Postures and Low Back Muscle Strain

Photo by Larkery

One cause of low back muscle strain is having an unhealthy spine through habitual poor posture. If you sit all day in a slumped position, your low back is loaded into a forward or flexed position, and the muscles of your back are continually stretched. As a result, you may be more likely to strain a back muscle from light tasks such as loading/unloading the dishwasher. 

Not only does slouching affect your back muscles, but it causes your disks to bulge backwards. The more pressure from bad posture, the more likely your disks cannot realign properly. This leads to pinched nerves, which shoot pain or other symptoms down your leg(s), such as sciatica. 

On the other hand, those with a healthy spine (through repetitively good posture and exercise) may tolerate light tasks but strain their backs when doing more strenuous work such as moving furniture. It is important that both individuals practice good posture and body mechanics in order to avoid straining the low back during routine daily tasks, and especially during difficult physical activities.

What To Do for Sciatica in my Leg

Photo: John Ragal

There are multiple causes of sciatica or back pain that radiates down the leg(s). The most serious cause of sciatica is when a nerve root in the spine is being pinched by a bulging disc or by arthritis-type changes in the spine itself. Not only can this cause shooting pain into the leg(s) but also weakness in the leg and changes in the sensation in the leg (for example numbness or tingling in a portion of the leg or foot). If this is the case, it would be diagnosed through MRI and treatment options would be recommended by your doctor. 

Physical Therapists treat many patients with such sciatica. The key to relieving this type of sciatica is to stop the compression of the nerve root in the spine where it is being pinched. This can be done through positioning and exercises. If you are completely compliant with Physical Therapy and get no relief from any sciatica symptoms, then your doctor may try injections (usually with Cortisone) to provide some pain relief. This is a steroid, which provides an anti-inflammatory response. If you do not want injections, you may be prescribed oral medications for pain relief and/or anti-inflammation. 

Other conservative treatments for sciatica are going to a chiropractor, mechanical lumbar traction (requires a MD prescription) or getting acupuncture. Also some people get relief from inversion tables. Aquatic Physical Therapy (doing therapy inside a swimming pool) is another helpful tool for patients with sciatica.

Why You Should Get Physical Therapy For Your Back Pain

I recently treated a patient with leg pain that radiates from his back. It goes into his thighs and even down below his knees. This pain began 3-4 months ago, and he is unsure how it started. Before his session, I knew his walking had been problematic because when he stood up in the lobby, he significantly stooped over and could barely get his balance. He was using furniture and walls to hold onto. So my initial goal was to find an exercise that would immediately improve his ability to stand up and walk. 

I treated him for 10 minutes with one or two exercises lying on the mat. Then he stood up tall and walked easily back to his chair. He could not believe he was walking that well because since his symptoms began, he has the most pain and difficulty with initially getting out of a chair to walk.

So if you have back pain, you could possibly be only a few minutes away from pain relief. Schedule your Physical Therapy today!

Back Health Survey Discussion: Risk Factors for Low Back Pain

The discussion points here respond to the questions from yesterday's post, entitled "Back Health Survey."

1. How frequently do you perform moderate-high intensity exercise? In general, back health is improved as you do regular exercise, especially cardio exercise and strength training. However, it is important not to injure your back during exercise with excessive, early high intensities or uncontrolled bending/twisting.
   
2. How many hours/day do you sit on most days of the week? Likely, you have minimal control over how much you sit at work, but the rest of your day is yours to stand and walk more! Too much sitting puts your spine in a rounded or flexed position for long periods of time (unless you practice perfect sitting posture with additional lumbar support). Also, sitting does not promote cell growth and circulation as well as standing/walking, so it can lead to spine issues later in life.

3. How often do you perform back strengthening exercise or core strengthening? I recommend you do this at least 2-3x weekly, even if only for 5 or 10 minutes each time. Good back strengthening includes back extensions (backwards bending or arching of the back). Abdominal strengthening is also good (crunches are better for your back than full sit-ups). Core strength exercises of all varieties are great for your spine health, as they strengthen the deep abdominal and spine muscles, which will give natural spine support when you do strenuous daily tasks.
   
4. What is your usual sitting posture? First, check the chair you sit in to ensure it is ergonomic. Then add a lumbar roll (rolled up towel or round pillow) behind your low back. Sit at the back of the chair, then add your additional lumbar support.
   
5. What is your present weight status? Extra weight puts more strain on all your joints, including your spine.

6. How many episodes of major low back pain have you had in your lifetime (enough to limit your usual functional activities)? Low back pain comes in repeating episodes, so if you have had several, you likely will have more in the future. But it is not too late to get treatment, of which Physical Therapy can help significantly! Not only will you learn exercises but also things to avoid and how to self-manage your symptoms.

7. How far down did your low back pain symptoms radiate? Symptoms that radiate further down the leg are worse than those in the back only. That is because nerve(s) are being pinched in the spine, causing the symptoms to shoot downward. The key to treatment is to find what eliminates the leg symptoms and moves them more centrally, to the spine (AKA centralization).
   
8. How did your low back pain resolve? Your risk of future back pain is increased if your prior back pain has never resolved or has become chronic. In this case, you and your medical team have not yet found the ideal treatment plan, so all options should be considered, perhaps multiple times.

9. How often do you practice proper body mechanics during daily activities (such as squatting instead of bending, avoiding twisting, and good lifting techniques)? This may be the single most important factor to decrease your risk of future low back injury! Simply begin to implement body mechanics changes in your daily life. Soon they will become habitual.

10. How much heavy lifting do you regularly perform? Heavy lifting can increase your risk for back pain unless it is always performed correctly (spine straight and using the legs only to do the work of lifting).

11. How often do you participate in high risk sports/activities (such as skiing, skydiving, skateboarding, 4-wheeling, etc)? Trauma obviously can cause major back injuries or worse (becoming paralyzed or even death), so proceed only with extreme caution, and practice utmost safety measures.
   
12. How often do you perform standing forward bending exercises (such as touching the toes)? This is one of the single worst exercises you could perform. Your spine does not need to be stretched into a forward bent (flexed) position. What is your reason for doing this exercise? If it is for hamstrings stretching, use an alternate technique. If you do this out of habit or from something you learned in your past, change it because this can majorly damage your spine.

Top 7 reasons why sitting causes back pain

1. Most people sit with slouched posture, which puts your low back in a rounded or flexed position for hours each day. Our backs were not made to stay in one position all the time. This can cause future problems in the spine such as arthrits, herniated disks, and sciatica.

2. People who sit at work typically sit for too long without changing positions. If your job involves sitting all day, standing up, stretching or walking around briefly every 30-60 minutes will help.

3. Very few people sit with lumbar support, which helps to align the low back. Good posture starts with the pelvis. Tilt your pelvis forward so that less of your buttocks are supported on the chair. That way the bottom of your pelvis is supporting your trunk and you increase the arch in your low back. Once you have that position, use a lumbar roll/pillow to maintain it.

4. A slumped low back leads to a rounded mid back with shoulders rounded forward and the neck to be excessively forward. This can lead to progressive neck problems and even shoulder pain (especially with lifting overhead).

5. Aside from sitting at work, we tend to have a sedentary lifestyle, with many leisure activities done also in the sitting position. With present technology, we can do almost everything from the convenience of our homes. While it is convenient to buy clothes and even stamps at home, it is taking a toll on our backs. Having a sedentary lifestyle leads to obesity, which carries multiple health risks.

6. We do very few activities with our spines extended backward, which is an important position to achieve regularly for optimal back health. If you do not regularly lean backward (increasing the arch in your low back), then start doing so several times daily. It can be done sitting or standing. Another way to arch backward is to lie on your tummy and prop up on your forearms.

7. Slumped sitting posture puts the back muscles (and other back tissues) in a lengthened or stretched position while also causing the muscles and tissues on the front of the hip, abdomen and chest to be in a shortened position. This imbalance can cause further posture problems, weakness and instability with greater risk for back pain and injury.

Pregnancy and BACK PAIN

This is for all the new moms and new moms-to-be out there. If you are not one, please pass this on to someone who is! I write this both from my PT experience and my own personal experience.

First, let's talk about pre-pregnancy. If you are planning on having children in the next few years, I recommend starting a regular exercise routine that includes core strengthening. The better shape you are in before pregnancy, the easier it will be for you to lose your baby weight. I highly recommend pilates exercises to strengthen your core (even 2x/week can be beneficial). Start healthy eating habits now in order to keep your weight down. It will be much harder to lose excess weight once you have children.

During pregnancy, you may likely get back, pelvis, hip or sciatic pain because your ligaments are getting lax in order to prepare for childbirth. My recommendation is continuing but modifying your exercise routine that you hopefully started before pregnancy. Walking, swimming and prenatal yoga/pilates are ideal types of exercise during these 9-10 months. However, listen to your body and modify/limit the exercises that cause or aggravate any of your back or leg symptoms. Wearing a support belt may be helpful and is worth a try if you are having a lot of back pain (they are not very expensive). If you have a lot of pelvis pain and are diagnosed with sacroiliac joint (SI joint) dysfunction, an SI belt can be very beneficial. Stay active as much as possible and try not to overeat. If you gain 50 or more lbs., it will be more difficult to lose the extra baby weight. 25-35 lbs. is the recommended amount. (I gained 35-40 lbs. with both of mine and within 6-9 months lost it all).

During childbirth, I highly recommend Lamaze, walking as much as possible and getting onto hands-and-knees during contractions. Have someone push deeply on your back during contractions if you are experiencing back labor. Having experienced both natural labor and labor with epidural, I personally preferred natural labor. I will leave you with a quote from my yoga video: "Squatting is the position of choice for childbirth around the world." That's just one more reason to learn how to squat (see yesterday's post)!