Last week, we looked at some of the treatment options for back pain, and especially low back pain. Hopefully we busted the myth that drugs are the only way to go – but this week, let’s look at an even better option, how can we prevent back pain from occurring in the first place?
Todays question is especially relevant, since for many people, back pain is a recurring condition – whichever treatment method you eventually opt for, there’s a good chance that you’ll experience back pain again if you don’t take proactive steps to change the circumstances which caused you to be in pain in the first instance. If, like many of us, your job or lifestyle exposes you to a high risk of back injury or strain there’s still a good chance that you’ll experience pain again at some point, but proactive prevention can go a long way to reducing the duration and severity of pain if it does reappear.
The anti low back pain workout
Exercise is a great option for reducing back pain, especially low back pain. For those of us with limited time, a daily, 30-minute walk is an actually excellent way to get started – is not just an easy way to stay active and burn calories, it’s also a great tool for maintaining flexibility in the lower back. Even better though, is a comprehensive workout designed to support the lower back.
As part of a recent experiment, researchers divided 71 Low back pain (LBP) sufferers (36 men and 35 women) into two workout groups. Participants either walked each day or engaged in a graded workout, emphasising lower back stability exercises. After 12 months, researchers assessed the participants ‘levels of pain and disability, physical health , fear-avoidance of exercise and self-reliance.
The study showed that at 12 months, group comparison showed a reduction in perceived disability in favour of the targeted exercise group, Ratings of physical health and self-efficacy beliefs also improved in the exercise group over the long term, though no changes were observed for fear-avoidance beliefs.
What the study tells us, is that targeted exercises (of the kind we can give you here at complete chiropractic!) can have a significant impact – however, exercise alone will not totally resolve the situation. Many patients do still have aspects of life they try to avoid in the hopes of preventing pain. This is where chiropractic treatment can really shine, since our approach is to eliminate the underlying cause of the condition – thereby effectively preventing future injury.
These are some typical exercises which can provide relief for lower back pain – these exercises are all safe to perform but should only be taken as far as is possible without incurring severe pain. As a general program, perform three repetitions of each exercise pictured below – hold each position for a count of 5.
A spinal professional such as a Chiropractor can and should tailor a specific exercise program for you, based on your specific condition.
Resistance training resists pain
Some research also shows that adding resistance training to your workout regimen wards off LBP. What exactly is “resistance training”? For some of us, the term makes us think of powerlifting but simply put, it’s actually any exercise where muscles contract against an external resistance. It can be accomplished with weights, rubber exercise tubing, your own body weight, water bottles, or almost anything else to hand – no need to join the gym! No matter how you exercise, resistance training amplifies strength, tone, mass and endurance.
As part of a recent analysis, researchers compared resistance training to standard aerobic exercise for musculoskeletal health, body composition , pain, disability and quality of life in patients with chronic low-back pain (CLBP). Researchers divided 27 LBP study volunteers equally into three groups: ( I ) resistance training, (2) aerobic exercise or (3) a no exercise control group. During the 16- week study participants increased the intensity and amount of exercise.
Researchers measured each group’s progress after eight weeks and again at 16 weeks. The resistance training exercises “significantly improved” their musculoskeletal fitness, pain, disability level and quality of life (QOL). Conversely, the aerobic exercise group “showed no significant improvements in pain, disability, or QOL.” However, aerobic exercisers exhibited more “significant improvements” in flexibility, cardio vascular stamina and leg power than the resistance group.
Overall the study therefore suggests that a mix of resistance and cardiovascular training is likely to be effective in warding off LBP, but that resistance training probably makes the biggest contribution to pain reduction.[1] If you need some advice in introducing some appropriate resistance exercise, just ask your chiropractor!
Postural correction
Today more of us than ever before work in sedentary desk jobs, and while these jobs might see fairly risk free, they are a nightmare for postural problems. Many instances of back pain that we see at the clinic can be traced back to poor posture. It’s not always the factor which caused the back pain in the first place, but it’s often an additional issue which makes the pain worse. Those of us working in more active jobs tend to be more aware of the need for good posture, safe lifting etc. but are of course also at higher risk in the first place!
At Complete Chiropractic, we are a Chiropractic Biophysics clinic. Chiropractic Biophysics is an advanced discipline within chiropractic which focuses heavily on long-term outcomes based on scientifically provable techniques. Chiropractic Biophysics goes beyond the normal Chiropractic remit and focuses heavily on identifying and correcting postural problems through what is called the “mirror image” approach. In this approach techniques such as Chiropractic adjustment, targeted exercises and traction are used to oppose postural issues such as kyphosis and gently guide the spine back to the correct, neutral position. Doing so reduces pressure on the spine, relaxes the muscles and combats the effects of hours spent sat at a desk.
A recent study reported on the results of ten Chiropractic Biophysics patients who were treated for thoracic Hyperkyphosis – the head forward posture which by far the most common issue we see today. In each of the cases, the patients were prescribed thoracic extension methods to oppose the kyphotic posture. In these 10 cases, the results demonstrated an average reduction in Hyperkyphosis of a significant 11.3° over an average of 25 treatments each lasting approximately 20 minutes, over an average of 9 weeks. As you might expect, patients also experienced a reduction in pain levels and disability ratings.
This randomly selected series of cases contributes to an existing group of studies which have also shown CBP approaches to be effective in treating Hyperkyphosis and other postural problems and thereby for reducing the potential for long-term health problems.[2]
The great news about postural correction work is that it works to naturally, and painlessly oppose the stresses and strains which are imposed on your spine by your everyday work for as long as you keep up with the treatment. Critically, this provides individuals with a way to combat the negative effects of desk work, especially when the conditions of the work itself cannot be changed.
Check your lifting technique!
A substantial number of low back pain cases are either caused or made too painful to bear by a stress or strain – without any doubt, poor lifting technique is responsible for the majority of these incidents.
It’s a common misconception that concerns around lifting technique are limited to those working in manual jobs, perhaps in the construction industry, in the warehouse or maybe something more unusual, like baggage handling at the airport. There’s no doubt that proper lifting technique is vital in these professions, but these basic principles are relevant to almost everyone! The key thing to ember is that it isn’t just heavy, but also repetitive lifting that can be a problem.
Are you a mum? – perhaps your child doesn’t weigh that much (or perhaps they do!!) but you’re picking them up often, and frequently in a poor position.
Do you commute on public transport? – Your bag or rucksack probably weighs more than you think, and you might be holding on to it for a long time!
Work in an office? – Perhaps you lift infrequently, but those occasional items you do lift might actually be very heavy, boxes of printer paper, water cooler bottles and even stacks of folders, if lifted poorly can and do cause injury!
Like most things’ spine related, when it comes to safe lifting, the importance of correct posture cannot be overstated. You have probably heard the common advice to “lift with your knees, not with your back” – often the common advice isn’t totally accurate, but on this occasion, it is!
A recent study which measured a group of healthy men lifting a 10 kg weight confirmed the load that not bending your knees can impose on the spine. In the study, scientists measured electrical activity in the men’s trunk muscles and the pressure between the vertebrae of their spines. Both the load on their spines and activity in their muscles were significantly higher when the men bent their backs, rather than their knees while lifting.[3]
Therefore, always try to practice safe lifting – take care to:
- Start with your body as close to the load as possible, avoiding reaching out to grasp it. This keeps your centre of gravity where it should be.
- Avoid reaching over your head – use a ladder instead.
- Focus on your legs when lifting – shifting your mental focus has been shown to activate muscle groups more effectively.
- Don ‘t arch or twist your back – keep it straight.
- Hold the load close to your torso between your shoulders and waist for minimal back strain.
It’s not just lifting technique which is a factor here – knowing your load is also critical to avoiding injury.
Numerous trials have proved that not knowing roughly how heavy a load is before lifting subconsciously influences posture, balance and spinal load. Lifting an object that is heavier than anticipated can throw your body off balance, especially if you are already in a less-than optimal lifting posture and strain the lumbar region[4]
It may seem that this would only be a problem when the load is heavier than expected, but researchers have also identified potential hazards when the weight is less than you thought. Anticipating and preparing the body for a heavier load alters the impact of the load on the spine and throws the body off balance, risking injury.[5]
Another possible hazard comes from lifting a load that is asymmetric – that is to say that it’s heavier on one side than the other. Researchers have found that people lifting such loads have to quickly shift their trunks to com pen sate for the unexpected irregularity. This decreases the stability of the spine, putting these individuals at risk for hurting their lower backs.[6]
Chiropractic Maintenance Care
Since low back pain does so frequently reoccur it’s no surprise that there has been some considerable research by Chiropractors into trying to keep it at bay. In addition to encouraging all of the approaches we have already discussed here, it’s clear that regular care and appropriate intervention can go a long way to reducing the risk of further low back pain incidents. There is no single treatment protocol which has been shown to be more effective than any other for ongoing care once your initial pain has been resolved – instead chiropractors provide a tailored package of treatment known as “maintenance care”.
Maintenance care is essentially ongoing chiropractic care (usually less frequent than primary care for a painful condition) which seeks to prevent your original complaint from flaring up again. Maintenance care usually includes spinal manipulation, some form of exercise or stretching prescription, and specific advice tailored to your individual circumstances. At Complete Chiropractic, our patients can benefit from tailored approaches designed for their specific lifestyles. Work at a desk all day – We’ll probably recommend Chiropractic Biophysics postural work and some home exercise. Construction worker? You might benefit from more regular adjustments and sports massage.
It’s this personal approach which makes maintenance care the best option for preventing the return of back pain. In fact, a 2018 study[7] considered a large sample of 328 participants with a view to establishing how effective maintenance care really is. The group of patients selected for the trial ranged from 18 to 65 years old, and had all suffered from non-specific low back pain – all had also had an early favourable response to Chiropractic care. After an initial course of treatment, eligible subjects were assigned to either a maintenance care group or a control group. The study sought to establish the total number of days with bothersome LBP that each patient experienced within 52 weeks.
The results of the study were clear – maintenance care resulted in a reduction in the total number of days per week with bothersome LBP compared with the control group. During the 12-month study period, the MC group reported fewer days in total with bothersome LBP compared to the control group. The study, therefore, concluded that maintenance care is an effective way to help prevent low back pain from reoccurring.
There you have it – if you’re proactive you can do a lot to reduce your risk of back pain, and if you are suffering with pain there are many drug free treatment options. We’ll be finishing this series next week, with a look at a back pain recovery model, and how you can use it to speed recovery if pain does flare up.
[1] J Strength Cond Res 20p9 Epub.
[2] Jaeger JO, Oakley PA, Colloca CJ, et al.: Non-surgical reduction of thoracic hyper-kyphosis in a 24-year old music teacher utilizing chiropractic biophysics®
Miller JE, Oakley PA, Levin SB, et al.: Reversing thoracic hyperkyphosis: a case report featuring mirror image ® thoracic extension rehabilitation. J Phys Ther Sci, 2017, 29: 1264–1267.
Fortner MO, Oakley PA, Harrison DE: Treating ‘slouchy’ (hyperkyphosis) posture with chiropractic biophysics®: a case report utilizing a multimodal mirror image® rehabilitation program. J Phys Ther Sci, 2017, 29: 1475–1480.
Fedorchuk C, Snow, E: Reduction in thoracic hyperkyphosis with increased peak expiratory flow (PEF), forced expiratory volume (FEV) and SF-36 scores following CBP protocols in asymptomatic patients: a case series. Ann Vert Sublux Res, 2017, Oct 12: 189–200
[3] Spine 2006; 31 :18-23
[4] Arch Phys Med Rehabil/ 2002;83 :48-59
[5] Ergonomics I 997;40:559-75
[6] Spine 2003; 28:764-70
[7] Eklund A, Jensen I, Lohela-Karlsson M, Hagberg J, Leboeuf-Yde C, Kongsted A, et al. (2018) The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back painÐA pragmatic randomized controlled trial. PLoS ONE 13(9):e0203029.
