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. 

27 comments:

  1. Thanks! I came across this article after googling "pain in lower back when leaning forward". I've had a really tight pain in my back (right at the very bottom, close in to the spine) for a week now - much worse when leaning forward and yet it's felt like that's what I've needed to do to stretch out the muscles. I'll stop doing that! The hip on that side has been a bit tight for a while and, having read your post, it's just reminded me that for a month or more now, I've had a really really tight section at the back of my thigh on that side too which I assume was hamstring but hasn't been helped much by me stretching my hamstrings! Hmmmm... I guess it's probably all connected, but I'm not sure which of my hip/back/knee started it! Thanks for the advice.

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  2. Glad the article helped Chloe! Thanks for reading, and good luck with the back pain!

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  3. I've been suffering from back pain for some time now. I have tried to undergo different treatments, but up to now, my back pain still returns. I've been unconsciously stretching and leaning forward because I thought it would lessen the pain. It’s a good thing that I read this article and learned that doing so would just make my back pain more severe.

    Shaunna Schumacher

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  4. I stumbled on this blog and this post is really helpful. I'm having pain when bending forward on the side of my lower leg. Sometimes I can feel it a bit at the back of the thigh(like the burning sensation you talked about) and I'm having pain on the same side in my upper back. I'm doing a yoga teacher training and I used to be a hardcore runner- plus I haven't had the greatest posture. Think they are related? The pain in the upper back comes and goes and seems to be coming from the rhomboids. Thoughts?

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  5. Hey Heather,

    Thanks for the comment and thanks for reading! Honestly, it is hard to diagnose and give you a good answer online. Generally speaking, if you have leg pain that goes past the knee that is originating from the back, there is some sort of nerve root compression. If leaning forward makes it worse, then I would 100% stop!

    As for the mid back pain, nerves from the thoracic spine do not branch down to the low back and legs. However, the pain can definitely still be related through tight and tender musculature, or even a referral pain.

    Also, on a side note- poor posture is not good, that is true. But the research shows that what is even worse is a sustained posture- even if it is "good posture." It is more important to change positions and be variable with your posture then to avoid "poor posture." It helps to load all tissues evenly and prevent injury. So slouch away, I sure do (in moderation)!

    Hopefully that helps!

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  6. Suffering from lower back pain, I googled and read this article. Great help, I muat say. Like everybody else, I was making the same mistake of continuously bending forward to relieve the pain! Thanks for the warning. Now, the first thing in the morning, I wash my face and I have to bend forward at the wash basin, trying to figure out how to avoid that.
    Count on me as your third fan ( and regards to your parents.)

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  7. That's great, glad the article helped! Good luck with the back pain

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  8. Thanks so much for your article! I am the first to tell ya that leaning forward will mess you up! I injured my back 20 years ago and from time to time my back will act up so bad that i can hardly walk. I was searching airline tickets at a friend's computer the other day and had to lean over since the computer was so far out of reach. I did this for over an hour, and well, let's just say the very next morning, i couldn't walk, and i was in so much pain, i had to call off work! I knew about bending over, since i've certainly been there and done that, as well as lifting anything too heavy, but never related leaning over...until now. My problem is L5 S1, so i'm also hurting in my hips. This is no fun. I will say this though, since I began dancing in a dance group 4 years ago, my back has become much stronger. I just need to learn what my limitations are.

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  9. Thanks for reading Jeanie! And I am glad to hear you are on the right track with your back pain, all the best!

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  10. Hi Sean... thank you for your article! Last night as I was half running upstairs whilst swallowing a mouthful of food I had a sudden back spasm and sharp pain! It has been very painful since and also very painful(almost impossibe) to bend forward... looking down is also very painful but arching backwards isn't that difficult at all though there is a continuous pain also in the lower back area... Though I know it is difficult to diagnose over the internet would you have any idea what it might be?
    Many Thanks
    Barry

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  13. Thank you for this! I recently started having back pain last week and have been leaning forward trying to relieve it. Guess I'll stop doing that now! Thank you!

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  14. From last one month m suffering wid same kind of problem. I consulted wid physiotherpist n yoga trainer they advised me to do back bending exercise nd to avoid forward bending. Though i feel pain in backward bending only not in forward. But now incidently i met another yoga trainer somewhr n he told me to do vise versa i.e to prefer forward bending. The pain is on a point in lower back jus above the hip line and sometimes in middle back part which is probably due to poor posture or excessive sitting time. Please guide.

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  15. From last one month m suffering wid same kind of problem. I consulted wid physiotherpist n yoga trainer they advised me to do back bending exercise nd to avoid forward bending. Though i feel pain in backward bending only not in forward. But now incidently i met another yoga trainer somewhr n he told me to do vise versa i.e to prefer forward bending. The pain is on a point in lower back jus above the hip line and sometimes in middle back part which is probably due to poor posture or excessive sitting time. Please guide.

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  16. I have spinal stenosis and pain in a tiny spot in my buttocks. The best relief I get comes from bending forward and touching my toes and eery doctor told me not to arch my back.
    I get epidurals regularly, three to four ties a year.
    And I dance. Often and rigorously, ballet, jazz and folk dancing. In this way I keep limber and manage my pain.

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  17. I would love to get your view on how to get rid of spinal stenosis

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  18. The description of symptoms of leg pain is greatly explained by web health network. It's a must read.

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  19. Dr. Delanghe,
    I tried a little maneuver to try and determine if my back pain is muscle or ligament/disc related. I had a small (I hope) injury yestarday, caused from a slight bending foward while cooking; was not carrying extra weight, only a spatula.
    I will call the maneuver the "stabilized immobile contraction passover". Laying flat on the bed, pain totally subsided, and allowing the spine to maintain the comfortable position at all times, I started a muscles contraction in the shoulders and slowly passed it down the back into the buttock muscle groups. Since the spine did not change position and the pain did recur upon muscle contraction as it passed over the area of concern, is there a greater likelihood that the injury is from muscle strain rather than ligament/disc injury?
    To ALL readers, please do not diagnose yourself, especially if you did not understand what the suggested maneuver does by attempting to remove spine movement, a diffuculty thing to do without a good understanding.
    Thanks for the article!
    Regards,
    Todd

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  20. This comment has been removed by the author.

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  21. Hey,

    Great Post!!

    Thanks a lot for sharing this useful post on lower back pain.

    I completely agree with you that Lower back pain can be a debilitating condition that stops you enjoying life. You find you can no longer do all the activities you use to do. You avoid certain tasks and miss out of lots of fun filled activities with your children, family and friends.

    I will surely consider all your tips in order to recover from my lower back problems.

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  22. Excellent Article! The information provided in the article about to lower back pain is very useful. I will follow all the suggestions provided here to avoid my back pain.

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  23. Great Article ! I have created a yoga style with NO forward bends.. All the poses help align the spine .. Please check it out at www.yogalign.com

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  24. Thanks for Sharing. nice posting and really like for self care massage tools. we provide Massage Therapy, physical theraphy, back pain, lower back pain treatment in Deerfield beach USA

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  25. Wonderful information on this very complex topic! I've heard many people asking what is lumbar myelopathy lately and have had some trouble finding good, definitive answers. Have you ever written about myelopathy? It seems like this condition is making it's way through the doctors offices and hospitals and with aching patients lately. If you have any details about lumbar myelopathy symptoms I would be excited to see it posted! That would be incredibly helpful.

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  26. Thanks so much for this informative article & such a useful information. I have cervical spondilytis get pain in the neck and upper back due to pinched nerve. please suggest self acupressure for this.
    Middle back spasm

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