Robert P. Nirschl, M.D., M.S.
Since 1968 the incidence of low back pain has increased dramatically, with 80% of the adult population reporting at least one episode in their lifetime. Many researchers suggest that most pain will go away within 12 weeks on its' own. However without medical treatment, 90% of the population with low back pain will experience recurrent episodes, with 35% being "sciatic" pain which affects the buttock, leg and foot. Thus, without proper preventative exercises and a general base of knowledge most of us are slated to live with recurrent low back pain.
One of the main reasons for this dramatic increase is that we have adopted a more sedentary life style with poor sitting and standing posture. We tend to sit in a slouched position with our heads protruding forward and away from the trunk. It has been suggested that the average North American bends their spine forward approximately 5,000 times per day. Over time we lose our ability to "reverse the spinal curves" or maintain proper spinal flexibility.
A major ramification of a sedentary lifestyle is general muscle weakness. Back pain specifically is almost always associated with major weakness of the trunk and abdomen. Our bodies are in a constant war with gravity and muscle strength is a critical component in successfully fighting this battle. Although passive treatment such as massage and manipulation (in which you the patient are a spectator in the process) may be temporarily comforting, muscle strength requires active participation. It might be noted that proper rehabilitative exercises often require education and supervision of truly qualified medical and physical therapy professionals.
The cumulative stresses of everyday living can also lead to tightening and stiffening of tissues which may impede ones ability to move in a pain free range of motion. For example, headaches are commonly linked to tightness in the neck region. Often simple stretch breaks can minimize or abolish these annoying pains.
Proper sitting posture is key in preventing spinal pain, and the low back must be positioned correctly in order for the head to align in the best position. When sitting keep your chin tucked in (not up) and your neck drawn back. From a side view your ears should align with your shoulders. Do not slouch; keep the entire length of your spine up against the back of the chair and maintain the curve in your low back. You may find it helpful and comfortable to use a lumbar support or back roll. These rolls can be a great help in the car, or airplane, or just sitting at work.
When sleeping try to position yourself on your side or back. You should only use one pillow and may find it helpful and comfortable to roll a towel to about a 3" diameter and slip it into your pillow case. This roll can be used to provide support in the crook of the neck, the area from the shoulders to the base of the head. Many people also find that using a pillow between the knees in side sleeping or under the knees when sleeping on the back is comfortable. Mattress surfaces should be firm, not saggy, and it is best to flip your mattress every month.
Lifting injuries are a common cause of spinal pain, and individuals who lift on the job are at higher risk. Lifting from the waist, a "stoop" lift, relies more on the passive restraints of the back (e.g. ligaments and the intervertebral discs) and for this reason should be avoided. Bending at the knees to lift or "squat" lifting, allows you to rely on the muscles and the bony support. One should avoid twisting during a lift and always hold the object in close to your body. Know your limits and ask for help when lifting heavy objects.
Occupational hazards include prolonged sitting, vibration, patterns of asymmetrical postural demands, and as previously mentioned lifting. For example, professions at great risk are nurses and truck drivers. Other general health risk factors include cigarette smoking, cardiovascular disease, diabetes, and obesity.
Consult your doctor and be sure to seek proper advice regarding specific exercises to alleviate and prevent spinal pain. Once a program has been developed you should have great success. Via active exercise and postural change you, the patient, are in the driver's seat, being able to correct and control your own destiny.
Julie Landis, M.S.P.T.
Robert P. Nirschl, M.D., M.S.
Julie Landis is a licensed physical therapist working at the Nirschl Orthopedic & Sportsmedicine Clinic in Arlington VA. Dr. Nirschl is a practicing orthopedic surgeon and sports medicine physician at Columbia Virginia Hospital Center Arlington, Va. and is Associate Clinical Professor of Orthopedic Surgery at Georgetown University medical school in Washington, DC.