Managing Your Back Pain
Core Stability and Proper Posture
Proper posture is the foundation of trunk stability. Posture techniques should be performed daily, at home, and at work to achieve maximum benefits. Core stability and strength is an integral part of maintaining a healthy spine and when properly complemented with core muscle exercises, can put you on the road a healthier back and improve your overall quality of life.
The Importance of Core Stability
The core serves as the muscular corset that works as a unit to stabilize the body and spine with and without limb movement. In short, the core serves as the center of the functional kinetic chain. The core has been referred to as the ‘powerhouse,’ the foundation or engine of all limb movement. All movements are generated from the core and translated to the extremities. Comprehensive strengthening or facilitation of these core muscles has been advocated as a preventative, rehabilitative and performance-enhancing program from various lumbar spine and musculoskeletal injuries. The ‘core’ has been described as a box with the abdominals in the front, paraspinals and gluteals in the back, diaphragm as the roof, pelvic floor and hip girdle musculature as the bottom, and hip abductors and rotators laterally. All these muscles have direct or indirect attachments to the extensive thoracolumbar fascia and spinal column, which connect the upper and lower limbs.
Stability of the lumbar spine involves both passive stiffness, through osseous and ligamentous structures, and active stiffness, through muscles. A bar spine, without muscles attached, is unable to bear much of a compressive load. Spinal instability occurs when either of these components is disturbed. Gross instability is true displacement of vertebrae, such as with traumatic disruption of two of three vertebrae. On the other hand, functional instability is defined as a relative increased range of the neutral zone (the range in which internal resistance from active muscular control is minimal). Active stiffness or stability can be achieved through muscular co-contraction, akin to tightening the guys of a tent to unload the center pole.
A major advance in our understanding of how muscles contribute to lumbar stabilization came from recognizing the difference between local and global muscles. Global (dynamic, phasic) muscles are the large, torque-producing muscles, such as the rectus abdominis, external oblique and thoracic part of lumbar iliocostalis, which link the pelvis to the thoracic cage and provide general trunk stabilization as well as movement. Local (postural, tonic) muscles are those that attach directly to the lumbar vertebrae and are responsible for providing segmental stability and directly controlling the lumbar segments during the movement.
Proper Posture Prevents Back Pain
Poor posture (sitting, standing, or lying down) makes the back more vulnerable to injuries and back pain; weak or shortened muscles contribute to poor posture. Fatigue also contributes to poor posture and back pain.
Poor Posture and Back Pain
When the spine is not in proper alignment the muscles, ligaments and spinal joints all are under extra stress. Muscle strain is the most common cause of back pain due to poor posture.
Discs can also suffer from poor posture. When the spine is in proper alignment, the cushioning, shock absorbing discs that are in between the vertebrae are not overly stressed and not as subject to injury.
Lower back pain is the most common back pain caused by poor posture, as the lower back supports most of the weight of the body. However, poor posture can also cause upper back pain, especially in those who slouch. Neck pain is also common.
Strong Muscles for Proper Posture
Muscles support the spine. A weakness in any of the muscles that support the spine makes it difficult to maintain proper posture. Poor posture is a common cause of back pain due to muscle strain, especially lower back pain.
– Exercises that strengthen and stretch the muscles that support the spine help maintain proper posture.
The back muscles, ligaments & discs are under extra stress when the spine is not in proper alignment. Strong muscles help keep the spine in proper alignment and prevent back pain. Strong muscles also prevent the spine from extending beyond its normal range of motion, which is essential to protecting the ligaments and disks from injury.
Flexible Muscles for Proper Posture
Tight, shortened muscles in the back or buttocks can throw the spine out of alignment and cause back pain. Stretching the back muscles is important for good posture, but other muscles, such as shortened hamstrings (muscles in back of thigh), can also affect spinal alignment.
What is Good Posture?
Many people remember being told ‘Stand up straight’ or ‘Don’t slouch’ when they were children. Like ‘eat your vegetables’, this is still good advice. The spine, however, is not actually straight. The healthy spine curves inward at the neck, outward at the chest, and inward at the lower back. These two curves balance each other to ensure that the pull of gravity is evenly distributed. If the curves of the spine are increased or decreased the muscles, ligament and joints have to work harder to support the weight of the head and body. This leads to fatigue, strain and back pain. When standing, the center of the head, the shoulders, center of the body, knees and feet should line up vertically.
COMMON POSTURE ERRORS
Common posture errors of the lower back that cause lower back pain:
Swayback – an increase in the natural inward curve of the lower back.
Flattened back – a decrease in the natural inward curve of the lower back.
Common posture error of the upper back that cause upper back pain:
Rounded or hunched shoulders – an increase in the natural outward curve of the upper back.
Common posture error that causes neck back pain:
Head Forward – ears in front of the shoulders, caused by a bent over position or hunching the shoulders.
The Lower Back Posture Errors
The positioning of the pelvis controls the curve of the lower back. The pelvis should be in a neutral position. If the pelvis tilts forward, sway back results (the natural inward curve of the lower back is increased). If the pelvis tilts backward, flattened back results (a decrease in the natural inward curve of the lower back). Control of the pelvis is key in keeping the lower spine in proper alignment and preventing lower back pain. Like the spine, the pelvis is supported by muscles of the back, and abdomen and buttocks and strengthening these muscles helps maintain good posture and prevent back pain.
SWAY BACK – A Common Posture Error of the Lower Back
When the pelvis tilts forward the lower back arches excessively – sway back. Sway back places extra stress on the ligaments of the spine and leads to back pain. Sway back is more common in a standing position than in a sitting position. Wearing high heels also causes the pelvis to tilt forward and contributes to sway back.
Shortened muscles can also cause swayback. Stretching these muscles and maintaining the pelvis and spine in a neutral position can restore good posture and relieve back pain. Not only can shortened back muscles cause sway back and back pain, but shortened hamstrings (muscles at back of thighs) can contribute to sway back and back pain.
Test for sway back: There should be a slight inward curve to the lower back. To see if your back curves excessively (sway back), stand with your back against a wall, place your feet about 6 inches from the wall. Make sure you head and buttocks are against the wall. If your posture in correct, you will have no more than two inches between the small of your back and the wall. If it is over than this, you have sway back.
*If you have more than 2 inches between the wall and your neck, the muscles in the back of the neck and back need stretching. Don’t be impatient. Lengthening the muscles through stretching exercises must be done gradually to avoid overstretching injuries. Overstretching muscles in the neck and back can result in intense neck and back pain and stiffness.
Sleeping on your stomach shortens the muscles in your back and encourages sway back. Sleeping on your side with the knees bent helps counteract a sway back and can relieve back pain.
The pelvic tilt exercise (see back exercises) is especially good for a sway back and can relieve lower back pain. The ‘cat’ is also beneficial.
FLATTENED BACK – A Common Posture Error of the Lower Back
There should be a slight forward curve to the lower back. Flat back is more likely to be a problem when sitting than when standing. If the pelvis is tilted too far backward, the lower back loses its natural curve, muscles and ligaments are stretched, causing lower back pain.
Upper Back Posture Error
ROUNDED SHOULDERS is a Posture Error of the Upper Back
If your shoulders are rounded you need to stretch the chest muscles and strengthen your upper back muscles. Rounded shoulders are usually the result of slouching. Prolonged slouching can strain the muscles between the shoulder blades, causing upper back pain. When slouching, the natural forward curve of the neck is also exaggerated, which can also result in neck pain. It is more common to slouch when sitting. Slouching is often caused by fatigue, especially when sitting in front of a computer.
Slouching also compresses your diaphragm, when leads to shallow breathing. Proper posture allows proper breathing and sufficient oxygen intake. Getting enough oxygen helps to relax muscles and prevents stress from building up in the muscles, especially the muscles of the neck and back. Tense muscles are a common cause of back pain and neck pain.
Other Posture Error
HEAD FORWARD- A Common Posture Error
The back of ears should be in line with shoulders, chin parallel to floor. Being in a bent over position or slouching causes the head to be too far forward. When standing or sitting in an upright position the weight of your head (about 15 pounds) is supported by your entire spine, which acts as a pillar for your head.
Poor posture habits such as leaning forward puts the burden of supporting the head on the muscles in the neck. This causes muscle strain and pain in the neck and can even cause headaches.
Once the neck muscles are strained, leaning your head over for even very short periods of times can cause neck pain. Proper posture allows strained neck and back muscles to heal more quickly.
The head is heavy and the muscles of the neck take the entire load when your head is forward, creating neck pain.
Proper Posture While Sitting
Many people spend much of their workday sitting. Proper posture while sitting is vital for preventing back pain.
Even when maintaining good posture, sitting for prolonged periods of times can tire the back muscles. Take frequent breaks from sitting; take a short walk every half hour to hour, as the human body was not designed to stay in one position for long periods of time.
Also, the discs are under more pressure when sitting than while standing. Having a chair that reclines slightly shifts you weight onto the backrest of the chair; this allows your back muscles to relax, and takes some of the pressure off of the discs.
Adjustable Chairs With Good Back Support Prevent Agonizing Back Pain.
The pelvis should be in a neutral position. Certain chairs cause the pelvis to tilt backward, decreasing the curve of the lower back (flattened back), which places extra stress on the lower back and causes back pain. If you don’t have access to a chair with a good back support, place a small pillow in the small of the back to correct the curve.
Some people try too hard to sit up straight and actually end up tilting their pelvis forward and arching their back. This increase in the curve of the lower back (sway back) also strains the lower back and causes back pain.
When sitting in a chair, the feet should be supported. If the seat is too high for the feet to reach the floor, use a platform to rest your feet on. The knees should be level with or slightly higher than the hips.
Besides lower back pain, neck pain is common when good posture is not maintained while sitting. Make sure your computer monitor isn’t too high of low. You shouldn’t have to tilt your head up or lean forward to see the screen. We often extend our neck to look at a computer screen, sometimes because it is too far away, sometimes out of habit. Looking upward or looking downward or sideways (which is common practice when viewing a document upon a desk) puts excessive strain on the neck and upper back and causes neck and back pain.
The arms should hang at your sides. If your computer keyboard is too high or too far away the arms have to be kept raised or extended, resulting in tense shoulder and upper back muscles and back pain.
The top of the computer screen should be just below eye level. When reading, place the material on an angle; don’t place the reading material flat on a desk or your lap. Leaning your head over for prolonged periods of time is brutal on your neck muscles.
Proper Posture While Lying Down
Supporting the spine in its natural alignment while sleeping is important to let the back muscles fully relax and to avoid overextending the muscles, ligaments and spinal joints. A supportive and comfortable mattress is important and using a pillow (between the knees for side sleepers, under the knees for back sleepers, or under the hips for stomach sleepers) can also help take stress of the spine.
Lying on side with knees bent – pillow between knees for support: Lying on your side with the knees bent helps counteract a sway back and can relieve back pain. Using a pillow between the knees helps prevent twisting of the spine.
Lying on back with knees bent – pillow under knees for support: Lying on the back with straight legs can cause low back pain. If you prefer to sleep on your back, bend your knees slightly and place a pillow under them for support.
Lying on your stomach – pillow under the hips: Lying on your stomach increases the curve of the lower back, leads to shortening of the muscles in your lower back and encourages sway back. If you absolutely must sleep on your stomach, place a pillow under your hips to help support the lower back. However, sleeping on the stomach also can strain the neck and is generally not advisable.
Neck support: The pillow supports the neck by filling the space between the head and shoulders. The pillow should not force your head upward or allow it to fall downward, but should keep it in a neutral position. The pillow should also feel comfortable. People who sleep on their stomachs only need a very low pillow.
The Role of the Mattress
A good mattress will conform to the spine’s natural curves and keep the spine in proper alignment.
When lying on a saggy or too soft mattress, the spine is thrown out of alignment. An overly soft mattress allows the lower back to sink too far into the mattress, which can irritate the spinal joints and result in lower back pain upon awakening. Back muscles also become strained as they attempt to keep the spine in proper alignment.
If the mattress is too firm there will be gaps between the inward curves of the body and the mattress that leave parts of the back unsupported. Pressure points will be created on the parts on the body that has contact with the mattress, as there is less area to distribute the weight of the body. The solution is to get a relatively firm mattress with enough cushioning for comfort. (There must be enough cushioning to distribute the weight of the body and eliminate pressure points) If you already own a bed that is overly firm, adding a good quality foam topper may be enough.
A mattress wears out gradually – springs and foam gradually lose their ability to recover height – resulting in a gradual loss of support and comfort. Sleeping on a new mattress may improve sleep and reduce back pain and stiffness.
Keeping the spine in proper alignment while standing, sitting and lying down can relieve or prevent back pain.
Change Positions Frequently for Back Pain Prevention and Relief. Holding any position for too long can also tire out the back muscles and cause back strain and back pain. Holding a position in which the spine is out of alignment makes the back even more vulnerable to back pain. Changing positions frequently will avoid using the same muscle group for too long.
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