Low Back Pain Zach Reid PT, DPT, Cert. MDT

Low Back Pain ● 50-80% of adults will have back pain o 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

Spine Neck (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 curve o back fully supported o feet flat on the ground o head/neck maintained in neutral o reduce the pressure exerted on your back

Effect of Posture on Disc Pressure STANDING LYING SITTING BENDING WHILE STANDING

Effect of Posture on Disc Pressure STANDING LYING SITTING UPRIGHT BENDING WHILE STANDING SLOUCHING

Effect of Posture on Disc Pressure STANDING LYING SITTING UPRIGHT BENDING WHILE STANDING SLOUCHING SITTING SUPPORTED

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

● 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

When to Seek Help ● No improvement after 10 days ● Pain below knee / “pins and needles” ● After an accident ● Back pain coupled with bladder problems Do 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

● 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 past o Back pain attacks do not occur in isolation o They are part of a continuous lifetime cycle Most people do what feels good but…...does it MAKE you good?

Questions? M&M Physical Therapy