When it comes to low back pain, we are told that sitting for too long is not good for our backs. Why is that the case? What does sitting do to our low back?
There are low back pain studies that have been conducted that measure the pressures in the spinal discs with various activities. One study in particular 1, involved a 45 year old male who had a pressure device inserted into his L4/L5 disc. This allowed researchers to measure the amount of pressure change in a variety of different activities. Running, sitting in various postures, lifting with both good and bad mechanics and even stair climbing were measured. What we observed from this study is that there are different pressures that the disc undergoes with differing positions. You may be asking, how is this relevant to me?
What is critical to remember with patient’s is that if we treat a large group of people who have low back pain with the same interventions, we are going to help some people and we will not help others. This is where subgrouping comes into play. Subgrouping is when we take a history from the patient about their issue. From experience and research we have found certain subgroups of patients have certain characteristics and presentations. It makes logical sense that if we can subgroup patient’s with low back pain, that we can offer them more specific interventions that will better address their impairments. This is much more effective than just giving everyone the same interventions and only some people get better. More on the subgrouping in next weeks article!
Low back pain treatment can revolve around the reduction of your pain. When you go see a practitioner it is often because you are in pain, which is an unpleasant experience. When we are given medication, offered injections, or prescribed a specific treatment, one of the goals is to help reduce your pain. Physical therapists often take a similar approach to low back pain. There are often movements/positions that make your pain better and some that make your pain worse. There is a phenomenon called peripherilization and centralization. Some patient’s have low back pain that is associated with radiating pain that goes down the leg (sciatica). One of our goals with this type of patient is to help centralize their pain. If we can take the pain out of the leg and move it toward the center of the back we can predict that the patient has a good prognosis (they will get better with our interventions).
When it comes to treating low back pain there are studies that will show sitting is bad for your back and just as many studies that show sitting and standing create similar stresses on the back. You may now be asking, “What is the best position?” I will tell you that in my opinion it is somewhere in-between. I advise my patient’s to not go longer than 1 hour without getting up out of your chair or if you start in standing, sitting down. This variability will help to off load some of the structures that could be affecting your back. Set the alarm on your phone so that you have to get up and move around.
You may already know intuitively that one position is better for your back because the other causes pain. Another concept that needs to be addressed is the concept that not all hurt = harm. As I am writing this, I am coming up with more ideas for blog posts! More on the hurt = harm later!
The moral of the story when it comes to low back pain and in that matter, reducing the risk of developing low back pain is that you need to move your body. Motion = lotion is what I tell my patients.
If you found this article helpful, share it with a friend. If you need more specific advice, call or text me at 501-529-2010, or you can shoot me an e-mail at Brian@pinnacledpt.com. My name is Dr. Brian Murphy, I am a physical therapist and owner of Pinnacle Physical Therapy located in Little Rock, AR.
Thanks and here’s to helping you reach your PINNACLE!
5507 Ranch Dr, Suite 203
Little Rock, AR 72223
Wilke, Hans–Joachim, et al. "New in vivo measurements of pressures in the intervertebral disc in daily life." Spine 24.8 (1999): 755-762.
When it comes to low back pain, there is no shortage of providers you can go see. You can see your primary care physician, a chiropractor, a massage therapist, a physical therapist, a yoga instructor, an orthopedic physician and even a neurosurgeon.
You may be asking, how do I then decide who is the right choice for me?
Some people want to avoid medications, surgery, and injections at all costs. This narrows the field of potential practitioners off the bat. If you are to see a physician, very likely you will be prescribed medication, given some kind of diagnostic test (X-ray or MRI) and then prescribed physical therapy. The involvement of specialists (orthopedic spine physicians and neurosurgeons is often not the first line of defense).
Some practitioners offer more conservative approaches to treatment of low back pain. Massage therapists offer soft tissue work and stretching to address pain and limitations. Yoga instructors offer movement based interventions. Some pure Chiropractors believe that disease processes stem from a malalignment of the vertebrae (bones in your spine.) Their treatment is thus geared toward adjusting the spine so that the nervous system can function properly.
I can speak the most intelligently about physical therapists. We are movement specialists who address our patient’s impairments to help them stay active and pain free. A good physical therapist looks at the movements of your whole body to see if there are compensations in the normal patterns of movement, to find muscle weakness, to find joint restrictions, tight muscles, poor balance, and assess how a patient’s environment and activities may be affecting their pain and limitations. From there, we start to address those impairments and very often pain subsides and we can ramp activity back up.
Another difference I see in good practitioners is the ability to help patients with low back pain become independent. If you are constantly receiving care and are not taking an active role in your own recovery and health, I think you are not being properly cared for. I don’t know too many practitioners that you can take on vacation with you to help you when your back gets flared up. Because there are so many factors that play a role in a patient’s pain a very multimodal approach to intervention is indicated.
Brian, what do you mean by multi-modal approaches in low back pain treatment? I mean that there has to be a combination of manual therapy (hands on techniques) and active exercise. I do not believe in passive approaches to care. I am not going to stick you on a TENS unit (thing that makes your skin tingle) with an ice pack for 15 minutes while I catch up on notes. What in life has come easy to you without having to put in work or effort? I am telling you now that dealing with your body is no different and in fact often is harder work.
I don’t like to give generic advice and exercises, but there are recommendations and movements that are well researched that can help reduce the risk of injury and also help alleviate current pain that may be stemming from your back. This advice does not mean that you should not go see a skilled medical provider that will employ the above mentioned approaches to your care.
Over the next weeks I will be providing this information on how you can get back to doing the things you love, after all, we can all live with some pain, but when it starts to interfere with our hobbies and interests, we have to say enough!
If this advice and these movements help you, please feel free to let me know. Write it in the comments below.
I appreciate you reading and let me know if I can be of further service to you.
Here’s to helping you reach your PINNACLE!
Dr. Brian Murphy , DPT, OCS, ATC, PES, TPI II Medical
Owner of PInnacle Physical Therapy
5507 Ranch Dr Suite 203
Little Rock, AR 72223
Doc, what is causing my low back pain?
Does low back pain bring you in to see your doctor? I know for me, that pain and limitation in my daily activities spurs me to get examined. With the prevalence of low back pain in our population today, I have many patient’s who want to know what is wrong with them. Here is where I will dive into the research to tell you why low back pain in medicine is a tricky condition.
So what do I mean by tricky condition? Remember I told that most of my patient’s come in to me asking what is causing my low back pain?The answer is anything but clear. The term pathoanatomy is how much of medicine is taught in medical school, physical therapy school, and many other schools for body workers. This term means that we are looking for an anatomical reason for what the patient is telling us.
For low back pain this would include looking at films to help us determine the cause of pain. It seems logical that this would point us in the right direction of how to best treat patient’s with low back pain. However, this is far from the truth. The research tells us that most diagnostic tests (X-ray, MRI, CT scan) when assisting in diagnosing the low back are of very little value. Why you might ask? Because of false positives. Many of these tests find so called “pathology” or abnormalities in patient’s who don’t even have pain!
That is confusing! Brian, you are telling me that if I go to my doctor and he orders an MRI and it shows degenerative disc disease but that the finding of DDD may not be causing my pain? Yes, my friend, you are exactly right! According to the research study by Savage et al1 it reported that 32% of asymptomatic subjects had had ‘abnormal’ lumbar spines (evidence of disc degeneration, disc bulging or protrusion, facet hypertrophy, or nerve root compression) and only 47% of subjects who were experiencing low back pain had an abnormality identified.1
If it were as simple as looking at an MRI to find the “cause” of low back pain, it would be much better cured and would not be such a burden to us and our medical system. Just the sheer fact that you can see a massage therapist, internist, orthopedist, spine surgeon, yog instructor, chiropractor, physical therapist tells us that there is no clear concensus on how best to treat patient’s with back pain.
Now, I am not saying that those diagnostic tests are not valuable, what I am saying is that often they are not needed on the first appointment to your medical provider. Say for instance that you go to your internist for an episode of low back pain, you may be prescribed a steroid, some pain medication, an X ray will be ordered and you will be sent to PT. If you add up the cost to you and the system of this approach, it will be exorbitantly more than going directly to your physical therapist.
Yes, that right, in the state of Arkansas, you can go directly to your PT first. What does that mean? It means no medications, no expensive diagnostic tests, no injections, no surgery and often a very effective non invasive way to get pain relief. We are trained to determine if your low back pain symptoms are of mechanical origin. There is a small chance that you may have a serious underlying issue that needs medical attention, but we are well educated in screening for those conditions and making appropriate referrals when necessary.
So you may be asking, if there is no specific problem in my back, then how do I get relief?This is where as physical therapists we are taught to subgroup patient’s with low back pain. Based on the signs and symptoms of your condition we do a thorough history to start to determine what are the factors related to your back pain. Is there mechanical stress from work, poor postures, anxiety or depression, is there signs of instability, are you having pain that radiates below the knee, are you in a chronic state of pain? All of these questions and of course our movement examination will allow us to determine a specific treatment plan for you! Your medical provider should be spending at least 15 to 20 minutes just talking to you to determine the best course of care to get to the root cause of your problem.
All the medication in the world will not help if you are constantly sitting with poor posture at work, or if you are bending and lifting improperly. It is time we expect our medical providers to look holistically at all the factors that are playing a role in our limitations, so we can have a multimodal way to attack those impairments so we can get back to enjoying our active lives in a pain free/reduced manor.
As always I am here to be a resource for you, I am available via e-mail at firstname.lastname@example.org or by phone call or text at 501-529-2010. I offer a FREE phone consultation to help guide you to a full return to the things you love. Please reach out.
Here’s to helping you reach your PINNACLE!
Savage RA, Whitehouse GH, Roberts N. The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males. Eur Spine J. 1997;6:106–114.
5507 Ranch Dr Suite 203
Little Rock, AR 72223
Dogwood Crossing Building