If you experience back pain, you are not alone. In fact, 8 out of every 10 North Americans suffer from back pain at some point in their lives (NIH,2012). Chronic back pain is a major public health issue which affects not only you, but also your family, the health care system, your work, and society as a whole. It can cause absences from work or social activities and even lead to a loss of a job. Chronic pain can also be associated with anxiety and depression.
Research shows that two out of every three people that experience back pain cannot even identify any specific mechanism of injury, “it just happens”.
But WHY does it happen? Can it be controlled, managed, or prevented?
As a physiotherapist, back pain is by far the most common complaint I treat, and yet, I find that the general population knows very little about simple back health. We have been taught how to brush and floss our teeth to maintain good oral health and we even know how to maintain our vehicles so they run efficiently and safely. But somewhere along the line, basic back care education for our own bodies is missed.
There are many factors that play a role in back pain, many different ways it manifests and many different ways that it can be addressed. We can’t discuss this all in one article. However, in my experience, I feel that the majority of cases can certainly be better managed, and potentially even prevented all together. Here are 6 helpful tips to keep in mind to help manage and prevent your back pain:
1) frequent position changing: prolonged sitting or forward flexion puts the most load on the low back and can contribute to disc problems. Prolonged standing or repetitive movements in any one direction can also place unfavourable strain on the spine. Frequently changing your position or taking mini-breaks throughout the day may seem ‘time consuming’ and unproductive at the time, but it can save you from debilitating pain in the long run.
2) use correct body mechanics: most people seem to understand they need to “use the legs when lifting or bending, strengthen the back and abdominal muscles, and exercise”. Unfortunately, most back pain patients I see are commonly performing exercises unsafely or incorrectly, or not at all. I rarely witness optimal posture or correct use of body mechanics with activities such as getting in/out of bed, bending forward to tie your shoes, reaching, lifting and carrying. These are just a few of the activities we do daily that can eventually cause back pain if not performed correctly. It is simple to learn, but accurate instruction and even demonstration from your physiotherapist can be helpful.
3) optimizing postural alignment: positioning your spine so that it maintains its 3 natural curves is key to a healthy back. When these healthy curves become too flattened or too arched, it can compress the vertebrae and the discs in between, causing pain or irritation of the nerves coming out of the spine. Whether you’re sitting, walking, lifting, exercising or sleeping, your spine should primarily be in its optimal position. Proper instruction and training from a qualified professional is essential in finding your ‘neutral spine’. When taught correctly and safely, Pilates, Yoga, and Physiotherapy exercises are great ways to attain and maintain optimal postural alignment.
4) proper footwear: back pain can result when your optimal alignment is compromised by improper footwear because certain muscles can become tight, shortened and overused, causing an imbalance. A consult with a pedorthist to assess whether or not orthotic inserts are required may be beneficial for some people.
5) overall physical health: maintain a healthy diet and body weight. Perform regular stretches, strengthening, and spinal stability/mobility exercises in a safe and effective manner. Many people with low back pain have poor core stability (or rarely know what true core stability means) and tight lower extremity muscles that both play a role in back pain. Numerous studies have shown that both Pilates and Yoga (performed safely and correctly) can help reduce low back pain. Consultation with a certified nutrition and health counsellor that focuses on the mind-body connection may also be beneficial.
6) manage your stress: many scientific studies have shown that stress is one of the MOST influential factors in back pain. Find effective ways to manage your stress. If your current coping strategies are not working for you, find support and resources that can lead you to better management. There are numerous approaches that are not within the scope of this article. CREATING time to mindfully unwind and participate in life activities that truly bring you joy, as well as participating in a regular exercise regime (performed correctly and mindfully) has been shown to assist in stress reduction. Often times there is no quick or magical ‘fix’ to stress management. It takes an ongoing active approach on your part to find healthy and sustainable coping strategies!
Unmanaged back pain warrants a visit to your doctor to rule out a serious medical condition. Your physiotherapist has the skills to assess and treat a variety of back conditions and knows when to refer back to your doctor if further investigation is required.
Incorporating healthy back habits into your daily life is another way you can take an active approach to your overall health and well being!
Whether you are preparing to hit the ski hills this season, play golf next season, perform fall yard work, or simply are wanting to continue to walk and perform all your household chores with ease and efficiency, it is important to be knowledgeable about core stability and how to apply it while performing any sports or activities of daily living. Most people have heard of the term ‘core
stability’, but few people actually truly know what it is and how to correctly engage it.
The ‘core’ is a group of muscles that surrounds the back and abdomen and is best described as a cylinder of muscles. The main function of the core is to stabilize and protect the spine and pelvis when the rest of the body is in motion. There are 4 main muscle groups that make up the inner core: Transversus Abdominus (TA), Multifidus (MF), Pelvic Floor muscles (PFM), and the diaphragm. TA is the deepest abdominal muscle that wraps around your abdomen like a corset, and is connected to tissue surrounding the spine. When TA contracts, it is similar to the corset being tightened, therefore assisting in increasing the pressure inside the abdomen which provides increased stability to the spine. MF is a deep lower back muscle which makes up the back part of the core. It is an important postural muscle that helps keep the spine erect. The PFM’s are the bottom part of the ‘cylinder’ or core. The diaphragm makes up the top part of the cylinder. When all of these muscles contract simultaneously, they help to maintain the pressure in the abdomen which then provides the stability to the spine and pelvis. It is important to note that the timing of these muscles is mandatory for effective core stability. For optimal core stabilization, all the muscles will activate together and just prior to any body movements and are ideally maintained throughout all movement, all day!
A common misconception is that "strong abdominals protect the spine". In fact, as described above, the abdominal muscles make up only one part of the core. Furthermore, only the deep abdominal muscle, TA, is involved in protecting the spine. The famous "6-pack" or Rectus Abdominus muscle that many fitness fanatics train actually plays no role in protecting the spine. Additionally, you may already be performing ‘core stability’ exercises, but instead of activating your TA correctly, you may be using the Rectus Abdominus (as evident by the abdominals ‘tensing’ and popping out and up) to compensate for the TA that you
aren’t quite sure how to find. This is a very common mistake and can lead to back pain. So please ensure you are performing your core exercises correctly!
Adequate core stability not only reduces strain on the spine, but also helps maintain optimal postural alignment which will help reduce risk of injuries whether you are playing sports, doing housework, or sitting and driving. Core stability is also an important part of any rehabilitation program. Not only back or pelvis injuries, but even injuries such as hamstring or shoulder strains should incorporate core stability as part of the rehab process. A strong core means a strong foundation from which our limbs can move more safely, with more power and efficiency, and with less risk of injury.
Core stability is also an essential part of any regular workout routine. Whether you enjoy recreational sports, competitive sports, or simply enjoy working out at the gym, addressing your core can improve your abilities and enhance your overall performance.
To ensure you are correctly engaging your core and to incorporate safe and appropriate core exercises to suit your needs, it is wise to invest your time with a qualified specialist for a few sessions first. If you experience low back pain or are dealing with specific spinal dysfunctions, then a visit to your physiotherapist or other trained health care professional is essential to ensure the most safe and effective core exercises are prescribed for you!
Being healthy and fit takes effort. We all know that there are many factors that contribute to living an overall healthy lifestyle, including diet, activity level, social well-being, managing stress levels, and being physically fit, just to name a few.
Physical fitness is an important factor that can improve one’s quality of life. There are several components that make up basic
physical fitness: strength, flexibility, power, agility, muscular endurance, cardiovascular endurance, co-ordination, and balance.
I want to discuss the often overlooked, but extremely important component, balance. An astonishing fact: Falls are the second leading cause, after motor vehicle collisions, of injury-related hospitalizations for ALL ages, accounting for 29% of injury admissions. (Canadian Institute for Health Information, 2004). Obviously, there are situations where falls cannot be prevented; however, frequently they can be avoided if we understand the underlying systems that contribute to balance.
Balance is the ability to control the body’s position. The body either controls its position statically, as in standing on one leg, or
dynamically, as in walking on uneven or slippery surfaces. Several physiological systems work together to influence balance. Sensory input from the eyes detects changes in position. The inner ear controls balance by monitoring the position of your head
(vestibular system). Our nervous system is involved in processing information which determines how quickly and efficiently we are able to respond. Our musculoskeletal system is also very important for balance. We need to have adequate joint range of motion, muscle flexibility and strength in our ankles, knees, hips, spine, and shoulders in order to safely and effectively ‘right’ ourselves when we are losing balance.
Balance dysfunctions can be addressed and treated, provided that your health care provider knows what system or systems are
involved in the balance problem. Once the source of the poor balance is identified, then your balance can be improved by improving the function of the impaired system. Occasionally the impaired system may not be able to be improved due to
certain medical conditions. In that case, your balance can still be improved by enhancing the function of the systems that are already working well.
Even if you don’t have a serious balance dysfunction, it is still important to include balance training in your regular exercise routine. Many fitness centers have group fitness classes that incorporate balance in their sessions. Yoga and Tai Chi have
also been shown to improve balance. If you understand the components of balance and seek out guidance to help you train your balance, you can significantly improve it, therefore reducing risks of falls or even minor injuries such as recurrent ankle sprains. Optimizing "balance" can contribute to improving and maintaining your quality of life!