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A young woman holding her sore back while getting up from her desk at home

Why Do 80% of Americans Get Low Back Pain?

About 80% of Americans suffer debilitating low back pain at some point in their life. This fact is staggering, yet it doesn’t have to be this common. The key to staying out of this group of low back pain sufferers comes down to one word: Prevention. If I had to choose one common problem amongst all low back pain sufferers, it would be bad low back position during common activities such as brushing your teeth, bending over, picking up a small child, exercising and sitting.

The lumbar spine, which is the lower part of the spine, is meant to have a natural curve to it that displaces the forces of gravity and weight evenly and minimally. When this natural curve is straightened, or reduced, the forces on the discs, muscles, and ligaments of the low back are significantly increased. For example, sitting without maintaining the natural curve increases the forces on those structures by 30-40%!

There are many conditions that can be covered under the umbrella of low back pain, but in this article, we will cover the following conditions for the sake of this article. The keys of prevention of low back pain are as follows:

  • Understand your symptoms and risk factors
  • Body preparation and positioning
  • Proper activities of daily living
  • Corrective exercises
  • Treatment consideration

Common Low Back Conditions

Lumbar strains and sprains

A lumbar strain is when an injury occurs to the muscles of the low back. A sprain, on the other hand, is an injury to the ligaments or joints; both, however, have similar pain and symptom patterns. When these muscles or ligaments become injured, it can lead to dysfunctional movements, and cause instability in the spine. Patients suffering from this diagnosis often have pain when attempting to walk, sit, exercise and can even occur during sleep.

The main physical causes of this condition are: 

  • Overexertion
  • Falls
  • Poor movement mechanics
  • Poor posture
  • Heavy lifting

However, with proper education, you can protect yourself from many of these causes. The primary sufferers of this condition, especially chronic cases, often are in poor physical condition with weak stabilizing muscles. A co-morbid factor of this condition is often a desk job that involves sitting for most of the day. This type of patient usually has poor sitting posture, which can lead to a weakening of your spinal erectors and destabilize the spine, contributing to the condition. The importance of a strong core and training your spinal muscles cannot be overstated.

In cases where the injury stems from a problem related to overuse, poor posture or improper exercise, there are steps that can be taken to help avoid these injuries from happening. Proper instruction about your postural habits can reduce the detrimental effects of sitting on the spine, as well as education about correct lifting form can reduce these episodes of low back pain and help you build a healthy spine.

Lumbar stenosis

This condition occurs when there is a narrowing of the spinal canal in the lumbar vertebrae (low back). Often this results in compression of the spinal cord, which can lead to pain, numbness, discomfort and radiating symptoms. What the mechanism of this is occurring is usually caused by the degenerative changes of aging. However, there are other causes.

The main physical causes of this condition are: 

  • Degeneration of the lumbar spine
  • Lumbar disc herniation putting pressure on the spinal cord
  • Osteoporosis
  • Dwarfism (achondroplasia)
  • Tumor

Degeneration of the spinal column is inevitable with aging and may reflect normal changes in an aging spine. It does not necessarily always result in lumbar stenosis but is often the most common cause.

While it is difficult or impossible to combat normal aging of the spine, there are some habits and tips you can use to reduce this condition related to the other causes. Reduce your chances of a lumbar disc herniation by learning proper bending and lifting bio-mechanics by utilizing your lifting power from your legs and not your back. As far as osteoporosis goes, make sure you are meeting your recommended calcium intake as well as incorporating weight bearing activities into your exercise routine (lifting weights). Post-menopausal women tend to be more susceptible to this condition and should ensure they are doing everything they can to prevent osteoporosis.

Lumbar Disc Disorders

The lumbar spine is made up of five bone segments called vertebrae. In between each vertebra are flexible intervertebral lumbar discs, which act as shock absorbers for the spine. The intervertebral discs are composed of two components, a tough outer ring of fibrous tissue called the annulus fibrosis, and a jelly-like center inside the annulus fibrosis called the nucleus pulposus. The structure is then held together by ligaments on the front and the back of the vertebrae. Additional support is provided by muscles of the trunk.

Diagram of the lumbar spine

In most cases, lumbar disc disease is the result of a normal aging process called disc degeneration which causes structural changes in the normal disc. As we age, the disc begins to lose fluid and become dried out causing the disc to compress. This may lead to the breakdown and degeneration of tough outer ring of the disc (annulus fibrosis) allowing the inner core (nucleus pulposus), to bulge out. This is considered a bulging disc. This puts pressure on the outer ring of the disc, which may cause low back pain. As further degeneration of the disc continues, or with continued stress on the lumbar spine, the inner jelly-like core may rupture out from the outer ring causing a ruptured, or herniated, disk. Once the inner nucleus herniates through the outer ring, pain in the lower back may improve.

However, the fragmented disc material can inflame or put pressure on the spinal nerves leading to an increase in sciatic leg pain, weakness, numbness, or changes in sensation in one or both legs. Most disc herniations occur at the lower lumbar spine at L4-L5 and L5-S1 levels. Occasionally, severe trauma can cause a normal disc to herniate or may cause an already herniated disk to worsen.

Risk Factors of Lumbar Disc Disorders

  • Age and Gender - the highest incidence in men between the ages of 30 and 50.
  • Obesity - being overweight puts added stress on lumbar discs.
  • Sedentary lifestyle - lack of exercise and poor core body strength.
  • Smoking - Smoking decreases oxygen supply to the discs causing more rapid degeneration.
  • Improper lifting - using your back muscles instead of your legs to lift heavy objects. Twisting while lifting
  • Posture - hyperlordotic lumbar curvature, anterior pelvic tilt (lower cross syndrome).
  • Repetitive activities that strain your spine - jobs that require constant lifting, pulling, bending, or twisting.
  • Frequent driving - staying seated for long periods and the vibration from the car can put pressure on your discs.

History and Symptoms of Lumbar Disc Disorders

Lumbar disc disorders may include one or a combination of the following symptoms:

  • Intermittent or constant lower back pain and pain in the buttock,
  • leg and foot pain, numbness or a tingling sensation in the leg and foot,
  • Weakness in the leg and foot
  • Decreased reflexes in the knee or ankle
  • Changes in bowel or bladder function.

The symptoms will vary depending on if and where the disc has herniated, and what spinal nerve root is affected. Leg pain is usually greater than low back pain with disc herniations and nerve root involvement. However, if there are only annular tears without herniation, the pain will be localized to the low back and buttock. The onset of pain can be sudden or gradual after an injury. Pain may follow heavy lifting, twisting, or straining activities or repetitive stress trauma. However, patients may not recall a prior injury or a precise time the condition began because it is often preceded by frequent episodes of less severe low back pain that usually resolved. Pain is usually characterized by sharp, shooting, or electrical pain that may be aggravated by movement, changing positions, sneezing, coughing, or prolonged sitting and standing. The pain is usually relieved with rest and a recumbent position.

Treatment of Lumbar Disc Disorders

Conservative care should be your first course of treatment to manage lumbar disc disorders, but treatment will depend on the clinical presentation, your age, overall health, and tolerance to therapies. With disc herniations, the first few days of care will focus on centralizing (reducing) leg pain, decreasing inflammation, and preventing further neurological loss by decompressing nerve root impingement and reducing the disc herniation. Osseous mobilization and manipulation and soft tissue therapy may be administered as tolerated.

Home care will consist of pain-relief repetitive positional exercises and lumbar stabilization exercises. We will also educate you on ways to protect your lower back, positions to avoid, and how to manage activity. In most cases, bed rest will not be recommended as the sooner you are up and moving, the better the prognosis. Once pain and inflammation have decreased, we will continue working on lumbar stabilization and progress into proprioceptive training. We will evaluate muscle imbalances using posture and movement patterns with the goal of restoring good bio-mechanics and core body strength.

Your home care will emphasize the progression of stabilization protocols and corrective exercises. If you fail to respond to conservative treatment, or in cases of severe neurological loss, a referral for a surgical consultation will be recommended.

Diagram of a facet joint

Facet syndrome

Over half of facet syndrome cases occur in the neck (cervical spine), and a third occurs in the low back (lumbar spine). Facet joints are the small joints in the back of the spine that are responsible for much of rotational movement and limits side-to-side movement. The pain is often worst when moving from a sitting position to a standing position or moving from a bent-over position back to an upright standing position.

The main physical causes of this condition are: 

  • Excessive weight
  • Overuse (sports or labor)
  • Whiplash/motor vehicle accident
  • Pre-existing arthritis
  • Sitting for long periods of time

However, with the proper education, you can protect yourself from many of these causes. The primary sufferers of this condition, especially chronic cases, often are in poor physical condition with weak stabilizing paraspinal muscles. A co-morbid factor of this condition is often a desk job that involves sitting for most of the day. This type of patient usually has poor sitting posture, which can lead to a weakening of your spinal erectors and destabilize the spine, contributing to the condition. The importance of a strong core and training your spinal muscles cannot be overstated.

In cases where the injury stems from a problem related to overuse, poor posture or improper exercise, there are steps that can be taken to help avoid these injuries from happening. Proper instruction about your postural habits can reduce the detrimental effects of sitting on the spine, as well as education about correct lifting form can reduce these episodes of low back pain and help you build a healthy spine.

Lower Crossed Syndrome 

The abdominal muscles are inactive and not supporting the spine, while the spinal erectors are pulling the lumbar spine forward, resulting in something called hyperlordosis. This means that the spine in the lower back has an exaggerated curve, which can result in accelerated degeneration of the joints of the spine.

At the same time, the hip flexors are facilitated and are chronically tight while the gluteus muscles are inhibited and have reduced activation. This leaves the back muscles to do most of the work to extend the spine instead of the gluteus muscles keeping the pelvis level.

Diagram of Lower Crossed Syndrome

Body Preparation and Positioning 

Sternum Up - Keeping the sternum up automatically sets the body into the good posture and maintains:

  • Neutral Spine: Maintaining good spinal alignment decreases the stress placed on the spine and discs.
  • Hip Hinging: Bending at the hips, and not the low back, decreases the stress placed on the low back and increases strength & power.
Diagram of the proper lifting power zone

Optimal Activities of Daily Living Considerations

The below images and descriptions were resourced from The Journal of Bodywork and Movement Therapies (2004) 8, 85–87 written by Craig Liebenson, DC

These are a sampling of some daily activities that you may encounter. We encourage you to practice and apply the body preparation and positioning described above. The Sternum Up, Power Zone and Abdominal Bracing should be utilized to protect and spare the spine.

Hip Hinge

  • Keep the spine upright by hinging from the hips as you bend your knees
  • Maintain all three points of contact as you move to an upright position
Hip hinge diagram

Going from Sit-to-Stand 

  • Start in a seated position at the edge of your chair with your feet under your thighs before sitting up
  • To initiate movement begin upward movement by using your hips and knees
  • To avoid strain to your back, keep your torso upright when rising from the chair.
Sit to stand diagram

Picking up a bag of the ground

  • When picking up a bag from the ground, bend from the hips and knees.
  • Make sure to keep the back flat and keep lower back’s natural curve by keeping it curved forward while bending.
  • When lifting, initiate the movement by keeping the back flat while extending with the hips, and tightening the glutes.
Diagram of lifting a bag

Brushing your teeth

  • Keep your chest upright while brushing the teeth.
  • When you bend forward to rinse your brush or mouth bend from the hips, not from the waist.
  • Keep your chest lifted while you bend forward.
Proper positioning for brushing your teeth

Changing a diaper

  • Before changing your baby ensure that you have a changing station that is the appropriate height.
  • If it is too low (below your waist), you will be forced to bend forward from the waist.
  • The correct height is approximately waist high and allows you to maneuver your baby without having to bend much.
Diaper changing diagram

Picking objects from ground 

  • When lowering to pick up the object, bend from the knees and keep your chest lifted.
  • When lifting keep your spine upright by hinging from the hips and knees.
  • If the object is not directly in front of you, it is important to keep your chest lifted in front of you while keeping your lower back’s natural curve.
  • Avoid lifting immediately after sitting for a prolonged period.
Picking up objects from ground diagram