What Causes Lower Back Pain, How Do We Overcome It and How Do We Keep Our Backs Healthy?

Introduction

In the UK today, more than 2.5 million people suffer from back pain on a regular basis. It is estimated that back pain costs the UK some £6 billion a year with 180 million working days lost.

Before we go any further, ‘Back Care’ needs to be defined. For the purposes of this article, when the term Back Care is used, it is referring to the lower back region. It is of course possible to get pain in your middle and upper back regions too.

Now, I’m sure you have either had back pain or known someone close to you who has suffered from back pain at some time.

There are many different types of Back Pain and their causes can be complex.

Some back conditions include:

• Disc derangement
• Sciatica
• Spinal Stenosis
• Sondylolisis
• Spondylolisthesis
• Spondylitis

It is not the intention of this article to outline appropriate rehabilitation protocols for each condition, or indeed to explain each condition, but to provide some basic steps to follow to achieve an optimally functioning back.

Firstly, if you are suffering from back pain, you should see a professional. This is especially true if it has lasted longer than two weeks.

Any professional rehabilitation program should involve a ‘client centred approach’ which means that the back pain sufferer is treated as an individual who has back pain and not back pain that has an individual.

However, many professionals treat the back pain and not the person who has the pain.

What Does This Mean?

Let us say a patient enters a professional’s clinic and the professional diagnoses a lumbar disc bulge, they would then give the same treatment to that person as they would to anyone with a disc bulge.

For instance, a General Practitioner may suggest medication and rest, a surgeon may suggest surgery, a physiotherapist may suggest manipulation and rehabilitative exercises, a massage therapist may suggest massage and a personal trainer may suggest exercise. All these can and do play a role in a successful plan to overcome back pain.

However, whatever the injury, the causes can be varied. Without finding out the cause (aetiology) it is less likely that a return to normal function and a reduction or elimination of pain will be achieved.

It can almost be guaranteed that most professionals you visit will only investigate the area that is in pain and the surrounding area. In this instance, they may investigate the lower back and perhaps the rest of the spine and pelvis. However, back pain can be caused by a problem in the head, jaw, neck, foot or even an internal organ amongst others.

So what can cause Back Pain?

De Rosa and Porterfield state, “… at present, identifying with any certainty the exact tissues involved in most low back pain is virtually impossible” ( quoted from 1).

Bogduk states, “Virtually every structure in the lumbar spine has at one time or another been implicated as a possible source of low back pain. As a result, controversy outweighs conviction in the field of low back pain. There is however, an increasing amount of information that sheds light on this field” (2).

There are very frequent references in literature however, for the need for postural correction as part of the treatment.

Below, is a list of possible primary and secondary causes of lower back pain:

• poor posture
• faulty ergonomics
• muscle imbalance
• faulty lifting techniques
• poor abdominal wall function
• Visceral-Somato Reflex
• Spinal fractures
• Spinal tumours
• Spinal infections
• Degenerative disease

By no means is this list exhaustive.

Poor Posture

“Posture is usually defined as the relative arrangement of parts of the body. Good posture is that state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity irrespective of the attitude (erect, lying, squatting, stooping) in which these structures are working or resting. Under such conditions the muscles will function most efficiently and the optimum positions are afforded for the thoracic and abdominal organs. Poor posture is a faulty relationship of the various parts of the body which produces increased strain on the supporting structures and in which there is less efficient balance of the body over its base of support.” (1)

In today’s society, good posture has almost become extinct. With a general lack of activity and an increase in sedentary jobs, poor posture has become the norm.

“Bad posture is a bad habit and unfortunately, is of rather high incidence. Postural faults that persist can give rise to discomfort, pain or disability. The range of effect from discomfort to incapacitating disability is related to the severity and persistence of the faults. ” (1)

Faulty Ergonomics

One of the biggest causes of poor posture today is sitting at desks and use of computers and telephones. Many workers today sit slumped for eight hours a day, looking down at their computer, whilst hunching their shoulders to use their keyboard. Those who spend many hours driving a vehicle are also very prone to poor posture.

“The incidence of postural faults in adults is related to this tendency towards a highly specialized or repetitive pattern of activity.” (1)

Being seated for eight hours a day using a computer can be described as ‘repetitive’.

Sitting with poor posture for long periods of time can cause muscles that are in a shortened position to stay shortened. Also, muscles that are in a lengthened position for long periods tend to stay lengthened and normally become weak.

Muscle Imbalance

When opposing muscles crossing joints are not at their normal lengths it is known as a muscle imbalance. Muscle imbalances cause joints to sit in an unnatural position. In other words, they lose their optimal axis of rotation.

Muscles that stabilize joints, also known as Tonic muscles, have a tendency to shorten under faulty loading. Muscles that move joints, also known as Phasic muscles, have a tendency to become long and weak under faulty loading. Often a joint will have phasic muscles on one side of a joint and tonic muscles on the other. The tonic muscle if held in a shortened position for long enough will develop a greater resting tone in the muscle than the opposing phasic muscle. This will pull the joint towards the tonic muscle and into an unnatural position.

Muscle imbalance results in undue stress and strain on bones, joints ligaments and muscles. The greater a persons muscle imbalance, the more wear and tear their joints and connective tissues are likely to have over time.

Muscle imbalances in the body can cause the following in the lower back:

• excess pressure or compression on the disks
• shear and torsion on the vertebrae and vertebral disks.
• disk degeneration
• spinal instability
• entrapment of spinal nerve roots
• fracture of pars articularis
• Sacro-Iliac Joint dysfunction
• Scoliosis (unnatural lateral curvature of the spine)
• abdominal wall dysfunction

Any of the above outcomes of muscle imbalance can potentially cause pain or injury.

Pain in the lower back can also radiate down one or both legs. Pain radiating down one or both legs may indicate that a dorsal root ganglia is compressed. This is known as Radicular Pain. The dorsal root ganglia in basic terms, is one of two strands of nerves originating from the spinal cord and passing through the gap (or foramina) between vertebrae.

In addition to poor sitting and ergonomics, there are other possible causes of poor posture and muscle imbalance.

They include:

• lack of physical activity and exercise leading to muscle weakness
• poor breathing pattern
• faulty jaw mechanics
• faulty vision
• Atlas subluxation (rotated first cervical vertebra)
• Visceral (organ) stress
• Emotional blockages.

As mentioned earlier, most therapists and exercise professionals are not trained to identify the aetiology of back pain. This can only be accurately found after a detailed assessment.

Unfortunately, most therapists are guessing. This is why many people do not overcome their back pain and have to keep going back for regular treatments. This is not to suggest therapists aren’t good at what they do. In fact, I refer many of my clients to therapists.

The human body is the most complex system we are aware of. It is unlikely you will ever find one person who will be able to do everything required to get you functioning optimally and pain free.

Faulty Lifting Technique

It has also been shown that many injuries occur due to faulty lifting technique. Injury occurrence has been shown to be high when an object is lifted far from the body, with straight knees or with the body in a twisted position.

When lifting objects, especially heavy objects, you should always ensure the object is close to your base of support. This is normally just in front of your feet. You should also ensure you bend your knees, do not twist your torso and keep your lower back from flattening (or rounding) as much as possible.

Quite often an injury caused by lifting can merely be ‘the straw that breaks the camel’s back’. In other words, the spine and surrounding tissues may have been progressively degenerating for some time without pain. A pain free back does not necessarily mean a healthy back.

Having a strong body with good muscle balance will reduce the likelihood of hurting your back whilst lifting objects.

Mothers with small children have to be particularly careful when picking up their children. Pregnancy and labour weakens the musculature that supports the lower back and can take up to two years to fully recover. It is possible for the musculature to never get back to pre-pregnancy levels, especially if the woman leads a sedentary lifestyle.

It is highly recommended that post-natal women seek the guidance of a C.H.E.K Practitioner to re-condition the abdominal wall musculature after pregnancy (see www.bodychek.co.uk or www.chekinstitute.com to find a Practitioner near you).

Poor Abdominal Wall Function

The abdominal musculature helps to support the lower back. Muscles such as the Transverse Abdominus, Multifidus, Diaphragm, Pelvic Floor and Internal Obliques (3,4,5) along with the connective tissue called Thoraco-Lumbar Fascia (3) help to keep the lower back stable and strong.

This is believed to be partly achieved through three identified mechanisms, Intra-abdominal Pressure, Thoraco-lumbar Fascia Gain (3,4,5) and the Hydraulic Amplifier Mechanism (3). It is believed there are other mechanisms that play a role that we are not aware of yet.

If these abdominal muscles do not have adequate strength and endurance they leave the spine ‘exposed’ and more susceptible to injury.

The abdominal wall musculature can also be inhibited by gut inflammation which can be caused by Food Intolerance, Fungal Infection and Dysbiosis (more bad bacteria than good in the gut). This will also leave the spine exposed.

So it could also be the foods you eat that are causing your back pain. A C.H.E.K Holistic Lifestyle Coach or Healthexcel Metabolic Typing Advisor can help you identify if your foods are causing your back pain.

Visceral-Somato Reflex

Back pain can also be caused by the visceral-somato reflex. This is where an internal organ is dysfunctional and because it is linked neurologically to a muscle or group of muscles, the pain is felt in the muscle and not the internal organ. Viscero-somato Reflex can cause spasm or inhibition (relaxation of muscles).

Dysfunction to the bladder, kidney, spleen or large intestine is known to sometimes cause lower back pain (6).

Spinal Fractures, Tumours, and Infections

Spinal fractures, tumours and infections are uncommon, even in older people.

I have seen a number cricketers and dancers with a fracture of the spine, known as Spondylolisis. Careful assessment and a precise corrective exercise programme helped them become pain free and in some instances get them back performing.

How Do We Reduce or Eliminate Back Pain?

“Correction of the existing conditions depends upon understanding the underlying influences and implementing a program of positive and preventive educational measures. Both of the foregoing requires an understanding of the mechanics of the body and its response to the stresses and strains imposed upon it”. (1)

Therefore, for an optimally functional and pain free body, you should receive an assessment from a C.H.E.K Practitioner (see www.bodychek.co.uk or www.chekinstitute.com to find a Practitioner near you).

• A Level I C.H.E.K Practitioner can assess you for posture, muscle length tensions; joint ranges of motion, abdominal function and Sacroiliac joints.
• A Level II C.H.E.K Practitioner can assess everything above, plus a Primal Movement Pattern™ analysis, gait analysis, dynamic stability assessment.
• A Level III C.H.E.K Practitioner can assess everything above and plus an assessment of respiration, mastication (jaw & bite mechanics), vision, auditory & vestibular function, the upper cervical spine, visceral relationships, emotional status and the upper quarter (head, neck and shoulders).

A C.H.E.K Practitioner can give you the tools to reduce or eliminate your back pain. This is normally done through a stretching and strengthening corrective exercise program, advice on ergonomics, nutrition and lifestyle and referrals to appropriate allied health practitioners to ensure no stone is unturned.

As Paul Chek, the founder of The C.H.E.K Institute would say “If you’re not assessing your guessing”. Without assessing the whole body thoroughly, you really are guessing what the aetiology might be.

Also, just treating the affected area might only bring short-term relief. This normally results in having to make frequent visits to your therapist. If you can not afford multiple treatments with your therapist, then you might have a problem relieving yourself from the pain.

You may then take medication for the pain that then lead to unwanted side-effects and the downward spiral continues.

If there is not a C.H.E.K Practitioner near to your home or workplace, a good Osteopath, Chiropractor or Physiotherapist would be the next best choice if you currently have back pain or even if you don’t. These therapists can identify faulty joint alignment. They can manipulate joints and stretch muscles as required as well as providing home exercises.

Even if you don't have back pain, C.H.E.K Practitioners, can help to prevent future injury.

Preventing injuries is a little like regularly changing the oil in your car and not waiting for the warning light to flash on your dashboard. If you think what would happen to your car if your oil ran out, compare to what you think might happen if you do not look after your body by using preventative measures.

In addition to visiting a health professional, you can do the following to help prevent back problems:

1. Sit up straight and do not slouch, especially if you spend long hours seated. Set an alarm to remind you to sit straight every 15 minutes.
2. If you use a computer at work, take breaks regularly. Get up and walk around before returning to your desk.
3. If you have a choice between standing and sitting, standing exerts 4 times less pressure on your back (7).
4. Use a Swiss Ball to sit on at home or at work. Do not sit on it for too long however. Switch between a Swiss Ball and normal chair every 10 minutes or so.
5. If you use a computer at home or work, set up the ergonomics so you do not have to look downwards at the monitor. The centre of the monitor should be at eye level. Also, the keyboard should be low enough so you do not have to hunch your shoulders.
6. When using the telephone, try to keep your head straight and not tilt it to one side. If you use the telephone a lot, it would be wise to use a head-set.
7. Exercise regularly to avoid weakening of muscles. Whether you go jogging, lift weights at the gym, go for a walk, do the gardening or wash the car, it is important to keep active and strong. An ideal exercise regime would consist of stretching, lifting weights and cardiovascular exercise. Cardiovascular exercise consists of exercise such as walking, jogging, cycling, swimming etc. However, if you have an existing injury, receive advice before exercising.
8. When picking up objects, keep your back straight, keep the weight close to your base of support and do not twist as you pick it up.
9. Eat non-processed foods and eat organic wherever possible. Find out your metabolic type so you can eat the right foods for your unique body chemistry.
10. Avoid cigarette smoke and keep alcohol consumption to a minimum.
11. Take time out to relax and quieten the mind. Yoga, Qi Gong, meditation, relaxing baths and listening to relaxation tapes are just a few methods you can use.
12. Get eight hours of sleep per night and get to bed by 10.30pm.

Summary:

• Back pain is very common today with 2.5 million Britons in pain at any one time.
• There are many different types of back pain.
• Each individual category of back pain can have a number of different causes. It is vital to find the cause to ensure successful rehabilitation.
• Any rehabilitation program should be client centred and not symptom centred.
• Poor posture and muscle imbalance are common amongst those with back pain.
• For a full assessment and to find the aetiology a C.H.E.K Practitioner is best placed to help you. “If you’re not assessing your guessing”.
• Following the assessment, a C.H.E.K Practitioner can give you a corrective exercise program and advise you on nutrition and lifestyle factors. They can also refer you to appropriate allied health practitioners to ensure you are successful in reducing or eliminating your back pain.
• There are a number of lifestyle factors you can adopt on your own to help prevent back pain.

In health and happiness,

Leigh Brandon

(T) 0870 486 2470

(E) info@bodychek.co.uk

(W) www.bodychek.co.uk

References:

1. Kendall F et al, “ Muscles, Testing & Function”, Williams & Wilkins, 1993.
2. Bogduk N, “ Clinical Anatomy of the Lumbar Spine”, Churchill Livingstone, 1997.
3. C.H.E.K P, “ Scientific Core Conditioning”, Correspondence Course, C.H.E.K Institute, 1998
4. Richardson C, et al, “ Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain”, Churchill Livingstone, 1999
5. Lee D, “The Pelvic Girdle”, Churchill Livingstone, 1999.
6. C.H.E.K P, “ C.H.E.K Certification Program Level 1”, Course Manual, C.H.E.K Institute, 2001
7. C.H.E.K P, “ Scientific Back Training”, Correspondence Course, C.H.E.K Institute, 1998.

Disclaimer
No person should rely on the contents of this article. We expressly disclaim all and any liability and responsibility to any person in respect of anything contained in this article. It is advised that you always follow the advice of your Doctor.

To find out how we can help you further, call us on 0870 486 2470 or email us at info@bodychek.co.uk.