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.

Laptop Ergonomics Video

This video gives you some ideas for how to improve your posture and positioning when working on the computer. It is very brief (2 minutes).

Exercise Ball Chairs: Yay Or Nay?

I do recommend using an exercise ball chair if you have a desk job. It forces you to think about and practice improved posture. It also can help to strengthen your core (abdominals and back) muscles.

Exercise balls are beneficial for improving core stability and strength. They can be used for a variety of exercises and can easily be incorporated into your workout routines. You can find many exercise DVDs with specific theraball programs. The benefit of adding a chair to your exercise ball is that you can keep it at your desk or work station and potentially use it instead of your usual desk chair. Some exercise ball chairs have a little back support, but likely you will not lean against it; it is comparable to sitting on a stool. The chairs also have wheels, like most desk chairs.

The main downfall of the chair is that it may not be high enough for your desk. If that is the case, it is better not to use it. Good posture should be maintained while you are sitting at work, which means you need an ergonomic work station. The largest theraballs I have seen are 80-85 cm, which are appropriate for taller individuals. Some ball chairs may have a higher base, which could bring you up to the appropriate sitting height for your desk/keyboard. 

Another problem with using the chair is that you do not have any back support. Therefore, it may be hard for you to maintain good posture or your back may just get tired. With a normal chair, you have the option of sitting against the back of the chair and adding a lumbar roll or pillow behind your low back to improve the position of your spine. Realistically, most people tend to slump when sitting, and that is true with ball chairs as well.

A feasible option is to use a ball chair for 1-2 hours of your workday. Or you could simply sit on an exercise ball (without the chair) for short periods of time at work. The most important thing about your work station is to have upright posture, which matters more than the chair you use. If you really want to improve core strength, the best way is to do core exercises along with your workouts.

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.

Core strength position

What is the strongest position for your back to be in? Being upright with good posture! That is the only position that enables you to lift a very heavy load without hurting yourself. So let's talk about a few ways to strengthen your core in that position.

Sitting: Sit upright without leaning on the back of your chair. Make sure there is a small arch in your low back and that your shoulders are slightly back (under your ears). Your neck should not be strained forward. Look straight ahead. Now draw in your abs by bringing your belly button straight back toward your spine. Hold this position, without holding your breath, for 10 seconds. Repeat at least 5 times or just maintain the position for 1-2 minutes.

Standing: Stand upright with your back in the same position as described above. Draw in your belly button toward your spine. Hold this position, without holding your breath. Maintain the abdominal contraction as you slowly march in place (only lift each leg a few inches each time you march). Use arm support if needed for balance. The goal is to maintain the same spine position and abdominal contraction the entire time you march (1-2 minutes).

Squatting: Stand upright with your feet spread apart. Draw in your abdominal contraction as above. Squat down and come up slowly, keeping the same upright position. There should be no movement in your spine; all the movement is coming from your legs. Maintain the abdominal contraction the whole time, and do not hold your breath. Repeat at least 5-10 times. Only squat as far as you can with proper back position. And decrease the depth of the squat so as not to cause any knee pain.

To be continued!

PAIN PREVENTION while sitting

This is dedicated to Marti Bedell and her real estate team!

Do you sit a lot at work? Do you drive a lot at work? Excessive sitting over a lifetime can lead to back problems later in life. This is especially true if you habitually slouch. So how can you maintain a HEALTHY BACK over a lifetime of sitting?

First, try not to sit all day. Are there a few activities that you could do standing up? Mail, email, phone calls, etc? If you have a desk job, you are likely in the habit of sitting for almost all your daily tasks. But if you are creative, you could easily find at least a few minutes each hour to either stand or walk around.

Second, whenever you sit, be sure to sit with good posture. There should be a small arch in your low back, and your neck should not be strained forward. Your shoulders should be relaxed, and your forearms resting on your desk or keyboard. Your wrists should be straight.

Happy sitting (and standing)!

Lumbar Support for BACK PAIN

There is one simple and easy way to sit with improved posture, no matter what chair you are sitting in: to use a lumbar support or lumbar roll. Here are a variety of things you could use for back support. Just place them behind your low back, no matter where you are sitting. You could buy a lumbar roll, but here are some things you probably have around the house that will be just as effective.

1. Roll up a medium-sized bath towel.
2. Fold or roll up a small blanket.
3. Fold up a tablecloth or sheet.
4. Find a small, decorative pillow.
5. If you are in public and do not have a pillow, roll up your sweater or jacket.
6. For women--try using your purse.

The important thing to remember is to use lumbar support consistently. This includes in the car, in your recliner, in waiting rooms, at lunch, when reading, when watching TV, when on your computer, at work, and any other time you have to sit, especially for long periods of time.

Slumped posture may not cause you back pain right now, but it will in the future. So make a choice today to start new posture habits! Your back will thank you.

Low back pain related to sitting posture

Bad sitting posture may not cause you immediate pain, but down the road it will. This is especially true if you have a desk/computer job where you sit most of the day. Slouched sitting posture, done all day, every day, will cause progressive changes in your spine, making it less stable and more prone to injury in the future.

So here are a few tips for improving your sitting posture.

1. Adjust the height of your chair so that you are sitting upright.
2. Stand up for at least 1-2 minutes every hour that you are sitting.
3. Use a rolled up towel or small pillow behind your low back for lumbar support.
4. Make sure that there is a small arch in your low back most of the time when sitting.
5. If the chair you use most of the time forces you to have bad posture, find a different one that gives you better back support.
6. Good posture starts in the low back, not the shoulders. Once your low back is upright, the upper back, shoulders and neck will be more upright also.
7. If possible, do some work in the standing position.
8. Walk around during your lunch break or other breaks. Walk more when you are not working.

Do you have any other suggestions that have helped you to prevent back pain at work?