5 Minute Reads: Lower Back Pain
At any given time, 31 million Americans are experiencing lower back pain! As of 2010, low back pain became the single leading cause of disability worldwide. Low back pain is the second most common reason for a visit to the doctor’s office, outnumbered only by upper-respiratory infections. Experts estimate that upwards to 80% of the human population will experience low back pain at some point in their lives. It’s safe to say that we have a situation.
What’s causing all of this back pain?
If nothing else, lower back pain is one thing; complicated. Causes of low back pain are extremely multifactorial and there are limitless systems of the body that can play a role. The purely mechanical anatomy of the lower back itself is a complicated structure of bones, joints, ligaments, discs, muscles, fascia and more. All of these structures work in conjunction with each other, each moving, supporting or resisting ranges of motion and postures. All of these structures can be involved in symptoms. You can sprain a joint, strain a muscle, irritate a disc/nerve, on and on and on. While sports injuries, accidents and other traumatic events are oftentimes blamed for lower back pain, there are many times that innocuous movements catch the blame.
“I just bent over and threw my back out!”
“I was on the floor playing with the kids, and then all of a sudden could barely get back up!”
“We took a roadtrip, and afterwards my back was killing me!”
Common contributing factors to most low back injuries are: misuse/overuse. Overuse injuries are defined as “any type of muscle or joint injury, such as a tendinits or stress fracture, that’s caused by repetitive trauma.(2)” Misuse, simply put, is putting structures under load that they are not necessarily supposed to take on, whether it be duration/frequency/pressure associated. The natural initial reaction to hearing the term “overuse injury” immediately makes you think about specific activities that you’re doing, right?
“Maybe I shouldn’t deadlift?"
"I’m probably running too many miles."
"I'll just stop tying my shoes, I like sandals anyways!”
These could all very-well have something to-do with your symptoms. But, do they actually tell the story? Too often, these activities end up taking full responsibility for your situation, and maybe they’re simply just the highlighting feature of your situation?
Lets touch on lifestyle. Getting back to the word “overuse” (combined with misuse), there’s a common word thrown around here: microtrauma. Microtrauma is defined as the minor tearing of sheaths surrounding muscles and connective tissue. Microtrauma can be a useful training tool. It’s been shown that microtrauma is effectively used during eccentric (muscle lengthening) exercises. This stimulates certain responses which tell the muscles to adapt and rebuild as to respond to their increasing loads, thus in-turn increasing the overall strength of the muscle long-term. Microtrauma also occurs in situations in response to the demands placed on your body throughout your normal day. Let's look at some examples. Many of you right now might be sitting at your desk, reading this very article. A common sitting position is with the hip flexed to around 90 degrees, our butts on our seats, and varying degrees of “flexion” (or rounding) in the lower back. Depending on the lengths that you’re sitting like this, this very position can put certain structures in precarious positions and increase the likelihood to experience wear-and-tear of the structures of the lower back. Sticking with this example, let’s say we sit this way for 4 hours a day, Monday through Friday. That’s 4 hours per day of the same posture, compounding to 20 hours per week that we’re placing similar prolonged stresses on structures of our low backs. Does this mean that your lower back will hurt on Friday afternoon? It’s definitely possible, but not necessarily always the case. But, what can happen later?
Circling back, earlier we discussed innocuous movements that cause low back pain episodes. “I just bent over and threw my back out!” Did this one episode of bending really cause this just to happen out of the blue? Or was the “bending over” simply the straw that broke the camel’s back (excuse the bad pun). To be forward thinking, was your lower back already “primed” for injury following a week of compounding lifestyle stress?
Proper movements and positions are the key here. The more you can put yourself into favorable positions, moving favorably, and moving in general, the better off your outcomes will be. It’s no secret, staying healthy takes work. Consistent, deliberate activities are key. Standing, sitting, “hip-hinging”, all of the buzzwords. More movement, and proper movements, prepare you for your life. The more you’re prepared for what life throws at you, the more likely you’ll be able to bend over and tie your shoes without fear of lower back pain. Consistent, deliberate activity.
1. Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116.