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Low Back Pain
Zach ReidPT, DPT, Cert. MDT
Low Back Pain
● 50-80% of adults will have back paino up to 40% each year
● Back pain is ‘normal’
● Common cause of work disability
Low Back Pain
● 80-90% resolve in about 6 weeks
● Traditional view of acute vs. chronic pain is wrong
Assumed Natural History of Back Pain
TIME
Only a few turn into chronic pain
Real Natural History of Back Pain
TIME
Acute
Exacerbation
Recurrance
SpineNeck (Cervical Spine)
Thoracic Spine
Lower Back(Lumbar Spine)
Spine
● Bones
● Discs
● Ligaments
● Nerves
● Muscles
All of these structures can cause back and neck pain
Disc Annulus
Nucleus
Spinal Cord
Think of the disc as a jelly donut
Demographics
What are the characteristics of people with back
pain?
● Prolonged sitting/driving
● Sustained bending/stooping
● Heavy lifting
● Anxiety/fear of pain
● Poor health/self-reported disability
What happens when we sit like this for a prolonged period of time?
● Neck Discomfort● Back Discomfort● Headache?● Shoulder Pain?
Most back and neck pain occurs as a result of prolonged loading of the disc and ligaments
What happens if you bend your finger backwards and hold it there for five minutes?
● Strain on the discs and ligaments occurs immediately
● Pain does not set in until years later
The results of postural neglect
Sitting Posture
You have to fix your sitting posture!● Goals
o maintain normal lumbar curveo back fully supportedo feet flat on the groundo head/neck maintained in neutralo reduce the pressure exerted on your back
Effect of Posture on Disc Pressure
STA
ND
ING
LYIN
G SIT
TIN
G
BE
ND
ING
WH
ILE
S
TAN
DIN
G
Effect of Posture on Disc Pressure
STA
ND
ING
LYIN
G SIT
TIN
G
UP
RIG
HT
BE
ND
ING
WH
ILE
S
TAN
DIN
G
SL
OU
CH
ING
Effect of Posture on Disc Pressure
STA
ND
ING
LYIN
G SIT
TIN
G
UP
RIG
HT
BE
ND
ING
WH
ILE
S
TAN
DIN
G
SL
OU
CH
ING
SIT
TIN
G
SU
PP
OR
TE
D
Sitting Posture
● Standing is best● Sitting while supported is good● Sitting upright unsupported is ok● Slouching is bad
Your sitting posture must support your spine while keeping your feet flat on the
floor
Modifying Your Workspace
Modifying Your Workspace
● Consider using a lumbar roll● Designed to maintain the natural curve
in your spine while sitting● Keeps your lower back and neck in the
proper alignment
Modifying Your Workspace
Sitting Posture
● reminds you about your posture
● increased muscle activation
● muscle fatigue● unsupported sitting● feasible?
What about sitting on a physioball?
Body Mechanics
Body Mechanics
Body Mechanics
Body Mechanics
When to Seek Help
● No improvement after 10 days
● Pain below knee / “pins and needles”
● After an accident
● Back pain coupled with bladder
problemsDo I need an MRI?
Mechanical Pain● Most back and neck pain is mechanical in
nature
● Why TREAT mechanical pain with non-mechanical solutions?
Mechanical pain needs to be treated with Movement
Functional Strength
● Inactivity ‘decays’ the human body
● The goal is to maintain a level of fitness and activity no matter the age
Functional Strength
Flexibility
Flexibility
● We bend forward on average 3,500 times per day
● How often do we bend backwards?
Smoking and Low Back Pain
● Nicotine increases pain
● Former smokers or those who have never smoked experience less pain
Osteoporosis
● Loss of calcium = weakened bones
● Regular exercise encourages bone growth and decreases incidence of fractures
Self-Treatment
● Continue to do what has worked in the pasto Back pain attacks do not occur in isolationo They are part of a continuous lifetime cycle
Most people do what feels good but…
...does it MAKE you good?
