Your Lower Back – a real PAIN in the ASS…and wallet? Here’s what you can do about it before it gets that way.

“You’re only as strong as your weakest link”

I mentioned in my Instagram post (@kevingreen.fitness) yesterday about how costly our lower backs can be.  Believe it or not, it IS a real pain in the ass, myself included.  Although I grew up playing sports throughout most of my childhood, into adulthood (took a few years off during my office job tenure) and more recently now working in the fitness industry, I have always been conscious of my lower back.  I noticed it first during a rip around the ice rink on skates when I was younger – somehow the position skating puts my body into fires up my lower back muscles and hindered an otherwise fun and enjoyable skating experience.  This, and the occasional morning wake up to a sore back, or standing for prolonged periods of time in dress shoes (I had a previous career in banking, for those of you who don’t know!) led me to investigate further.

“Is it really just because I’m getting old?  Does getting old automatically mean I have to have back pain, or take pain meds to manage it?”

The answer to those questions, is ABSOLUTELY NOT!  Seems like heresy to those of you who have been dealing with back pain for a while, but there are a number of causes to this ailment, and a number of solutions to this, some of which don’t necessarily involve an Advil, Tylenol, Dr Scholl’s orthodics, a visit to the chiropractor, or an orthopedic surgeon.

Before we dive into it a little bit, Here are some of the stats.  What kind of impact does back pain make in the world we live in today?  According to the National Centre for Health Statistics “background” data from 2004 (that was 13 years ago; imagine how much worse it is today):

• 12-15% of the US population (yes I know we’re in Canada. These stats are still relevant, not to mention staggering) showed up in a doctor’s office to report back pain – 44 million times that year, in fact.
• 43-60% of adults reported experiencing neck or lower back pain in the previous 3 months.
• Overall, almost one out of two (half!) of people experience back pain at least once a year.
• A reported 33.7 million people spent one or more days in bed in the previous year because of back pain.
• Although 90% of people suffering from their first episode of back pain will be asymptomatic within 3 months, 40-60% will predictably have recurrent episodes.
• Estimated annual direct medical costs for all spine-related conditions were $193.9 billion ($6,000 per person in the country), of which $30.3 billion was directly associated with back pain.  This total accounted for 5% of all visits to physicians, clinics, and hospitals.
• The annual indirect cost in lost wages as a result of spine disorders was $14 billion!

When I first discovered how significant this actually is, I was stunned.  Almost everyone I know either has had or knows someone who has back problems; it’s as common as the common cold it seems.  However, it seems like it has been dismissed as a “part of life” and not much can be done but accept it as we grow older as time takes a toll on our bodies.

One interesting thing I read in the book “Movement” by Gray Cook (more on this in later posts, it’s an absolutely insightful, invaluable resource), is that as folks like me that are interested in, or are stakeholders in the study of movement, is that we will decipher the puzzle of the body with our own biased pair of spectacles.  A personal trainer will apply their knowledge of exercises to correct “back issues”, whereas a chiropractor will apply their knowledge of some form of manual therapy or adjustment.  A general practitioner (your family doctor) may recommend some form of pain medication, and the orthopedic surgeon will recommend perhaps a corrective surgery.  As practitioners in health, it is important that we examine the root of the back pain and apply the most effective method of rehabilitation, not necessarily one that we can easily apply based on our knowledge or experience.

As such, myself being a personal trainer, I want to expand my capability to help clients beyond what is applicable on the gym floor.  However, should my client express pain in their lower back, I would apply what is within my knowledge (as well as my scope) to assist them.  Outside of this, it is good practice to refer to other professionals who can examine or assist further.  That being said, one thing that all health practitioners I believe can and should mutually agree upon, is that the origin of all back pain is rooted in the client’s ability to move, or how they move on a daily basis.

“So, I experience back pain on a REGULAR BASIS.  What can I do RIGHT NOW to help?”

That is the right question to be asking.  First, it’s imperative that before you take on a rehabilitative regimen recommended by a professional, that you do a self assessment as to your lifestyle now and in the past – can you think of any contributing factors? Here are a few “Weak Links” that may help you make that determination:

• Poor Aerobic Condition:
  • Muscles need oxygen like engines need gas; much like the intravertebral disks and ligaments in your spine.  How efficient is your heart at getting that oxygen distributed throughout the body?
• Overweight:
  • The more the frame of your body needs support (body mass), the harder it has to work, and is therefore more susceptible to injury.  Are you carrying a little more cargo than what is considered healthy for your height and weight?
• Imbalances:
  • Not just imbalances in our musculoskeletal system – but what about emotional? Or work life balance? This can also play a factor. (Stress can manifest itself in physical pain, particularly in the lower back)
• Old Injuries:
  • THIS is a big one – a major predictor of future back ailments.  Your body is just like paper, metal and wood: Its cracks and tears and breaks can be glued, taped, stapled or welded, but it may never be as strong as it was originally.  What injuries did you have and still deal with today?
• Re-injury:
  • How many times have you re-sprained your ankle? This and many other reinjuries are caused by one or several of these reasons:
    • Incomplete rehabilitation
    • Strenuous recreation to soon
    • Improper warmup of the affected area
    • Poor nutritional support
    • Medication “camouflage”
  • This can create a constant “spiralling” of your condition – only able to rehabilitate the injury to a certain point, making this your new baseline.
• Ageing Effects:
  • This is the reality of life that we all must accept: as we get older, the probability of injury increases, and so do the severity, time to heal, and degree to which our bodies heal.  GOOD NEWS: we can slow this process down.
• Structural Defects:
  • Sometimes we have inherent design defects, and are a contributing cause, ie. scoliosis or another vertebral anomaly.
• Genetics:
  • Things such as degenerative disk disease, arthritis, heart disease etc. are things we may be predisposed to based on our genetic make up.  Genetics and structural defects are two “weak links” we can’t do much about, but with adequate and appropriate movement, we can limit the effects these conditions have on our quality of life.

How many of these factors apply to you?  I’d be hard pressed to find anyone who would say none of these are factors in their life, back pain or not (I mean, we’re all ageing, are we not?)  So in light of this, here are a few KEY THINGS to keep in mind when you go about your daily routine, that will help alleviate that nagging back pain:

“An aligned frame is ideal for movement and load bearing, fatigues less easily, and is less susceptible to strain.  It is an essential part of being healthy – and staying that way.”

1. Posture:
   1. Would you be surprised if I told you our bodies still haven’t evolved such that we are not designed to be in an upright, standing position (or sitting position for that matter) for extended periods of time? This is why back pain is so prevalent.  The standing and seated positions (even with “perfect” posture) put great amounts of pressure on our lower back.  Proper posture will help mitigate these effects.
2. To sit or not to sit:
   1. Sitting (as mentioned above) can actually be quite stressful for the lower back (lumbar spine), more so than lifting heavy in the gym or walking, even with proper posture. So you commuters, travellers and office workers beware!
      • An easy remedy is to stand up every hour or so and walk around, and lightly stretch and flex your torso.  Your co-workers might look at you funny, but you’ll be the last one laughing, trust me.
      • Keep your feet on the floor when you’re sitting (swaying your feet in your chair actually pulls on the pelvis, and distorts the natural curve of the back)
      • Adjust computer monitors to eye level (or if you’re using a laptop/tablet, in a position where your neck is neutral, as in not excessively tilted up or down)
      • Opt for the office chairs that have built in lumbar support, and likewise with your selection of automobile.  Think of how much time you spend in your vehicle in a given week.  How many hours could you potentially be putting your back at risk?
3. Watch those BLT’s (Bacon, Lettuce, Tomato?)
   1. Be mindful whenever you are Bending, Lifting and Twisting.  Activities involving these types of movements generally are good for the body – except when done with poor form or with a lack of engagement of muscles supporting that movement.  Be deliberate when executing these kinds of movements.
4. Let’s Put Back Pain to Bed:
   1. Not surprising here is the role of sleep and the quality of sleep given the mattress we sleep on.  General rule: lay on your back on your mattress for 2-3 minutes.  If you feel like you need to put a pillow under your knees to alleviate some back discomfort (ie. prevent over-extension in your lower back), you need to change your mattress.  Sorry…
5. Get up! But s…l….o…w….l…y.
   1. Gravity can be a real bi*@# sometimes, especially when you’re first rising out of bed first thing in the morning.  Some people are morning people and hop out of bed as soon as the alarm goes off.  Good on ya; historically I haven’t been much of a morning person (more so now).  When you’re horizontal in bed through the night, the disks in your spine are rehydrating after being compressed all day, forcing fluid out of those disks.  This rehydrating process, however makes your spine especially vulnerable first thing in the morning (think full water balloon – very likely to burst).  Ever had a “back attack” soon after waking up, by doing a seemingly harmless task such as leaning over the sink to brush your teeth?
   2. Safest way to get out bed (elite athlete or otherwise):
      1. Roll to your side, assuming a fetal position.  Point knees off the side of the bed, as you slide your feet and legs off the side of the bed, help yourself up with your elbow and forearm on the bed.
   3. If you’re a morning gym goer and presently have some form of back pain, be careful.  Because you’re back is especially vulnerable in the first few hours after waking, consider a later time in the day to exercise.  If that’s not possible, ensure to spend a little extra time warming up, especially the problem areas, prior to attempting your first exercise or lift.

Speaking of Which: I will write a post later this week sharing a couple of exercises that would be immensely helpful in dealing with lower back pain that you can do on your own.

“Professionalism, especially in the fitness industry, is having the self-awareness to know when to ask for help when we don’t understand something.”

I would like to wrap up this post with a few words toward a specific audience, namely my esteemed fellow personal trainers out there.  I’ve come to see a few videos and posts on the interwebs the last couple of days, depicting clients performing certain lifts, and these clients explicating their “confidence” in their lifts and how they have executed them with appropriate form.

I feel this topic is especially relevant on my post about lower back health, because the content in these videos, I frankly feel were “cringe-worthy”, as these clients are very much compromising just that – the health of their lumbar spine.  Fellow trainers, I’m reaching out to you: our clients depend on us to share our knowledge and expertise in the subject matter, to coach them to better themselves and reach for their greatest potential in terms of their fitness and health.  I IMPLORE you to please do an honest, humble assessment on your own knowledge and experience in some of these exercises/lifts.  If you know deep down that your knowledge is sub-par to a standard that it can be taught to a client, please do some more research and/or ask for help.  We have a duty to our clients to ensure we provide them with sound fitness advice – lets strive for the excellence we expect if we were to pay for the service ourselves.

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Until next time!

Yours in fitness,

Kevin