This information is for those of you with chronic or recurring low back pain. If you had a serious accident, have serious neurological symptoms like complete loss of sensation or control of your bowel and bladder, or if you have a fever associated with this pain, please call or see a Medical Doctor immediately as these may indicate very serious conditions.
The majority of back pain is mechanical in nature. That means the moveable soft tissue components of the spine are normally the things that get injured. Things like the ligaments that provide support and prevent the spine from moving into damaging ranges of motion; the discs between each vertebra that provide shock absorption and mobility of the spine; the joint capsules that surround the facet joints and give it mobility and support; the tendons that attach muscle to bone to move our spine but also to stabilize it against forces like gravity; and the fascia that covers every muscle fiber giving it it’s shape, elasticity, and strength.
This information is for those of you with chronic or recurring low back pain. If you had a serious accident, have serious neurological symptoms like a complete loss of sensation or control of your bowel and bladder, or if you have a fever associated with this pain, please call or see a Medical Doctor immediately as these may indicate very serious conditions.
The majority of back pain is mechanical in nature. That means the moveable soft tissue components of the spine are normally the things that get injured. Things like the ligaments that provide support and prevent the spine from moving into damaging ranges of motion; the discs between each vertebra that provide shock absorption and mobility of the spine; the joint capsules that surround the facet joints and give it mobility and support; the tendons that attach muscle to bone to move our spine but also to stabilize it against forces like gravity; and the
fascia that covers every muscle fiber giving it it’s shape, elasticity, and strength.
The lumbar spine should have a natural inward curve and when this is maintained there is equal distribution along the entire vertebral disc and facet joints with no strain to the ligaments, tendons, and myofascia. First, try this experiment: Pull your index finger back just before it hurts and hold it there for 1 minute. When you release it, you will probably feel stiffness and maybe even pain as you bend it back. You have strained the soft tissue components of the joints and deformed them slightly registering as pain. When you maintain a flexed posture for prolonged periods it’s the same thing for your low back. The muscles and associated fascia become over-lengthened, stiff, and weak. The ligaments and joint capsules become over stretched making them fragile and inelastic. There is more pressure on the front of the disc causing the jelly-like nucleus to bulge back towards the spinal cord eventually causing spinal or nerve impingement.
What am I doing during the day to cause this?
This always reminds me of the movie Baby Mama, when Amy Poehler yells at Tina Fey, “I don’t know your life!” I’m always learning new ones, but here are some of the deleterious ways we injure our spine. The most common cause of low back pain is stress from poor posture. I call these different positions posture habits. Habits are things we do without thinking about and most of my patients don’t even know they do them. They always have to think about it before they tell me, “Yeah you’re right! I do that all the time?” These positions are comfortable because your body has become molded into that position and takes very little effort. That usually means are muscles aren’t doing any work and we are just resting on ligaments and joint capsules. This is true in the shoulders and hips as well.
In our modern world, the main culprit is sitting for long periods of time with poor posture. The average American sits about 14 hours a day. That’s a long time and a lot of stress on our low backs. Other postural stresses include bending over with a rounded back for prolonged periods, lifting objects with a rounded spine, sleeping in awkward positions on a poor mattress, poor standing posture when ironing, vacuuming, etc., standing with the “sassy hip” rather than on both feet, leaning on the center consul when driving, curling up on one side of the couch, crossing the same leg over when sitting, and my least favorite position: Sitting on your foot. That tilts your pelvis toward the opposite side and overstretches the hip muscles, knee, and ankle.
I have a lot of patients who work out and they feel great in their workout but after sitting for a while their back pain begins. They always think it was something they did in their workout but it’s usually what they did afterwards. The soft tissues are very pliable and distort easily after exercise. So make sure you cool down properly and don’t go into a flexed position right after your workout.
LIFESTYLE MODIFICATIONS
Before we get into the exercises, let me show you how to reduce the strain on your low back
Proper Sitting
When you sit down, take a second to lift and tilt your pelvis to a neutral position after you scoot all the way against the backrest. If you’re not sure how to do this, then reach under your buttocks one at a time and pull the sit bones toward the backrest. Typically when we plop into a chair or booth our pelvis is tilted backward making it even more difficult to sit up straight. Another problem, especially getting into cars, is that the inside pelvis gets pushed into the sacrum as we slide into our seat. This jams the SI joint together and rotates your hip out. Thats why your right knee always rests out to the side when you drive. To correct, lift your buttocks up and rotate your right hip forward or left hip if you are a passenger.
Time to Move
I’ve known patients who can sit and work at their desk with no restroom, drink, or food breaks for 8 hours. It almost seemed like they were bragging but mentally I was shaking my head. We are designed to move. Movement nourishes our muscles and joints and stimulates our brain as well as decreases pain. At minimum, you should take a break and move every hour. Stand up, lean back a few times (proper technique shown later), go for a walk, do some slouch overcorrect movements. If it takes less than an hour for your pain to start, then immediately stand up and stretch to take the pressure of your discs and relieve the stress on your ligaments.
The Lumbar Roll
If you are going to be stuck in a chair or driving for long periods, one of the best things you can do for yourself is get a lumbar roll. It requires no mental or physical exertion to maintain the lumbar spine. And when you are laser focused on a project or making good time in the car the last thing you want to do is stop so you can move around. If you are currently in a bout of pain this is a mandatory tool to not injure the tissues further. Our ultimate goal is to develop strength in your low back so that you only need to use the lumbar roll for long road trips or airplane rides. I recommend the McKenzie Original or Super Lumbar Roll
Mattress
Sometimes it’s the sleeping surface that is causing your back pain. Medium-firm mattresses, on average, have the best results with patients who wake up with low back pain. I recommend Tuft & Needle for prices, quality, and customer service. I’ve had patients move their $6000 adjustable mattress to the guest room after sleeping on this mattress that’s under $1000 for a California King.
The Night Roll
Another ingenious device by Dr. McKenzie, the Night Roll wraps around your entire waist and ties in the front keeping your spine in a neutral position in relation to the hips and pelvis. When you sleep, firmer mattresses push the wider pelvis/hip towards the spine stressing the soft tissues all night. This device counteracts that. Bear in mind it may be uncomfortable for a few days as your body adjusts to it.
Sleeping Position
It is very hard to correct your sleeping position because you will toss and turn all night but if you are having trouble going to sleep because of pain, try this. Be as symmetrical as possible. Don’t like in bed with one leg straight and the other one out like you are about to be outlined in chalk. If you sleep on your back, put a pillow under your knees. If you are a side sleeper, bend both hips and knees evenly and put a pillow between your knees. That will take tension off the IT Band, which pulls into the hip, and into the SI joint.
Working While Bending Over
If you are in acute pain, just don’t do it! You probably won’t even be able to but especially don’t do it the first few hours in the morning when the soft tissue components are stiffer. I’m sure you probably all feel how stiff you are first thing in the morning. Better options are learning the hip hinge, squatting, and kneeling. In each you keep a stiff spine, brace your core like you are getting punched in the stomach and move through your hips.
Lifting
If you have to lift something up lean back with your hands on your sacrum 5 times before and after, especially if it’s heavy. Correct lifting technique involves keeping the inward curve of your spine so keep those low back muscles engaged.
• Stand close to the load and brace the core like getting punched in the stomach
• Bend your knees and hips keeping your back straight
• Grab the load securely and lean back to counterbalance the weight in front keeping the load close to your body.
• Lift by straightening the knees and the hips, not by pulling with your back
McKenzie Exercises
If you have pain radiating down the hip, leg, or even down to your foot you probably have a herniated disc that is putting pressure on a nerve root. The goal for these exercises is centralization which is the movement of the pain to a more midline location. If your back pain worsens, but the pain down your leg starts moving up towards the back, then this is.a positive indication that the pressure on the nerve root is being diminished. The back pain is likely due to the reformation of the soft tissues that have been deformed for so long. The longer you’ve had your pain the longer this may take, but you can speed the process up dramatically with a few visits to my clinic. I have treated many patients in these McKenzie positions and they show dramatic improvement over a few visits. Depending on the severity and length of injury it may take weeks to find significant relief with just the McKenzie exercises.
When you are in severe acute pain, you should start with Exercise 1 and work your way to Exercise 4 until the pain subsides. Once you are out of acute pain we can begin with strengthening exercises. There are various levels of progressions with each exercise and everyone is different so that will be covered in the clinic on a patient-by-patient basis.
Exercise 1: Lying Face Down
• Lie face down with your arms beside your body and your head turned to one side.
• Stay in this position, taking slow deep breaths through your diaphragm. You’ll know you’re doing this when you feel your stomach push into the ground. You should also feel a nice stretch in the low back muscles. Do this for about 2-3 minutes.
• Start each session with this exercise and do them 6-8 times a day.
Exercise 2: Lying Face Down in Extension
• Place your elbows under your shoulders so that you are resting on your forearms..
• Take deep breaths and try to relax the muscles in your low back, hips and legs completely.
• Remain in this position for 2-3 minutes
• Exercise 2 must always be performed before exercise 3 in acute cases.
• If you get no response or benefit you probably are not able to apply significant pressure on your own and will need to get assistance in the clinic.
Exercise 3: Extension in Lying
• Put your hands in the pushup position
• If your pain is mostly on one side, you can slightly modify the starting position by shifting your hips away from the painful side.
• Slowly straighten your elbows keeping your back, hips, and legs relaxed as you do this.
• Push yourself up as far as pain permits, hold for a few seconds and then slowly lower down.
• Each time you press up try to go a little farther. If it feels like your pain is releasing you can hold the position a little longer.
• Perform at least 10 reps, but feel free to do more if it’s relieving your pain.
Exercise 4: Extension in Standing
• When you are in acute pain, this can replace exercise 3 if you are unable to get on the ground.
• Use this if you have been bent over too long, seated too long, and before as well as after lifting heavy objects.
• The moment you start feeling pain perform exercise 4 immediately
• Stand upright with your feet slightly apart and place your hands in the small of your back with the fingers point towards your spine and sacrum.
• Bend backwards at the waist as far as you can using your hands as a pivot point.
• Keep the knees straight and hold for a couple seconds before returning slowly
• Perform 10 reps at least or until you reach maximal range of motion.
Exercise 5: Side Glide Against Wall
•If you have an antalgic lean, like you are in The Matrix and are trying to curve around a bullet try exercise.
•Place your feet together about a foot from the wall. Pain-free side closest to the wall.
•Hold your arm against your side with the elbow at a right angle
•Keep your shoulder and upper body against the wall and slide your pelvis towards the wall using your other hand to add more pressure
• Hold for several seconds then slowly release pressure
• Repeat 10 times trying to move the pelvis further and further toward the wall Remember, you are doing the exercises correctly when:
• Pain centralises from your leg, thigh, or buttock towards your back
• Pain intensity gradually decreases
• Your range of motion increases
If the opposite happens you should immediately stop performing that exercise and contact the
clinic.