By Dr. R. Greg Lusk, DC
If you've read my last few articles you'll recall that I've been trying to create more awareness of a functional diagnosis for low back pain (LBP), versus only knowing what is structurally wrong with a specific anatomical tissue. In other words, it is important to figure out which movements or biomechanical loading directions cause LBP. You may also remember that bending forward (i.e. spine flexion) was identified as a very common direction of motion that results in LBP. With that in mind, practicing "spine hygiene" with common postures and activities of daily living can reduce the amount of flexion imposed on your low back, thereby keeping it relatively neutral, which in turn minimizes unwanted symptoms.
Changing how we move and rest, with the goal of sparing the low back, can be challenging as our current methods of doing things and moving our bodies are well rooted. However, with increased attention and regular practice new habits and patterns of motion can be adopted. Starting with sitting, affectionately referred to as "the new smoking", many of us have a tendency to slouch, especially with prolonged time in this position. The fact that we often sit on soft, minimally supportive couches or recliners doesn't help as they encourage sagging of the spine into a rounded position. I often suggest to put a small pillow or rolled up towel behind the lower back to help support and maintain the neutral curve. Better yet, and particularly if you're in significant discomfort, sitting on a more firm piece of furniture such as a dining chair can offer more relief. Move one into your living room if you must to discourage use of the alternatives. You want to sit as far back as possible though as not having your behind against the back of the chair encourages more slouching. The same advice can be applied to sitting while driving and sitting at work, which most of us do much of daily. Use that pillow, towel, or rolled up sweater for that matter, to support the low back curve if your vehicle seat or desk chair doesn't offer enough lumbar support intrinsically. Adjusting the back rest to a more upright, vertical position can also help you achieve the goal of a more neutral spine position. Variable, adjustable height workstations have become increasingly popular and the options out there are numerous. Thankfully, the cost of some are quite reasonable, well worth the value it could add to managing low back pain. Not that standing all the time is the answer, but having the flexibility to alternate body positions regularly changes how we stress our spines and disperses the accumulating stresses that occur if only a singular posture is used.
Standing with poor posture, where the shoulders are rounded forward and the head is drooped, is commonly observed in those with or without low back pain. Once again, this encourages mild spine flexion while also increasing muscle activity in our low back extensor muscles. This adds more compression to our spinal tissues which doesn't help when things are already sensitive. Instead, roll the shoulders back and lift your rib cage to position your upper body more over your hips. Interlacing your hands behind your low back while standing helps to maintain this posture if prolonged standing is needed, and is also preferable to standing with your arms crossed, which also increases demand on the back muscles.
Sitting and standing are two major culprits, but there are many other things to consider to practice good spine hygiene while performing the multitude of our daily tasks. More to come.
This article is for general information purposes only and is not to be taken as professional medical advice