Top 5 Habits of People who Conquer Chronic Low Back Pain
Chronic Low Back Pain is an epidemic. Low back pain is the single leading cause of disability worldwide (1). According to a 2006 systematic review, low back pain costs Americans over $100 billion per year including healthcare costs and lost wages due to time missed from work (2). Some studies estimate that 80% of people will experience low back pain at some point in their lives and it’s definitely the most common reason people walk into our clinic. As “experts” in the field of musculoskeletal pain and injury we do feel we have a duty to provide people with the tools they need to overcome low back pain and avoid becoming a statistic. We also see a lot of people who come in and get better and some who come back time and time again with the same complaints.
Why is it that some people overcome low back pain and others don’t? Would you believe me if I told you that it has little to do with severity of injury? There are so many flaws in our healthcare system that are contributing to this problem that I could write an entire post on that alone. That being said, as individuals blessed with free will and autonomy over our own bodies we must take responsibility for our actions and the lifestyle decisions that are conducive to the chronic low back pain epidemic. We are fully aware that most people are uninformed when it comes to the best ways to self treat and manage back pain and the best ways to prevent future back injury. We are here to provide you with the most important lifestyle hacks and habits that are essential in managing and conquering low back pain as well as optimizing your bodies function.
Before I lose you….THIS IS NOT ANOTHER THERAPIST RANT ABOUT CORE STRENGTHENING AND STRETCHING. While core strength and flexibility are definitely components of back pain they are only small pieces to the puzzle. The habits outlined below are the often overlooked yet ESSENTIAL in managing and conquering low back pain.
So what are the habits of people who conquer chronic low back pain?
Habit 1: They stay off the couch
Rest is not your friend. Many people think that after they suffer a back injury that they need to rest. They lay themselves up in bed or on the couch and they skip all exercise and they wait for their back to get better. This is the absolute worst thing you can do. People who conquer low back pain stay as active as possible. They modify their usual exercise routine so that it is manageable for them. This may mean staying away from heavy lifts and opting to do a lighter weight, high rep strength workout. Maybe they skip the weights all together and do a light run or a walk. The fact of the matter is, it doesn’t matter what you do as long as you do something! Why is movement so important after hurting your back? Increased blood flow in and out of the disc helps to remove waste build up that accumulates due to inflammation from the injury and provides a fresh influx of inflammatory cells to repair tissue damage.
Maintaining range of motion and flexibility is also a byproduct of choosing to move your body rather than rest it after a back injury. The less you move the stiffer you will get and the harder it will be to regain that motion in the future. Not moving to end ranges of motion is detrimental to your body. Being comfortable moving through end ranges of motion will equip your body with what it needs to avoid injury in the future. Life often requires that we move through end ranges, and, if you have both the strength and flexibility to do so you will be a lot more prepared when it happens and a lot less vulnerable to injury.
Habit 2: They avoid sitting as much as possible
Word on the street is that sitting is the new smoking. Modern day society involves entirely too much siting. Humans were not meant to spend most of the day in a sitting position. Not just sitting but sitting in a slouched position supported by an overly padded office chair or recliner so that our bodies have to do as little as possible to maintain that position. The problem with sitting in a supportive chair is that those trunk muscles that support the spine no longer have to be active. Over time, these trunk support muscles become deconditioned and weak. Weak trunk muscles means more stress on the spine and pelvis and leaves you vulnerable to injury. People who conquer low back pain are comfortable on the floor. They can sit for long periods unsupported and are very aware of their body position throughout the day. Getting on and off the floor requires a certain level of mobility and it also requires you to move through wide ranges of motion. Both of these things are crucial for ensuring a healthy spine. If you are afraid to move and get on the floor due to pain this will only inhibit you and keep you vulnerable to future back pain and injury.
Many people are required to sit during their work day and we get that. The best way to navigate around this is to alter your environment as much as possible to allow for position changes and to increase your awareness of HOW you are sitting throughout the day. It is important to maintain a neutral spine and engage your trunk musculature rather than melting into the chair. Sit up tall, pull your shoulder blades back and down and pull your belly button in towards your spine. This will ensure that your postural muscles are activated and your spine is in a good position. Try to keep both feet flat on the floor and make sure your weight is evenly distributed over both butt cheeks. If you can, take intermittent breaks throughout the day so that you are not sitting for longer than 30 minutes at a time. Stand up, go for a walk and get on the floor. Spend time in a deep squat, on your stomach, on your back, sitting indian style….. you name it. Being comfortable in all positions is something that all healthy spines have in common.
Habit 3: They spend ample time barefoot
You read that right. Spending time without shoes is KEY when it comes to conquering low back pain. You may think I’m being over dramatic…but I’m not. Shoes inhibit natural foot movement, decrease sensory input to the feet, and weaken the small, but important, muscles of the feet. So what does this have to do with low back pain? One word.. GAIT! Your gait pattern, which is a fancy way of saying the way you walk, is significantly altered when wearing shoes compared to when barefoot. Over time, shoes cause ankle and foot mobility deficits which leads to an alteration in the way your foot strikes the ground. Altering the way your foot strikes the ground will cause compensations at the knee and the hip which will ultimately lead to abnormal stress on the lower back. People who spend a lot of time barefoot usually never experience low back pain and that is no accident.
Did you know that a normal gait pattern requires a minimum of 45-55 degrees of big toe extension? 60+ degrees of big toe extension is required for running. Most people lack this required big toe motion because shoes inhibit the big toe from moving throughout the intended range of motion. Big toe extension is essential for normal gait because it activates the windlass mechanism of the plantar fascia which propels the foot forward during gait. Without adequate movement at the big toe your body will compensate in order to achieve forward propulsion. As a result of this gait compensation, it is common to develop tightness in the ankle (specifically ankle dorsiflexion) as well as limited hip extension. With limited hip extension you will develop tightness in the hip flexors. Tightness of the hip flexors results in increased compression and stress on the lower back. The psoas muscle, which is a major hip flexor, attaches to the spinal vertebrae from T12 - L4. When that muscle is tight you can see how it would add to spinal compression as well as change the position of the spine and pelvis. Lacking hip extension also leads to inhibition of the glute muscles, which are major pelvic stabilizers when functioning properly.
Obviously, you can’t exactly go around without shoes all the time. All we are asking is that, whenever possible, take your shoes off and walk around barefoot. Spend your weekends barefoot. Walk around your house barefoot. Work in your flower beds barefoot. Whenever possible, take off your shoes and socks and allow your foot to work without the restriction and inhibition that comes with shoes.
Habit 4: They eat a healthy diet
Any extra weight you have on your body will add stress to the joints, the spine especially, and most people understand this. Having extra weight around your midsection will pull the pelvis forward, thus placing extra strain on the lower back. Beyond the physical strain of having extra weight it’s also important to consider the effect nutrition has on tissue healing and inflammation. Foods high in sugar, artificial trans fat, vegetable and seed oils, and refined carbohydrates have all been shown to increase inflammatory markers in the body as well as to increase insulin resistance which will also promote an inflammatory environment. Too much inflammation is a bad thing because it increases the bodies susceptibility to pain and interferes with the bodies immune response system which is pivotal in tissue healing following an injury. People who consume a healthy, low inflammatory diet create an environment that is ideal for tissue healing. Allowing the body to heal properly is a key component of overcoming a back injury and preventing future flare ups.
Habit 5: They take advantage of direct access Physical Therapy
Thanks to direct access, you no longer need a doctors referral to come see a physical therapist after injuring your back. Billions of healthcare dollars are wasted each year on unnecessary MRIs, XRAYs, muscle relaxers and specialist visits all in the name of back pain. Direct access allows you to skip all of the unnecessary steps and get right down to addressing the issue. People who conquer low back pain don’t wait for their back to get better on its own only to hurt it again 6 months later because they never addressed any of the underlying problems. Sure, most people suffering from their first back injury will eventually get better on their own. But, without changing any lifestyle habits that are contributing to the vulnerability of the lower back to injury, it won’t be long before they injure their back again and usually worse. This time they might go to the doctor or the walk in clinic and get prescribed some muscle relaxers or pain medication. The problem with these types of medications is that, while they may make you feel better, they inhibit the natural inflammatory process which is essential to healthy tissue healing. This causes toxins (byproducts of the inflammatory process) to build up within the surrounding spinal musculature due to lack of blood flow resulting in muscle guarding and further inhibition of key spinal stabilizers. Now you have the combination of poor habits resulting in unnatural stress on the spine, unhealthy and inhibited muscle tissue ( thanks to incomplete healing processes ), and movement compensations that are so significantly altered that it will take a lot of work to get them back to where they should be. This, ladies and gentlemen, is a recipe for chronic low back pain and all of the unnecessary surgeries, other healthcare expenses, and unpaid wages that come with it. If they had only come to see a physical therapist after their first injury their story could have been entirely different.
People who take control of their health will come to see a Physical Therapist soon after their initial back injury. This will not only help to ensure the best environment for tissue healing, which will increase the speed of the healing process, but the Physical Therapist will also be able to identify the underlying strength, flexibility, and mobility deficits and the resulting positional and movement problems that have lead to the back injury. Becoming aware of these deficits and how to fix them gives you the power to take control of your health and avoid future back pain issues.
Take home message: We are not meant to exist sitting all day on couches, lazy boys and desk chairs. Our bodies need to move through a variety of positions throughout the day. Those positions should involve active muscle involvement and ideal joint and spinal alignment. Our feet need to be free to move and our bodies need to be fed “real” food. By “real” I mean food that existed thousands of years ago. A diet that is high in sugar and refined carbohydrates only primes the body for pain and dysfunction. Take control of your own health. Last but not least, when in doubt consult a Physical Therapist. We are trained to analyze movement patterns, identify deficits contributing to those abnormal movement patterns, and to address those deficits and restore normal movement so that you can learn to function with a healthy spine. If you want to get serious about your health, low back pain or not, I strongly suggest you find a way to implement these 5 habits into your life. Your body will thank you.
Rubin, Devon. Epidemiology and Risk Factors for Spine Pain. Neurologic Clinics. 2007; 25.2; 353-371.
Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences [review]. J Bone Joint Surg Am. 2006;88(suppl 2): 21-24.