Back Pain in Contemporary Society

Back pain is a constant complaint of many people not only in the U.S., but worldwide.  This pain is not suffered exclusively by the person with pain, but also on all of our pocketbooks.  In fact, according to one European study in the journal Pain:

The paper reports the results of a ‘cost-of-illness’ study of the socio-economic costs of back pain in the UK. It estimates the direct health care cost of back pain in 1998 to be £1632 million. Approximately 35% of this cost relates to services provided in the private sector and thus is most likely paid for directly by patients and their families. With respect to the distribution of cost across different providers, 37% relates to care provided by physiotherapists and allied specialists, 31% is incurred in the hospital sector, 14% relates to primary care, 7% to medication, 6% to community care and 5% to radiology and imaging used for investigation purposes. However, the direct cost of back pain is insignificant compared to the cost of informal care and the production losses related to it, which total £10668 million. Overall, back pain is one of the most costly conditions for which an economic analysis has been carried out in the UK and this is in line with findings in other countries. Further research is needed to establish the cost-effectiveness of alternative back pain treatments, so as to minimise cost and maximise the health benefit from the resources used in this area. (Vol 84, Issue 1)

It is in everyones best interest to reduce these costs .  It is my opinion, much of the pain and economic cost could be alleviated by following a few basic principles administered in a regular low intensity exercise program.  With my clients I utilize many of the ideas set forth by R. A. McKenzie.  According to McKnenzie there are three main factors in the etiology of low back pain:  sitting posture, loss of extension range, and frequency of flexion. (The Lumbar Spine: Mechanical Diagnosis and Therapy, RA McKenzie)

Lets start with sitting posture.  What is it about sitting for extended periods of time that leads to pain and dysfunction?  If we remain seated for more than a few minutes the lumbar spine relaxes into a fully flexed state, this reduces the tension being held by the muscles into the ligament.  This constant tension on the ligaments leads to excessive stretching and loss of pliability.  Further this fully flexed position pushes the the fluid from the center of each lumbar disk towards the back which is the weakest point of the annular rings.  This is important due to the fact that when the annular rings fray and split nuclear fluid is leaked into the surrounding tissue creating a pain sensation.  Doing an office ergonomics assessment can greatly reduce to strain incurred at work.  The assessment includes creating and maintaining the appropriate height of your chair, keeping an appropriate height and distance from your computer screen, making sure that you are not rotated to one side more than the other, and simply standing up and stretching every 20-30 minutes can go a long way towards easing office posture pain.  For those who endure the rigours of a daily commutes take notice of your hips.  Often times you will find yourself carrying your weight to one side creating strain on the loaded side.  A lumbar support can also be a lifesaver for long car/plane trips.

Another major factor in back pain is loss of extension range.  In fact studies in 1972 and 1979 reveal that seventy-five and eighty-six percent of patients with low back pain had a loss of extension. (McKenzie 5).  As we lose any range of motion in our body, the rest of the joints compensate.  When we lose the ability to perform extension of the lumbar spine it starts to become flat.  This causes a compensation pattern in both the thoracic and cervical spine.  This reduction of curvature impedes the ability of the spine to distribute forces.  This results in an increase of intradical pressure (the pressure being applied to the vertebral disk) as well as to degeneration of the vertebra themselves.  This can in turn can be associated imbalances in the muscular system.  Simple extension exercises can remedy this problem.  Yoga offers many such movements, remember to start slow and incorporate these movements throughout the day.

The third major component in back pain is frequency of flexion.  This simply means the greater amount of time you spend in flexion the more likely you are to experience back pain.  Flexion positions include sitting, bending over, stooped posture, and often times sleeping in a flexed position.  If you have poor posture and spend a lot of time sitting you are at a high risk for developing repeated back pain.  Addressing your overall postural balance can alleviate many of the ailments from excessive flexion patterns.  Try setting a timer on your watch to go off every 15 minutes.  When the timer goes off check your posture and make any needed adjustments.

These repeated flexion patterns have become deeply ingrained motor engrams in our society and carry a heavy burden for us all.  The solution is daily movement to reprogram your nervous system which controls your muscular system.  Exercises do not need to be vigorous, but they do need to be done consistantly and with proper technique.  Over exertion and poor form are worse than doing nothing at all.  Find a modality of exercise that you enjoy and perform it frequently.  Not all back pain is the same and severe back pain should be treated by your Physical Therapist, D.C., or M.D..  Sever back pain includes but is not limited to burning (usually from fluid displacement) and sharp pains (often times from neural impingement).   For more information on back pain check out my previous blog.  Taking responsibility for your own health is not only empowering, it is a necessity!

Train Intelligently!

TJ Pierce

BS Exercise Science, CHEK 2, MTA 1