Tips for Bending With Low Back Pain

By Dr. R. Greg Lusk, DC

Sitting and standing were discussed thoroughly in my last article as they are common activities that trigger low back pain (LBP). Modifying how they are done form part of our daily upkeep of our backs, referred to as spine hygiene, which when coupled with appropriate exercises can help make you more resilient to symptoms. Bending is another frequent trigger for  low back pain and how it can be performed in a more spine sparing or friendly way will form the focus of this article.

If you have or had LBP, it is highly likely that bending is or was an aggravator to your symptoms. Imagine yourself flexing forward to put on socks, stooping to brush your teeth, or trying to pick up that pen you dropped on the floor. Many of you will dread the thought of having to do that when you have LBP. However, you can employ strategies to do this that spare the spine, allowing it to stay in neutral, thereby minimizing pain. Squatting, by moving predominantly at the hips and knees, will allow you to lower yourself without rounding your back. To get even lower you could use a lunging pattern. To perform this move, you stagger your feet one in front of the other and offset side to side, so you don't feel like you're standing on a balance beam. Once again, you move about the hip and knee joints while lowering the rear leg toward the floor, keeping the back straight throughout. From the bottom of this position you can generally reach near the floor with your hand with minimal spine motion needed. Good technique is paramount to minimize stress on the hip and knee joints so symptoms are not produced there, which may be particularly challenging for some of you with a history of injury and or arthritis there. An alternative that may be helpful is referred to as the golfer's lift or pick-up. Similar to the action you'll see a golfer perform to retrieve the ball from the hole, you balance on one leg while you hinge about the hip joint, lowering a hand toward the ground while the free leg extends backward as a counter-balance. Particularly for relatively light items, this is an effective way to get your hand low while keeping your spine neutral and your core tight. Balance may be an issue for some so using your free hand to lean on a wall or hold onto another firmly rooted object will provide another contact point for improved stability in this position.

The stooped (i.e. slightly bent) posture you can observe when someone is brushing their teeth over the sink, gathering laundry out of the washer or dryer, or kneeling to do gardening can also be modified to become more kind to your spine. With these activities we use our arms but really only need the free motion of one hand to be efficient. The other hand, which is typically non-dominant, can instead form a contact point of support on either the vanity counter, the appliance, or ground, while you also hinge at the hips and keep your spine neutral. The support hand now bears much of the load that leaning forward imposes on the spine, which is surprisingly substantial when you consider how much the upper half of our bodies weigh coupled with the multiplying power of leverage.

Good luck employing some of these ideas to bend with increased ease. With low back pain the more we can reduce all of the contributing sources of aggravation the more likely you'll experience decreased symptoms and prolonged relief. This article is for general information purposes only and is not to be taken as professional medical advice.

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.