that weakness in the back can run in certain families, just like heart disease. You might inherit a long back, for example, which puts greater leverage on your spine when bending and is therefore more prone to injury. You might inherit hypermobility, where you are super-bendy in your ligaments (more about this in the weakness section below). Or you might be more prone genetically to wear and tear (osteoarthritis) of your joints, including the facet joints in your lower back. Let’s face it, you can’t alter your genetics…but if you know there’s a family trait, then it becomes even more important to search for other things you CAN change.
5) Lifestyle and sports/activity
Having a sedentary lifestyle makes your back more prone to injury. Full stop. Exercise in any form is your back’s greatest protection against injury, just choose one that doesn’t bother your back!! It strengthens your muscles and increases the blood flow to all of the cells in your discs, joints, ligaments making them stronger and healthier. This becomes even more pertinent as you get older – just like an old car, older bodies need a bit more maintenance than younger ones. Pilates and Yoga are particularly good for your back. The odd massage/osteopathic or physio session for maintenance is a good idea too.
6) Cigarettes and alcohol/sugar
Yep, cigarettes and alcohol dehydrate your tissues making them more prone to injury and high sugar intake has hormonal effects on your tissues. Sorry, all the fun stuff is always to blame….sigh!
7) Holidays
Have you ever wondered why your back gives up on you when you go on holidays? This is SUCH a frequent occurrence. The truth is that when we suddenly relax after periods of massive go-go-go, our immune system takes a holiday too, and the result can be injury or illness. Please don’t blame the holiday, it’s all the stress that preceeded the holiday that’s at fault. Go easy for your first few days on holiday, it’s when you are most at risk.
8) Bed and chairs
So often, people with ‘bad backs’ need a specific bed or a specific chair to make their back feel okay. While this might be true if you’ve had a serious back injury or if you sit/drive for a living, for everyone else, I’m of the opinion that if you get to this point, then you are losing the war. A healthy back is designed to be able to sleep on different surfaces for 8 hours a night. If you can’t, then you are dealing with too much stiffness or too much weakness and you need to do something about this….pronto. Go ahead and get that bed or chair but just don’t let that be the only answer. This leads me nicely on to back-specific causes for low back pain. These are also factors that you can DO SOMETHING ABOUT……
BACK SPECIFIC FACTORS
1) Old injuries
The body keeps the score. That fall off a bike ten years ago may have apparently left you with no ill-effects, but it might just have left you with scar tissue in some area in your back. Always make sure that you have fully recovered from an injury and don’t go around with a half-treated leg/knee/back and expect your body to perform forever without complaining. Your body compensates somewhere else and it might well be your back doing the compensating. If so, this is quite likely to lead to an injury eventually. Go get yourself some physio.
2) Hips, knees and feet
Look after your hips, knees and feet! When you walk and stand, the forces from the ground are transmitted up through ankles, knees and hips upwards to your sacro-iliac joint and back. If you are limping around with a knee/hip/ankle injury, this puts tremendous strain on your back. So get injuries treated. Stiffness in these joints or in the muscles around them, causes micro-trauma to the back when you walk. The most common example is someone with stiff muscles around the hips: if you can’t stride to your full extent, your back has to rotate to give you the stride length you need. Add in 10,000 steps a day and that is 10,000 micro-rotations in your back. It’s not rocket science people! Eventually something in your back will start to complain. Stretching and moving your leg joints as you get older is so important for your back so go join a yoga class, my friends, you won’t regret it.
3) Childbirth injuries
Pregnancy and giving birth are not easy on your back. Your ligaments soften during the pregnancy , reducing the inherent stability to the area, and this lasts for a number of months after your new arrival. Also, the process of giving birth can cause injuries to pelvic floor or sacro-iliac joints. On top of this, spinal injections can cause minor trauma and inflammation to the facet joints. So make sure you aim for full recovery after giving birth, get injuries treated and strengthen your pelvic floor if it got injured or torn. There are lots of good physios specializing in women’s health so find one, they are a true gift to the universe and to you!
4) Weakness
Some ‘bad backs’ are mainly down to weakness. As I’ve said, your back has to hold you upright against gravity for maybe 14 plus hours a day. It’s a big job. The spine is a stack of bones with discs in between each two vertabrae acting as shock absorbers, all held together with ligaments. But these can only do SOME of the work. Your muscles are the main things that provide stability to this structure. And here is where it gets interesting: you actually have two sets of back muscles with very different jobs to do. Firstly, there are the ones that make you move in different directions, bend and straighten and do your work and secondly (more importantly) the deep muscles that HOLD all the discs and bones together WHILE you move. The deepest set are the ‘deep front line’ of muscles (google it) consists of your deep back muscles, your pelvic floor muscles , diaphragm, deep tummy muscles, part of your hamstrings and your diaphragm and other muscles above and below. These are helped in the stabilizing job by your side muscles (quadratus lumborum), abdominals, hip muscles and some of your shoulder muscles…who knew! So, you can be a really strong fit active person and STILL have key areas that are weak and underactive. This is especially true for hypermobile folk ( see below) but I’ve also seen strong rugby players with ridiculously weak core or hip muscles. This is why strengthening is SO IMPORTANT!!! I can’t stress this enough. Go join a Pilates class or a yoga class that involves a fair bit of strengthening, like mine (plug!). Yoga is known for its improvement in flexibility but the poses can be used for strengthening with the right cues.
5) Hypermobility
This is one of my favourite conditions to work with because the results are so satisfying. It is very under-diagnosed and mis-understood. When you are hypermobile, your ligaments are super-bendy ( or somewhere on the bendy spectrum). You folk tend to click and crack your backs or necks for comfort, you may be able to touch the ground with your palms without any stretching or have been ‘double jointed’ as kids. The effects on the spine can really affect quality of life. For you, BECAUSE your ligaments are bendy, you need more than others to strengthen your deep core muscles ( the set that hold things together while you move). Here’s the confusing bit: you can be hypermobile AND be stiff. Because your spine is inherently more bendy than other people’s, your other muscles have to compensate and often get stiff from overuse. Typically, hypermobile people have tight hip muscles and hamstrings but that can vary. My message is STRENGTHEN, STRENGTHEN, STRENGTHEN. By the way, you folk make great yogis coz you can do all the lovely back bends with ease that us other mere mortals take years to achieve…. But you need the strength to support that mobility or you can get injured.
6) Spinal stiffness
We all get stiff as we live more and age, we also get stiff if we use a body part too much like in certain sports or occupations. Signs that we are stiffening include not being able to look over our shoulder as much ( a mixture of thoracic spine and neck), not being able to bend our hips as much, not being able to reach beyond our knees when we bend, not able to stride as long as we used to. As we get older our bodies have a tendency to dehydrate a bit, and our joints are not as lubricated as they were before. Muscles get tighter too. This all leads to greater micro-trauma on the back as we use compensatory ways to move. STRETCH STRETCH STRETCH is a good start. But guess what? Tight muscles are often very weak, and by strengthening our flexibility improves so to maintain that stretchability ( is there such a word??), we need to strengthen. This is particularly true for the Hamstrings ( muscles at the back of our legs that stop us from bending to the floor). When we strengthen these, they chill out and let us bend more….magic!
7) Neck and upper back
These are all part of that spinal chain of bones/ligaments/discs. If you have a bad back, your neck often suffers and vice versa because they are all on the same team holding us up against gravity. So by keeping the neck strong and stretchy, and the ribcage too, we improve the health of our lower back. Yoga strengthens and stretches neck/shoulder/ribcage in a way that also impacts on our lower back.
8) Posture
Posture can be a bit complex but here are the basics: if you lower back is too curvy (lordosis) or too flat, it puts all kinds of strain on the discs, ligaments and joints. The middle ground is where our backs are at their happiest and where everything just works at its mechanical best. If you have hunched shoulders (kyphosis) or a head that is forward out of alignment, then this places greater forward-strain on your back. Go to a good physio for assessment. Posture is linked with weakness and stiffness ( see above) of different body parts. Once again, physical exercise is generally good for your posture. I'm biased, of course, but I think yoga is phenomenal for improving it, and Pilates can be good too.
Count up your factors and make a plan
Well, how many factors did you count that pertain to you? If there are 4 or 5, then you are in the running for getting low back pain at some stage of your life. See how many of them you can reduce or eliminate and make a plan.
Oh, and come along to one of my yoga classes of course! Click here to access my upcoming course for those with low back pain.
Thanks for your interest!
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