Low back pain is among the five most common reasons for a physician visit in the United States. It is responsible for billions of dollars in health care costs and lost time at work each year. It is largely a preventable problem. Mostly a musculoskeletal condition of overuse and improper body mechanics, low back pain may also be due to a less common disease process such as a tumor or dysfunction of an organ in the low back region.
Trigger points and nerve entrapments from tight muscles are easily remedied through massage, stretching and some aerobic and strengthening activity. With persistent back pain, it is important to have a physician diagnose the extent of the problem. Oftentimes, however, medication, surgery and/or bed rest is prescribed. If the condition is related to a ruptured or protruding disc, then surgery may be necessary. Statistically, over 50% of all low back operations end up with similar pain problems. Surgery may relieve the pain by removing some or all of a disc, but once again it doesn’t address what brought it on in the first place. Medication is useful for reducing pain and inflammation, but it does not treat the cause of the problem either. The original cause is due to tight muscles from improper body mechanics or overuse. Conventional medical wisdom says that bed rest is necessary for low back pain. Gordon Waddell, M.D., author of a recent systematic review on bed rest as treatment for back pain says: “Traditional management of back pain by rest is now discredited…We no longer use bed rest to treat any other musculoskeletal condition.” In general, bed rest is not recommended for any length of time unless lying down is the only position that does not elicit pain. Activity that is pain-free or minimally uncomfortable is preferable and may result in a faster recovery.
Aggravating Factors: Inactivity or dysfunctional biomechanics are the main factors which aggravate or instigate low back pain. Improper movement and posture can be due to the way the body has compensated for old injuries or can be related to stress and emotional strain.
Any time the trunk and head are tilted forward, even just leaning forward to hear someone speak or to write at a desk, the erector spinae muscles are in a contracted state. This includes standing postures, too. Bending forward with straight knees to rinse your mouth after brushing your teeth locks up the back muscles. Lying flat on your back without support under your knees can aggravate a sore back. Those “comfortable” positions we choose to stand in, with all the weight on one leg and the other foot twisted out in some other direction, favor muscles which are already too tight and can aggravate the back. Fatigue and overwork can certainly worsen back problems, too.
Self-health Measures: There are many things one can do to help low back pain. Overall, the best way to manage a low back problem is to have a balance between enough strength to do the activities of your daily living, adequate flexibility, and to have a good oxygen supply to your muscles through aerobic fitness. The other primary factors to consider are erect standing and sitting postures and good spinal alignment when lying on your side.
The following are just a few tips for preventing or taking charge of your back pain:
- Use lumbar support when sitting in a chair or automobile seat.
- Sit all the way to the back of the chair with your feet flat on the floor.
- Adjust the car seat back so that it is in the fullest upright position.
- Move the car seat closer to the steering wheel so your legs don’t strain to reach the pedals.
- Place one foot up on the bumper when lifting something from the trunk.
- Bend your knees when lifting.
- Avoid bending your back while lifting.
- If lifting something heavy, either get assistance or squat close to the object, hold it near your belly and use your legs to bring your body to an upright position.
- Avoid twisting your body while lifting.
- Instead of leaning over a desk, use a clipboard to bring your work closer to you.
- Take frequent breaks from any position, every 30 minutes or so.
- Avoid leaning forward and reaching. When possible, position yourself so you are closer to your work.
- When sleeping on your back, place a pillow under your knees.
- When sleeping on your side, try to keep your spine straight. A “body pillow” may prevent you from twisting and torquing your spine.
- Avoid sleeping on your stomach.
- Emergency relief position: In the event of severe back pain where there is no position of relative comfort, lie on your back on the floor and rest your legs (calves and feet) up on a chair or couch.
By Jill Bielawski and Jerry Weinert
Originally published in Massage & Bodywork magazine, February/March 2000.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.