How to avoid back pain
“Step on a crack, break your mama’s…”
Did you avoid stepping on the sidewalk cracks when you were a kid? I did as a game walking home from school, but I really didn’t think I’d injure my sweet mama if I did so. However, there are activities that we do every day that have the potential to harm our own backs. The medical literature is full of studies that show “low back pain is the leading cause of activity limitation and work absence throughout much of the world…” (Priority Medicines for Europe and the World 2013 Update, Chapter 6.24 Low Back Pain, World Health Organization). The same report states: “The causes of low back pain are rarely addressed.” Interestingly, the report comments on future research needs that focus on diagnosis with biomarkers for people at risk for back pain as well as treatments that include biomaterials for disc replacement in the spine and stem cell research to restore the discs.
Wait a minute. If “an ounce of prevention is worth a pound of cure” and not much is said in the medical literature about back pain prevention but rather, focus is on expensive experimental diagnostics and treatments, we should be putting more attention on prevention and caring for our backs. This is especially true the more active we are. Paying attention to proper form with strength training and posture during cardio exercises is KEY to preventing back injury. Further, in activities of daily living, awareness of body posture and mechanics when sitting, standing, lifting, and even sleeping will help us keep our backs healthy.
After my first back injury with lifting improperly in my 20’s, then noting it more when lifting my children in my 30’s, my visit to the physical therapist on back health education truly helped me when I started using the recommendations regularly.
The #1 key to remember with loving your back is: maintain neutral spine position as much as possible.
- Maintain a healthy weight. This may sound obvious, but it’s worth stating. Center of gravity may change our pelvic tilt causing “lordosis” (hyperextension of our lumbar spine and anterior pelvic tilt). Added weight can cause stress on our back. We should aim to maintain our ideal body weight. (Thank you, Body & Soul, for helping with this!)
- Change your positions during the day. Avoid prolonged standing or sitting. Sitting for a long time shortens your hip flexors and leads to anterior pelvic tilt. Prolonged standing can lead to lordosis due to weak abdominal core muscles. Take breaks at work to stand up and stretch from a desk job or sit down and rest in a job with lots of standing or walking.
- Avoid repetitive bending at the waist, especially with weights or resistance. Every degree you bend at the waist causes the back muscles to contract, to hold up your torso. Contracting muscles repeatedly or for a long time leads to muscle spasm, strain, and pain. If you exercise regularly, some exercises that may put you at risk for an injury if done repeatedly, with weights, or with improper form are: kettlebell workouts, deadlifts, bent over waist rotations, supine straight leg lifts, leaning forward with the elliptical or treadmill, and full sit-ups.
- Check your desk/workspace ergonomics. Lumbar support for your chair, proper height for your arms, looking at your computer with neutral neck position, and using a foot/nursing stool under your desk will de-stress your back.
- Side-lying sleeping position is best. A good pillow to keep your head and neck aligned with your body and a pillow between your knees to prevent spinal rotation feels great! If you sleep on your back, putting a small pillow under your knees to reduce lordosis is helpful (like they do at the massage clinics!). The worst position for your back that should be avoided is lying on your stomach which promotes hyperextension and rotation at the neck as well as lordosis of the back and even nerve issues from the arms bent and under the pillow.
So, feel free to step on all of the sidewalk cracks you want to! For a true back pain-free life, follow the above recommendations. And love your back as your mama loves you!
Liz is a Fellow of the American Board of Internal Medicine and a medical doctor for 23 years, formerly with the US Army, currently practicing in the Washington, DC area. In addition, she holds a Master’s of Public Health Degree and Assistant Professorship with the Uniformed Services University of the Health Sciences in Bethesda, MD and certification as a Group Fitness Instructor with the American Council on Exercise.