What are the causes of back pain? And what do we need to change in order to prevent back pain? Renowned physiotherapist Jason T Smith sets us on the (somewhat) straight and narrow.
Many of us spend more time at the desk than in our beds. Yet who pays as much attention to ergonomics as holiday snaps or a cute plant?
“Sitting for long periods of time can eventually lead to compression of the spine and postural fatigue,” says Smith. “These are two of the most detrimental factors in the cause of back pain.
“Sitting at your desk, with correct posture, shouldn’t feel like hard work. If it does, it’s quite likely that you will soon feel fatigued or become distracted and will lapse into a dangerous, ineffective posture.”
Slumped in your office chair while distractedly poring over Facebook risks the wrath of your boss as well as your back.
“If you find that you can’t sit or stand comfortably in a neutral position (with good posture) for more than five to 10 minutes, it’s very likely that you have poor core stability as well,” says Smith.
“Improving your posture and core stability can have a significant positive effect on back pain and back issues,” says Smith.
“A fun and proven way to improve your posture and stimulate your core stabilising muscles is to practise dynamic sitting with a physio ball. Sitting on a physio ball rather than your desk chair creates an immediate dynamic environment that demands continuous micro adjustments to your posture. I recommend swapping between your desk chair and physio ball a couple of times a day.”
To increase the efficacy of said ball, stand up and walk around regularly.
“It’s vital to make a conscious effort to get out of your chair every 30 minutes,” says Smith. “In doing this, the blood flow through your body will increase and your muscles will be given the opportunity to relax and reset. Doing some gentle stretches while out of your chair will also be beneficial.”
Out of the frying pan of the office chair and into the fire of the car seat. No matter how well designed your new car may be, most of us are still sitting in a position that screams back pain.
“Back pain is not something that is limited to the time we spend sitting at our work or home office desks,” says Smith. “If we are not observing the correct posture when we are seated in our cars, this can also contribute to back pain.”
Not only do we tend to slump in the car seat as we crawl home to the sanctity of the comfy couch, but we also overcorrect, overstraighten or lean back as we become increasingly uncomfortable and fidgety.
“The human spine isn’t designed to be perfectly straight,” says Smith. “A healthy back has gentle curves that extend from the neck all the way to the base of the coccyx. Your posture when driving a car should reflect this.
“Rather than hunching over your steering wheel when driving, tilt the seat back a little to reflect the natural curves and arches of the spine.
“You may like to use a lumbar support pillow to ensure the small of the back is further supported in the seat when driving long distances.”
Your bed, and getting enough time in it, can be the difference between a day free of back pain and one endured painfully lurching from one chore to the next.
Getting your bed rest right allows the spinal column to lengthen and ‘unload’ and by morning you should be a fraction taller and be at your most pain-free level of the day. By evening, of course, your spine will have again compressed, your nerves squeezed and your body will understandably be ‘crying out’ for horizontal healing.
“The bed is the most used piece of furniture in the home; however, many people underestimate the value of selecting the right mattress and pillow,” says Smith. “Without the right type of support, you may find yourself waking up with various aches and stiffness.”
You can buy your bed and pillow online, from a factory outlet or department store, or you can go to a sleep science centre (yes, they do exist) who specialise in ‘fitting’ you with the best mattress and pillow combo for your body and needs. And it’s not all about finding the comfiest, fluffiest thing out there. It’s often the slightly firmer mattress and contoured pillow that provide longer-term support.
“The mattress needs to support your body in a neutral posture,” says Smith. “The natural curves of the spine should be supported while the neck and shoulders are properly aligned. Your new mattress should also come with a ‘used by date’, at which time it is recommended you replace it.” The shopping list?
“When looking to purchase a new mattress, there are a few things to consider. It’s important that you give each mattress a sleep test before purchasing. Ensure your lower back is getting enough support, and that there aren’t any pressure points that are uncomfortable. If you have a favourite pillow, take it with you as well. This is the best way to simulate your actual sleeping position that you’ll experience on the mattress.”
If the shop manager won’t let you do this, take your business elsewhere.
Of course your back pain could be all in the mind.
“Stress can cause your heart to beat faster and muscles to tense. This can eventually lead to headaches, stiff necks and back pain,” says Smith.
It does this, more often than not, by creating dreaded and acutely painful muscle knots.
“Muscle knots are points within a muscle where the contracted fibres are unable to contract,” says Smith.
Stress often goes hand in hand with poor posture, giving rise to the appropriately painful term ‘postural stress’.
Stress-induced muscle knots may be painful, but they are also among the most treatable back-related conditions.
“Relief can be sought from your physiotherapist, who will perform manual therapy on the knotted part of your body and perhaps prescribe Pilates as a preventative measure,” says Smith.
“Pilates will assist in maintaining flexibility, improving posture, enhancing core stability, and decreasing stress as well as reducing back pain. The most common type of Pilates is found at your local gym. For superior results and a tailored program designed to suit your needs or condition, clinical Pilates, guided by a physiotherapist, is a great investment into your health.
“Once you have been taught these exercises, you can ask your physio for modified movements you can practise at home.”
Starting from the bottom and working your way to the top is a smart approach when seeking out the cause of pain, as many upper body aches can be triggered from ground zero – your feet, or more precisely, your gorgeous shoes.
“If the human foot were intended to walk on six-inch heels, we would have much different arches,” says Smith. “And notice that your toes do not come to a sharp point, so why should your shoes?
“Foot dysfunction can lead to a number of local injuries and conditions, including plantar fasciitis, tendonitis and stress fractures, as well as numerous other problems throughout the rest of your body, including knee pain, back strain and even headaches.”
After you’ve downscaled your heels, selected something with more comfort and support, with one eye on styling, you need to put your feet up and let the experts take a good look.
“A proper assessment of your feet by a physiotherapist should just about be a routine undertaking when considering your overall posture, health and physical capability,” says Smith. “A thorough physiotherapist will not just examine your feet – checking for mobility, swelling and possible biomechanical problems – but should also look at your overall posture and gait.
Since you rarely stand still, it makes sense that your feet should be evaluated in action.
“Remember that, ultimately, the way your body moves relies on a strong foundation and good base of support. Your feet play an important role in ‘setting the scene’ for much of your physical activity.”
Many of us suffer from exercise excitement – the enthusiasm of throwing yourself into physical activity, feeling your body come alive and the rush of all those happy chemicals pulsing through the system – followed by days (or weeks) where we haven’t the slightest inclination to get sweaty.
This is where much of the damage occurs – going in cold, too hard, too soon.
“A high ranking ‘workout fail’ is incorrect lifting techniques,” says Smith. “These incorrect techniques may favour the weaker back muscles. By bearing most of the load when lifting, it places undue stress and strain on this muscle group.”
“There is also the idea that pain is a good thing during workout. While loading the body in order to feel tension is beneficial, overloading can cause damage. Pain is always a symptom that something is not quite right, and may lead to an injury.”
Frequent, core-strengthening activities that don’t crash through the pain barrier are the key to back strength.
“When lifting, you should use the stronger anti-gravity muscles – mostly buttocks, thighs, and calves,” says Smith. “Keep a firm grip on the weight, hold the load close to your body, and never twist and bend while lifting.”
Stretching – seemingly out of fashion – is also important, says Smith.
“A lack of stretching before and after a workout may also contribute to back problems in the long run. The aim of stretching is to help restore normal length to shortened and fatigued muscles. Tight hamstrings can create drag on the lower back, producing pain if left unattended.
“A warm-up followed by gentle stretching before and after a workout will help achieve better flexibility, allowing more fluid range of motion in the limbs and spine.”