Almost everyone reading this has had or will have some form of nagging low back pain. Given the current pandemic, much of the world is now working from home and unable to see their therapist. But does that mean you can’t prevent or self-manage your low back pain? You can rest assured that having a solid understanding of occupational low back pain (LBP) has good scientific evidence to decrease the duration and severity of pain. Yes, symptomatic relief through manipulations and manual therapy may help, but you have the ultimate ability in keeping your back healthy.
Investing in the integrity of your lower back through exercise, weight control, and mindfulness appears much more cost-effective than money spent on costly equipment and cures. The culprits causing LBP remain elusive and complex, so the goal of this article is to provide an incomplete yet accessible guide towards managing LBP, something that you may find useful. Much of this guide is synthesized from the latest evidence and my clinical experience working with clients with LBP.
Workplace Stress Increases The Risk of Low Back Pain
Your back is a strong, and sturdy structure. Our modern vocabulary has introduced a veneer of fear in back pain with phrases such as “slipped disc”, “broken back”, “chronic pain.” Indeed, pain can be a frightening experience but you need to understand that pain isn’t merely mechanical damage. Pain is largely influenced by your current emotional and mental state. Research has shown that anxiety and stressful thoughts can increase the risk of pain and disability. Your perception is also the reason for the placebo effect to work, now apply it to work Practicing mindfulness and meditation are very important towards disposing emotionally-negative thoughts. I suggest trialing a meditation app such as Headspace or Waking Up as a practical solution towards coping with LBP. Having the perspective that LBP is something that you will overcome and can manage is significant in improving your pain.
Graph redesigned from Buruck et al. 2019. The authors pooled data from 19, 572 subjects. Social support was defined as two measures ranging from .75-.78. Workload confers the highest risk of developing low back pain, while factors regarding agency conferred the lowest.
Focus On Movement, Not Posture
Arguing against the significance of posture as a culprit for LBP still remains a hot take in discussions about LBP. This is both regrettable and annoying for many physical therapists like myself. Despite a good amount of scientific evidence finding no association with posture and developing LBP, the archaic theory is still circulating mainstream.
As renowned therapist Greg Lehman puts “Is it some “bad posture” that is the problem or is it simple that you aren’t moving? If we focus on posture we are focusing on the wrong things.”
Saying that your “bad” posture is the reason for your pain creates anxiety and guilt. This may exacerbate the ongoing pain that you experience. If you know that your bad posture is inherently the culprit for pain then why isn’t your body naturally doing something to relieve the damage and pain? If your body feels pain or discomfort, it will move. A lack of movement may actually play a much more significant role. It is common knowledge that sedentary behavior carries a myriad of problems such as increasing your risk of getting heart disease and diabetes, but did you know it can also increase the risk of low back pain?
Why does this common misconception persist? Well this is because nuance is at play. Sedentary behavior weakens the musculoskeletal system’s ability to sustain awkward positions so if a sedentary individual forces their body with high demands their muscles, and joints will be unsustainable leading to a lower back injury. It is the body’s inability to perform for a given demand, and not the posture that leads to injury.
Organize Movement Throughout Your Day
The strongest evidence for reducing and preventing LBP in office workers has been found in data around varying postures throughout the workday. This includes the use of standing-desks and miniature exercise routines. When you take active steps towards decreasing the amount of sedentary behavior and perform simple body exercises throughout the day, you can drastically decrease the amount of back pain you may experience.
My recommendation is having at least four small periods of 5–7 minute exercise breaks followed by a change in position. For example at 10:00 AM, if you are sitting you will perform a small 5 minute exercise routine at your desk and then for the next two hours, and then alternate. Currently, there is an overwhelming amount of free home-workouts that you can do at your desk, available through Instagram and YouTube.
Graph re-designed from data of Thorp et al. 2014 looking at the effects of comparing sit only to sit and stand workstations for overweight/obese office workers. The only anatomical region to reach statistical significance (p <.03) was lower back discomfort.
Concluding Remarks
The etiology of back pain remains elusive to scientists and clinicians. Advances in imaging techniques have not been particularly helpful and in fact imparted more noise to the clinical picture. For example there have been numerous studies that found healthy, pain-free individuals with all sorts of structural asymmetries and abnormalities. And likewise, individuals who suffer from excruciating pain have no significant structural abnormalities. What experts agree is that being active throughout the work day and deflecting anxiety has a very important role in preventing low back pain.
Strategies for Preventing and Managing Low Back Pain
- Organize movement throughout your day. Create a routine schedule that your body can appropriately accommodate.
- Focus on movement, and not posture. Modify your posture based on symptoms, some of you may find slouching relaxing, others sitting up. As Greg Lehman says, “If it hurts, try something else.”
- Practice mindfulness as a means of coping with stress and pain in the body. Improvements in pain and symptoms may take months to achieve, your body needs time to adapt.
Caveats:
In this article I tried to sift through a lot of technical and medical terms regarding back pain and provide an accessible format to self-manage LBP. There are certainly a few things that warrant a visit to the emergency if you have back pain, these include:
- Loss of bladder or bowel control
- Pins and needle sensation in the groin, genital, or perianal areas.
- Night sweats, fever, or sudden weight loss
- Progressing bilateral weakness and numbness going down the legs.
- History of cancer, tuberculosis, and osteoporosis.
If you do not have any of these things, please continue reading. If you do have these things along with your back pain please visit your local emergency.
What is physical therapy and how is my profession different from chiropractors, osteopaths, and other alternative health practitioners? Physical therapy is the identification, evaluation, management and prevention of any movement dysfunctions that arise from injury, and disease.
Disclaimer: The content on this site is provided as an information resource only, and is not to be used as a substitute for any diagnostic, treatment purpose, or professional medical advice. Using the information on this post or links is at the reader’s own risk. Readers should not ignore, or delay in obtaining medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.
References
- Steffens, D., Maher, C. G., Pereira, L. S., Stevens, M. L., Oliveira, V. C., Chapple, M., … & Hancock, M. J. (2016). Prevention of low back pain: a systematic review and meta-analysis. JAMA internal medicine, 176(2), 199–208.
- Zhang, T. T., Liu, Z., Liu, Y. L., Zhao, J. J., Liu, D. W., & Tian, Q. B. (2018). Obesity as a risk factor for low back pain: a meta-analysis. Clinical spine surgery, 31(1), 22–27.
- Thorp, A. A., Kingwell, B. A., Owen, N., & Dunstan, D. W. (2014). Breaking up workplace sitting time with intermittent standing bouts improves fatigue and musculoskeletal discomfort in overweight/obese office workers. Occup Environ Med, 71(11), 765–771.
- Davis, K. G., & Kotowski, S. E. (2014). Postural variability: an effective way to reduce musculoskeletal discomfort in office work. Human factors, 56(7), 1249–1261.
- Gibbs, B. B., Hergenroeder, A. L., Perdomo, S. J., Kowalsky, R. J., Delitto, A., & Jakicic, J. M. (2018). Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occupational and environmental medicine, 75(5), 321–327.
Lehman, G. Sitting Posture is Irrelevant to Pain Accessed: April 11, 2020: http://www.greglehman.ca/blog/2018/3/29/dear-mike-and-friends-why-sitting-posture-is-mostly-irrelevant-to-pain
