Standing up to Low Back Pain
By Sara J. Meadows, D.O., East Denver LIVING WELL Magazine
Low back pain is a common physical complaint in adults. Chances are that you or someone you know has experienced back pain with 80% of people experiencing low back pain at some time in their lives. Some low back pain will resolve without any treatment and most acute low back pain will steadily improve over a six to eight week period. The most important part of the treatment and recovery process for low back pain is an accurate diagnosis and a comprehensive treatment plan that includes medication, education and muscular rebalancing. No matter how bad your pain at the time of a low back pain episode, your body is giving you a signal with inflammation and muscle spasms that the body’s fine balance has been disrupted.
One of the greatest global offenders for low back pain is inactivity and sitting. And for most people, the more hours working equals more time sitting. This prolonged inactivity is arguable more damaging to the low back than heavy physical work. This concept is best understood with education regarding the anatomy of the lumbar spine and its supportive structures and common causes of low back pain.
The direct support to the lumbar spine consists of five bone structures that directly support the upper body and protect the spinal cord and nerves. In between these bones are the intervertebral discs and the small facet joints. Surrounding these bones and joints are ligaments and postural muscles. The dynamic indirect supporters of the spine are the surrounding muscles commonly referred to as “the core.” Without this core muscle group, the spine is more susceptible to compressive loads from gravity, weight bearing activities and repetitive stressors such as bending and twisting.
One very easy approach to protecting and supporting the spine is to find a balanced neutral posture with a constant gentle contraction of the core muscles achieving a good lengthened spine. It is difficult to sit up straight or to stand in a neutral spine when your “core” is weak and other muscles, such as the hip flexors and hamstrings, are too tight or out of balance. This muscle-balancing approach addressed in a comprehensive physical therapy approach seems simple, but when achieved, sitting and standing in neutral posture becomes energy efficient and pain relieving for most back pain complaints.
The common causes of acute low back pain are muscle strains, disc herniations and spinal stenosis, but other causes are also considered by your treating physician including fracture, infection and tumors depending on the specific history and physical exam findings. Radicular low back pain, commonly known as “sciatica,” is a sharp severe pain felt into the leg in the distribution of the sciatic nerve. Two common causes of acute lumbar radiculopathy or “sciatica” are from a disc herniation/injury or from spinal stenosis. Acute intervertebral disc herniations are most common in the ages 25-50, but can occur earlier and later in the life. The injured intervertebral disc can herniate and compress the exiting nerve or bulge and leak material, irritating the exiting nerve. This discogenic pain is often provoked by bending forward and improved with extension of the spine. Spinal stenosis is another cause for the nerve irritation that causes the symptoms of sciatica. Stenosis is most commonly caused by a combination of features such as intervertebral disc bulging and bone spur formation in combination with arthritic changes of the small joints in the spine called facet joints. Stenosis is commonly seen over age 50 and aggravated by standing and walking and improved with sitting and bending forward.
Spinal stenosis and discogenic low back pain will both activate the acute inflammatory cascade to protect the nerve, which can also contribute to significant pain and muscle spasms. Anti-inflammatory and muscle relaxant medications are used to address the body’s response to the injury in order to alleviate pain. If the pain is not rapidly improving, then physical therapy addressing muscular imbalance and muscle spasms is added. Another option available for compressive disc herniations resulting in weakness or spinal stenosis refractory to conservative approach is fluoroscopic epidural steroid injections that target the inflammation locally. Finally, if all of the conservative options are failing with progressive neurological changes, then surgical evaluation is suggested.
Standing up to low back pain with a neutral spine and achieving a good muscle balance with a strong focus on the dynamic supportive core muscles will help prevent and treat low back pain. Do not ignore the pain signals from your body. Stand up more, take frequent breaks from sitting to walk and move your body, and commit to support your spine with good posture to prevent low back pain.
Author Sara J. Meadows, D.O., is part of the Orthopedic Associates team. Reach them at 303-321-6600 or via denverortho.com.
