Low Back pain has been an epidemic among all age groups including adolescent, women, adults and old age. Low back pain can be acute because of trauma, injury or muscle spasm and chronic because of muscular imbalance, weak muscles, degeneration or compression.
Reasons of Chronic Low back pain
- Static Standing – Standing at one place without any movement can also exaggerate pain especially when there is instability in spine (spondylosis). Standing in one position with excessive lumbar curvature (where pelvis tilt forward and there is increase in lumbar curve) causes compression of the spinal vertebras. Wearing high heels or with heals only elevated shoes add fuel to fire by adding more pressure on disks.
- Sitting – It is a well known fact that extended sitting is one of the most common reason for Back pain. The reason is connected to inhibition of gluteal and hamstring muscle when sitting for prolonged time. The glutes keep our spine safe by taking the excessive load off from spine while sitting and standing. There is a muscle known as Psoas which connects the spine to the femur (thigh bone) also get shortened due to extensive sitting and shortening o this muscle pulls your lumbar discs inward causing excessive lumbar curvature and hence overloading of vertebra discs.
- Forward bending and twisting – Repeated forward bending combined with twisting of spine at one time lead to extreme sheer forces on discs. The changes don’t happen in weeks or months but the changes occur gradually with repeated flexion and twisting of spine.
- Posterior Bending – Posterior bending (also knows as hyperextension) of spine with load or with body weight especially when you have weak back muscles put pressure on vertebra discs.
- Heavy Loading – Repeated heavy loading on spine increases sheer force and pressure in discs leading to disc degradation especially when combined with spine instability. Disc degeneration is related to age factor while degradation is related to repeated micro trauma and can happen at younger age also.
Fixing Low Back PainL
- Deloading: It refers to unloading the spine from gravitational pull or any force. This is the same as physiotherapist giving traction to spine but you can do it while sitting or standing without any equipment. Don’t do it for extended period as it will elongate the muscles and create instability of spine. You can do it for 10-15 secs at a time with brief rest of 4-5 secs and can be repeated 10-15 times once or twice a day. This can be while sitting on chair by locking our elbows and hold the edges of chair with feet on ground and raising hips just above seat of chair and transferring body weight on arms and legs. It can be done standing facing a desk or table, holding the edges of table/desk with elbows locked while leaning forward and transferring body weight on arms and slightly raising feet but still touching the ground. Idea is to remove force from spine. Aerial yoga is also great at reducing force from spine in inverted poses where you are hanged upside down with the help of hammock.
2. Change Position frequently: Don’t sit or stand for prolonged time. By moving you are unloading spine intermittently. Avoid static positions.
3. Increase Spine Stability: Core strength and endurance provides stability to spine. Transverse abdominis (TVA) musculature is like a corset to your abdomen area and provides stability to spine. TVA activation drills and exercises can helps improve the spine stability. You can activate TVA by contracting the abdominal muscles inwards as someone is going to punch you in your stomach. This can be done while you are about to sit on chair or standing up suddenly by keeping spine neutral and contracting abdominal muscles consciously. The idea is to create a mind muscle connection for TVA activation when spine loading or extreme movements are required such as in sports, deadlifts, pushing or squatting. You can increase the spine stability in gym by performing back extension with bar at your back and pelvis stabilised on GHD bench or incline extension machine. Perform the exercise by keeping spine in neutral position, pelvis stabilised and with activated TVA.
4. Psoas Stretch: The leg raises with knee locked and holding some bench or pillars serve one purpose only extreme forces on Psoas muscle which they are not supposed to. Sitting for prolonged time, doing ab crunches, leg raises make you more prone to back pain especially in the presence of spine instability. If you already have tight Psoas with lordotic spine and anterior pelvic tilt work on elongating or stretching Psoas muscle. See the video for reference.
5. Strength Training: Strengthening the pelvic muscle, glutes, hamstring indirectly load the spine in a functional manner. Start with more of spilt squat version, lunges which will help you keep spine neutral, stretch the Psoas muscle and improve the spine stability. Hip hinge movements without flexing lower back increases spine stability such as in standing good morning or waiter’ s bow.