Friday, 13 April 2012

Why leaning forward might be making your low back pain worse

Welcome back readers!  Today, let me start out with a brief representation of a typical conversation I have had with a few devoted fans of the blog (and by devoted fans I mean people who I force to read it).

These fans will say to me something along the lines of, "Hey Sean, you blog about sports and science and stuff."

Trying to sound as intelligent possible I say, "Yeah."

Then they say, "Yeah, but, you're a chiropractor?

Again, delving into the recesses of my advanced vocabulary, I reply with, "Yup?"

They say, "Yeah, so why do you never talk about stuff relating to backs?"

Time to sound intellectual, clever and calculated.  I say, "Ummmmm."

There you have it; I don't know why.  I guess it all comes down to which article I have most recently read that is interesting or novel.  OR the topics are based on "fan questions" (aka. my parents ask me something).

However, I can't disagree with the idea of throwing in some articles relating to the back.  So, I will work on compiling some new and interesting research on back pain.  In the meantime I have something to tide you over.

I also write for the New Hamburg Independent, and below is one of my articles which was published in a mid-May issue.  It touches on a part of back pain that is often neglected, and may be part of the reason why yours is not getting better.  It is a basic summary, but a good start nonetheless, enjoy!

 Why leaning forward might be making your low back pain worse

Low back pain is an extremely common disorder that affects 8 out of every 10 people at some point in their lives.   In fact, 26% of adults in North America report some form of low back pain every three months.

More often than not, this pain is a result of damage and irritation to the joints, muscles, and ligaments in the low back.  In these scenarios, a general exercise regime with an emphasis on strength and flexibility is undoubtedly crucial to making a speedy recovery.

However, when the intervertebral discs are involved, this general exercise regime must be much more restricted.

The intervertebral discs are soft tissue structures separating the vertebrae that make up your spine.  The outer layer of the disc is composed of tough connective tissue, but the internal component to the disc (called the nucleus pulposus) is more jelly-like. 

When a disc injury happens, the outer layer of that disc can become torn, and the inner layer can subsequently protrude outside of the disc.  The most common direction this protrusion occurs is backwards and to the side.  The damaged disc itself can cause pain, but more importantly, this protrusion can cause pain via putting pressure on the nerve roots branching from your spinal cord.

Symptoms of a disc herniation include pain with coughing or sneezing, electric or burning pain traveling down your leg, and pain aggravation with leaning forward.

If your low back pain is related to the muscles and joints, activity helps to flush out inflammation that has accumulated, keeps the muscles strong, and helps to increase blood flow which aids the healing process. 

By contrast, with a disc problem, your activities need to be much more limited.  Specifically, you need to avoid leaning forward at all costs.

Picture the intervertebral disc as a tube of toothpaste; when you squeeze the end of the tube, the toothpaste will come out of the top.

By the same logic, when you are leaning forward, you squeeze the front of your intervertebral discs which causes the nucleus pulposus to travel even further outside of the disc.  

A common mistake patients make when dealing with back issues is to stretch into the direction of pain, falsely thinking that they are creating mobility in tight tissues.  However, when the pain is originating from a disc issue, rather than creating mobility, they are actually making the issue worse, putting more pressure on the nerves, and slowing the heeling process.  

In addition, when pressure is put on the nerve roots branching from the spine, pain can be experienced as symptoms in the back of the thigh.  Another common mistake patients make is to perceive this as hamstring pain, and try to solve the issue by stretching this muscle group. 

This is another activity that must be avoided.  The stretch will not only encourage forward bending in the spine which worsens the disc issue, but will also put tension in the already irritated nerve, aggravating the leg pain.

So what can you do to help manage back pain relating to disc issues?  The answer is undoubtedly multifactorial, but avoiding bending forward at the low back is of the utmost importance.