Monday, March 12, 2018

Bending Forward - A Common Factor In Persisting Low Back Pain


By Dr. R. Greg Lusk, DC

In my last article in January, I discussed the value of applying a "functional" diagnosis to a complaint such as low back pain. To refresh, it is the process of identifying movements and/or activities (i.e. functions) that produce or aggravate symptoms, as well as those that may reduce or even abolish symptoms. Aiming for this better understanding of factors that influence pain offers great value to patients, beyond the anatomical diagnosis, as they can independently modify behaviour and movement to modulate pain, in addition to the traditional approach of receiving a form of treatment to manage and/or mask the symptom of pain.

With respect to neck or low back pain, flexion (i.e. bending forward) is by far the most common direction which produces, aggravates, and perpetuates pain. This is not surprising as most of us have a posture that tends toward slouching versus sitting straight up and many of our activities of daily living involve spine flexion - sitting, driving, computer use, looking down at our phones, washing dishes, putting on socks, etc. Conversely, how many things do you do throughout the day or how much time do you spend in positions that involve bending your spine backward or extending your neck to look up? Not many and not much would be my guesses. If you consider that most clients that present to my office with neck or back pain also report no trauma or specific mechanism resulting in their pain, this points to a more repetitive, cumulative, or sustained source of strain as the culprit.

Ironically, although spine flexion can be implicated as a functional source of pain in many cases, patients will often describe prior relief efforts that have been largely flexion based. For example, for low back pain, I often hear people tell me that they've been bending forward or lying on their back and pulling their knees up to their chest, to stretch the "tightness" in their back. I understand the reasoning that led to this as those positions would stretch the muscles of the back by lengthening them as you bend away. However, other than a temporary sense of relief that is achieved by stretching the tissues, there is often no prolonged benefit noted. Similarly, many patients will report that resting in a recliner-style chair with their legs up is comfortable....until they go to stand up. The common denominator - the low back gets rounded forward in all of these positions and flexion stress can accumulate. I've heard Dr. Stuart McGill, a world-renowned spine researcher, comment previously that if spine flexion is what someone needed to get better then their daily life would simply make them better due to the volume of spine flexion done daily. There is wisdom there that demands considering a different approach.

Practicing "spine hygiene" is a valuable part of that strategy as it involves sparing the spine from aggravating loading patterns, by modifying how we move while bending, rising from a seated or lying position, brushing our teeth, etc. A future article will address these things in more detail so stay tuned. While flexion is commonly not well tolerated, I do want to stress that it isn't bad 100% of the time and will happen naturally during many activities. Sometimes we just do too much of it which results in degenerative changes over time and a sensitization to biomechanical forces in that direction. By limiting this sort of functional intolerance often a longer duration of pain relief can be achieved.

This article is for general information purposes only and is not to be taken as professional medical advice.