Last week I discussed the 4 mechanical stressors behind almost everyone’s back pain (see article here). Today I want to discuss how we manipulate them to avoid back pain, and if we end up with back pain, how to manage it and make it go away as fast as humanly possible. With a deeper understanding of the cornerstones and how to manage them, you will be in control of your back health for the rest of your life. By using these principles myself, I have recovered from two separate herniated discs (2013 and 2016) and still gone on to achieve my personal powerlifting goals.
Load was the first cornerstone I mentioned last time. I established that load is changed via three mechanisms: gravity, external weight, and muscle contraction. If you or your patient is “load sensitive” than incorrect application of any of those mechanisms will further your injury or at least keep it around. You may be wondering how you are supposed to change gravity. Well, you can’t (I know groundbreaking isn’t it?!). Since we cannot change gravity, we need to do what we can to change how it adds pressure to your back. Two options pop into my mind now. The first is to simply lie down. Lying down will change the line of action of gravity on your spine. Since gravity is always straight down, your spine is now perpendicular to that so the spine is no longer being compressed (loaded). Ok, ok, lying down on the job isn’t the smartest thing or the easiest thing to do. You are too far behind, you have too much to do, the boss will fire you, etc. The reasons are endless. So option number two is your best bet. I call is self-traction. Self-traction is a way of unloading your own spine and counteracting the effects of gravity and load principles in general. Take a look at the pictures below:
Here you can see my arms are straight and my elbows are locked. I am supporting some of my bodyweight on my arms (roughly 20-25%). In order to put weight on my arms, I need to bend at the knees like I am doing a squat. DO NOT BEND FORWARD AT THE WAIST. Once you feel some relief, hold that position for 5-10 seconds and then stand up again. Do this as many times as you need and do it multiple times throughout the day. What happens if the table is too low? Widen your legs as much as you need too in order to get to the height of the surface you are using. Common places that work well for self-traction include desks, conference room tables, and backs of chairs (not the ones with wheels!). You get the idea. You’ll notice in the pictures you can also do this from a door jam or something from which you can hang. In this version, reach up and grab on, slowly bend at the knees to lower yourself down, but DO NOT hang all your weight (again just about 20-25%). I’ve also shown how you can unload a little bit while sitting. As you can see, my butt is not coming off of the chair/table; I am simply locking my elbows and taking some of the load off my lower back. The more you unload your back throughout the day, the better you will be. External weight will undoubtedly add load to your back. When there’s a lot to lift or a large object, do the obvious. See if someone will help you or if you can avoid doing that task until your back feels better. If not, then you have to use good mechanics. Remember, the better position your spine is in, the more load in can tolerate. So remember, lift with your legs, keep the object as close to your waist and belly button as you can (reduces the lever arm), and keep your back flat. We need to be careful of what muscles we use when doing everyday tasks, most notably the hip flexors and the 6-pack abs. In one of my recent blogs, I review how to complete common daily tasks for optimal back health (see here).
Position is the next cornerstone. Controlling the lower back position (if you are position sensitive) is ultra-important. You do that with learning how to do a pelvic tilt. I’ve discussed at length how to do a pelvic tilt (here), how to keep that position once you’ve done the tilt (here), and how to transition that knowledge to common daily tasks (here). So today I will just cover very common solutions to very common positions. Sitting: the majority of Americans sit throughout the work day, and if you are flexion sensitive then you will be miserable. How to you change that? Use your seat adjustments to your advantage. For instance, when driving, use the lumbar support, raise your seat up to open up your hip-trunk angle, or look at special cushions designed to help you sit better (to be discussed). When at work, do the same. A popular tool I use with some of my clients is the car-cush (or tush-cush). The car-cush is just a little more narrow than the tush-cush, but otherwise exactly the same. It works by opening up your hip-trunk angle and making your lower back less flexed. Take a look:
Nerve tension is the third cornerstone and I talked about what to avoid if you are nerve tension sensitive (here). The nervous tissue runs from the back of your head, down to your butt, down the back of the legs, behind the knee, behind the ankle and into your toes. If you think of the nerves as one giant piece of rope, you will understand nerve tension. If I want to make the rope taut, I need to stretch it over every joint. This means, slouched sitting with your chin down by your chest, ankle pulled up so your toes are going toward your head, then extending your knee. If you slouch and have your chin down and your legs are in and under you then you are OK. The one end of the rope is slackened (the lower end). If you have your legs straight out, but are reclined then you again are OK. This time the top end of the rope is slackened. Make sure you don’t tighten both ends of the rope at the same time! The three most common pitfalls: driving, sitting on couch with feet on coffee table, stretching hamstrings.
The last cornerstone is static posture. Manipulating this is very simple, change positions, move around, and do it frequently. There are no special tips or trick for this one. These days there are a lot of ergogenic aids that make adjusting position possible, i.e. transitioning desks that you can sit or stand at and easily switch between the two, highly adjustable chairs, etc. If those are not applicable to you then slightly adjusting how far you are reclined is an option, slightly adjusting the pelvic tilt is an option, getting up to get a drink of water or take a lap around the office. There are plenty of possibilities, don’t make excuses why you can do any one of them.
Here is an analogy I like to use. Think of your body’s capacity as a dollar amount (i.e. $20,000). Everyone has bills to pay. The “bills” are the tasks you do throughout the day that you cannot make perfect and that you cannot avoid doing (i.e. going to work, cooking, shaving, etc.). You start with 20k; you have 10k in bills; now you have 10k to spend. If you like to work out, then make sure you have enough cash to spend on the workout. If you spend the cash by not paying attention to how you got out of bed, how you tied your shoes, how you took the trash out, how you sat at work all day, then you might not have enough to workout. If you don’t have enough and try to work out, then you get hit with an overdraft fee (i.e. your back hurts). Prioritize what you want to do and make sure you budget enough cash to be able to do it by not spending the cash on the little things that you can easily avoid spending it on. There you have it. Master these and I promise you your back pain will significantly improve. If you have any questions, post them below in the comments box!