Oh, My Aching Back

By Chad Krier, N.D., D.C.

If you suffer from low back pain, you are not alone. There are currently 75 million low back pain sufferers in the U.S. with 7 million new cases being diagnosed each year. This means that 8 out of 10 of us will experience back pain at some point in our lives.

Back pain can result from injury or trauma to muscles, ligaments, joints, bones, fascia, and intervertebral discs. However, back pain also arises from seemingly harmless repetitive motion events. In fact, non-injurious back pain is equal to back pain caused by trauma.

I believe that one of the main culprits behind low back pain is poor sitting posture.

Given the fact that low back pain occurs with about the same frequency in people with sedentary occupations as in those doing heavy labor, it appears that there is more to the picture than trauma alone. Indeed, I believe that one of the main culprits behind low back pain is poor sitting posture. There is a great deal of evidence to support this notion. In fact, a majority of patients with low back pain report an increase in pain when arising from a seated position. Further, an amazing 86% of low back pain sufferers have a loss of extension (bending backwards) range of motion secondary to poor sitting posture.

In poor sitting posture, the lumbar spine assumes a fully flexed position. This allows the low back (lumbar) muscles to become relaxed and stretched. The ligaments of the back are now forced to take over the weight bearing stresses that were intended for the muscles. Over time the strained ligaments begin to weaken. What’s the problem with weak ligaments? Glad you asked. Ligaments are responsible for holding the lumbar disks (water cushions of the spine) in place. When the ligaments become weak, they are unable to perform their job at full capacity and the disc may be allowed to bulge. The battle of the bulge ensues and causes pain by pushing on nerve tissue (ouch!). If the ligaments become so weak that they tear, then the disc may be allowed to herniate and really cause havoc. Herniation may lead to leg pain and bowel and bladder disturbances.

Picture your disc as a water balloon sandwiched between two bones. If you apply pressure to the front of the balloon (as in a stooped/flexed posture) the water will go to the back. If you apply pressure to the back of the balloon (as in a lordotic/extension posture) the water will go to the front. Repetitive flexed postures push the water backwards. If the ligaments responsible for holding the water in are weakened, you may spring a leak (bulge). If the ligaments are tom, you may blow a water main (herniation). Hence, it is wise to adopt healthy sitting postures that force the water to the front instead of the back of the spine.

If you really think about it, many of our daily activities are performed sitting, often in a flexed position; Namely, we sit when we eat, drive, watch TV, do computer or desk work, and during various meetings through-out the day. However, we rarely find ourselves going into extension motions. That is why it is important for us to begin to think about exercising our backs in different ways throughout the day.

Ideal sitting posture allows you to maintain a lordosis (curve) in the small of your back while keeping your chest slightly elevated. The problem is that maintaining this posture requires mental thought while our normal tendencies are to slouch without thinking about it. Hence, lumbar support cushions, chairs, rolls, towels, etc. are helpful tools to use in order to help us maintain our sitting lordotic posture.

In addition to lumbar supports, it is important to perform exercises that strengthen the muscles that surround the low back (core muscles). Namely, extension and flexion exercises of the low back are useful in promoting strength, flexibility, and stability. As the low back muscles become trained to do their job, the ligaments become less burdened. Giving the ligaments a break allows them to recuperate and gain strength. Eventually, with proper exercise and sitting postures the muscles and ligaments work more efficiently and are able to prevent the occurrence or reoccurrence of low back pain.

The exercises I generally recommend are taught in a progressive fashion (largely from R.A. McKenzie approach). Generally, they begin with the person lying on his/her tummy performing a series of extension exercises that raise the chest and neck off the ground. Starting in the lying position takes the added pressure of gravity off the spine and allows for easier motion. Once the lying exercises are mastered and pain has dissipated you can move to standing extension exercises. This brings back the weight bearing stress of gravity.

After mastery of extension exercises has been obtained, it’s time to introduce flexion in lying exercises (bending your knees toward your chest while on your back). I always recommend that following flexion you perform extension exercises to prevent any bulging of the disk that may result from too much flexion.

Eventually, when the co-learner is comfortable with their extension and flexion exercises, flexibility exercises are introduced to enhance blood and nutrient flow to joints and muscles. If you suffer from low back pain, it may be wise to consult with someone knowledgeable in the areas of spinal rehabilitation that can come up with a tailor-made program for you. As mentioned in the beginning, there can be a wide array of causes for low back pain. I’ve identified what I believe to be one of the main contributing factors to low back pain. However, it is always wise to find the individual cause of your pain and come up with appropriate therapies to address that cause.