Lower back pain is a very complex problem and may have many causes. One cause is when spinal tissue failure occurs as a result of high compression forces applied through the spine leading to spinal injuries. High spinal compression forces may lead to micro fractures in the vertebral endplates, compression fractures of the vertebral bodies and damage to the spinal discs (1-3).
Activities which cause high spinal compression forces include:
Certain body postures also create higher compression forces through the spine than others. For example, bending the spine while lifting, increases the pressures on the spinal discs by more than 100%. Spinal bending combined with twisting increases spinal disc pressures by more than 400%. On the other hand, when people recline backwards in a chair, even while adopting a slouching posture, spinal disc pressures reduce by 50-80% – a posture most of us adopt when we’re getting tired during extended bouts of sitting. Sitting up straight in a chair actually creates twice the spinal compression compared with reclining backwards in a chair – something to tell your granny or your teacher when they criticize your reclined slouching posture!
In 1979, it was noted that when heavy lifting was performed while holding one’s breath (for a few seconds), the intra-abdominal pressure was raised, the spinal extensor muscles activity reduced and both led to reduced compression loading on the lumbar spine, reducing the risk for spinal injury. However, if the heavy lifts extended for longer than a few moments, the breathe was released and the intra-abdominal pressure fell to much lower levels, reducing this spinal support mechanism substantially (5). This reduction in spinal compression due to raised intra-abdominal pressure was supported by research published in 2003, 2006 and 2010 and showed that the greatest benefit occurred when the body was in flexed (bent) postures (6-8).
The question arises as to how raised intra-abdominal pressure reduces spinal compression and helps to protect the spine from spinal compression failure leading to spinal injury and lower back pain.
Both abdominal and spinal extensor muscle contraction cause an increase in the spinal compression forces. However, the abdominal muscle contractions (0- 40% MVC) also assist in raising the intra-abdominal pressure, and when doing so, the net forces on the spine result in reduced spinal compression. In these circumstances it was also found that there was a reduction in the activity of the erector spinae muscles, with a greater reduction in these muscles’ activity corresponding to a greater increase in intra-abdominal pressure (8).
Furthermore, a 2013 published study revealed that chronic lower back pain sufferers who were experiencing a remission from their pain still exhibited lower levels of agonistic abdominal muscle activity and higher levels of antagonistic paraspinal muscle activity when compared to healthy individuals when performing spinal flexion (stooping/bending) with or without handling a load. This alteration in their abdominal and spinal muscle recruitment activity/ patterns could result in increased spinal loads (not measured in their study) and possibly contribute to the recurrence of lower back pain in individuals where these altered recruitment patterns have become the norm (9). On the other hand, research published in 2011 showed that activation of the core muscles showed no improvement in spinal stability, casting doubt on the mechanism in which core muscle rehabilitation is used to assist in the treatment of chronic lower back pain (10).
Adams M.A.; McNally S.D.; Chinn H.; Dolan P. (1994). Posture and the compressive strength of the lumbar spine. J Biomech. 27(6):791-791.
Nachemson A.L. (1981). Disc pressure measurements. Spine. 6(1):93-7.
It’s strange thing to think that your elbow angle is possibly related to your neck pain. But, it’s true. Well, more specifically, it’s true in certain situations. Read on:
Neck pain is sometimes caused as a result of tension or spasm in the upper trapezius muscle. The upper trapezius muscles are the upper fibers of the large diamond shaped trapezius muscle that covers the back of your neck and middle back, illustrated below. As you can see, the upper fibers connect the neck and the shoulder, and it’s normally in the mid belly region of these upper fibers that people experience neck pain.
Why does your upper trapezius muscle become inflamed or go into spasm and create your neck pain?
Well, one common reason is because of stress (which can cause inflammation of the trapezius muscle in the absence of trigger points and muscle spasm).
Another reason is because of fatigue of the upper trapezius muscle. When your upper trapezius muscle fibers are made to work under low loads for extended periods of time, they become fatigued and you are then likely to experience pain in the presence of spasm.
What causes the upper trapezius muscle to fatigue while you sit behind your computer and work?
There are a number of factors surrounding your computer workstation that can cause your upper trapezius muscle to fatigue and create neck pain for you.
One of the least well known reasons to creating fatigue of your upper trapezius muscle and hence your neck pain, is the angle of your elbow while you work.
A very interesting study found that when you work on your keyboard and mouse, the angle that you keep your elbow at will determine the level of your upper trapezius muscle activity and your neck pain. Keeping the angle of your elbow greater than 90 degrees, helps to reduce the fatigue of the upper trapezius muscle fibers and reduces neck pain.
This elbow angle position is important when it comes to where you position your keyboard and mouse as you work at your desk. As I’ve mentioned before in other posts, your screen needs to be arms length away from you when you’re leaning backwards against your chair’s backrest. In contrast to a closer position of the computer monitor than most people tend to adopt, the keyboard and mouse need to be positioned further away and not too close to yourself.
As you sit and type and mouse, your elbow angle must be open (i.e. greater than 90 degrees and up to about 120 degrees). Working on a desktop computer, this elbow position may be more intuitive, however, be more aware of your elbow angle when you work on your laptop as well. People often work on laptops in constrained positions and places, with the laptop quite close to you. Learning how to setup your computer workstation correctly is important to help reduce or prevent the common aches and pains us modern workers experience.
Where do you position your keyboard and mouse when you work? And do you suffer from neck pain?
Gawke J.C., Gorgievski M.J., van der Linden D. 2012. “Ofﬁce Work and Complaints of the Arms, Neck and Shoulders: The Role of Job Characteristics, Muscular Tension and Need for Recovery.” Journal of Occupational Health 54: 323–330.
Bansevicius D., Westgaard R.H., Stiles T. 2001. “EMG activity and pain development in fibromyalgia patients exposed to mental stress of long duration.” Scandinavian Journal of Rheumatology 30 (2): 92-98.
Marcus M., Gerr F., Monteilh C., Ortiz D.J., Gentry E. et al. 2002. “A prospective study of computer users: II. Postural risk factors for musculoskeletal symptoms and disorders.” American Journal of Industrial Medicine 41: 236-249.
If you’re one of the millions of office workers in the world, you will appreciate being able to sit comfortably for long hours at your desk.
The chair is the centre of your computer and desk workstation. Everything pivots around it. Do you know to position your chair correctly so that you’re comfortable while you work? Follow these 4 steps:
1. Elevate Your Chair to the correct Height
The first thing that you need to do is to set the height of your chair correctly. How do you know if your chair height is correct? It is not whether your feet touch the ground or not. If you use this as your guide, you are likely to set your chair too low, which will result in you shrugging your shoulders to reach your desk and your keyboard. Shrugging your shoulders for long periods at your desk puts you at a high risk of neck pain. Neck pain is very common among office workers and a low chair position in relation to one’s desk is one of the reasons why that this is so common.
So, to find the correct height for your chair, lean backwards against your backrest and elevate your chair until you are able to work at your desk and your keyboard with your shoulders relaxed. If your feet dangle, don’t lower your chair back again, rather get a footrest. If there is no money for a footrest, use some books or even reams of paper to support your feet. Don’t rest your feet on your chair legs, this will strain your back. Also, don’t ignore it if your feet don’t firmly touch the ground. It makes a greater difference than you think to use a support for your feet, even if it’s only a slight elevation that is necessary for you to be comfortable at your desk.
2. Bring Your Chair Closer to Your Desk
You might also need to bring your chair close enough to your desk. You need to bring your chair a lot closer to your keyboard and desk than you think you do. If you don’t, you will find yourself leaning forwards away from your backrest, which can lead to lower back pain.
If the armrests are a problem and preventing you from bringing your chair close enough to your desk because they are fixed, get someone from maintenance to remove them. If you have adjustable armrests, first try to lower them, but if the correct height of your chair causes them to knock against your desk, then raise them slightly to slide just over your desk.
“Armrests that can’t adjust low enough should be adjusted to slide just over your desk” by CS Body Health cc. All Rights Reserved. 2016
3. Incline Your Backrest Backwards to -8 Degrees:
Some people believe that if their chair is upright, they are sitting in good posture and sitting correctly. Good posture for the spine is maintaining the s-curve of the spine. Sitting too upright places higher loads on the spine than if it is reclined backwards. If you sit too upright, you will fatigue faster.
4. If Your Chair has an Adjustable Backrest
If your chair has an adjustable backrest, you need to make sure that the curve of the backrest is placed in the small of your back. This is to ensure that the s-curve of your spine is supported while you sit for long periods at your desk to help reduce lower back pain.
If you’ve been following my posts, you’re starting to realise that I keep harping on about how common neck pain is among office workers. During my pre-corporate practice days, lower back pain and knee injuries were the most common ailments I treated. Once I moved into the corporate environment though, I was totally amazed at the high incidence of neck pain I encountered.
There are various reasons for this high incidence of neck pain in an office environment. One large part is people’s posture while they work at their desks day in and day out (read my post on 4 monitor positions to cause neck pain). Another reasons for this higher incidence of neck pain is the high stress levels people are exposed to in the modern day office environment (read my post on stress and neck pain).
More and more computers are taking over and we’re working with less and less paper in our offices. A completely paperless office though, has not yet arrived for most of us. Does it really matter?
Who of you find yourself constantly referring to papers, writing on documents, capturing data from sheets and then working with the information on your computer as part of your job? I find this quite common among book keepers, data capturers, etc.
How does working between papers and a computer increase your risk of developing neck pain? There are a number of factors to consider in these scenarios.
Children. They’re little bundles of joy and we love to pick them up and cuddle or play with them, but who of you parents find that since you have kids, you’ve been experiencing an ache in your lower back?
Why is this? They’re small, we’re big and surely we’re strong enough to move them around anyway we like? Why then do some of us get this nagging pain in our lower backs?
Well, part of the problem lies in the fact that they’re small and we’re big, or, rather tall. When we go to pick these little people up, it means that we have to bend down quite low, close to the ground to reach them. What this means is that we inevitably need to do one of two things:
Ah, the old adage I hear you comment. We know this already! Really? If so, why are you still getting lower back pain? Do you really understand what you need to do? (Sign up for my back class for parents)
Most of us don’t like bending our knees when we go down quickly to pick something up off from the ground. Why is this? Well, it takes more energy to bend your knees than to bend your back, and all of nature generally likes to take the easy route.
We know, however, that bending our backs to pick up things (such as our children), is not good for us and leads us to develop lower back pain. Part of the reason that bending your back is bad for you, is because when you bend your back, you lose the curve in your lower back. You’ll notice that this is a recurring theme in all my posts if you’ve been following them.
The reason why I keep harping on about your spinal curve is that it is very important. Your spinal curve helps reduce the loading on your spine and thus the compressive and shearing forces on your spinal discs and joints. When all these forces become too high, you get mechanical failure that leads to lower back pain. 80% of the world’s population will suffer from lower back pain at some point, so this tells you how important it is to sit up and take note, and the note you need to make is: keep your spinal curve intact when you move and sit, and lift things, and especially when you pick up your children from the floor.
Ok, ok, so we finally agree that it’s not worth your while to take the easy way and quickly bend your back to to lift your children up from the floor. Nobody enjoys lower back pain. But, if you are observant, you’ll find that bending your knees alone won’t help you maintain your spinal curve either.
Let’s try a little experiment: Place your hand in the small of your back and keeping your legs together, bend your knees.
So, if you actually took the time to try this, you’ll find that bending your knees with your legs together really is not very helpful and creates a lot of work while still putting your back at risk of developing lower back pain.
The solution? Open your legs. Wide. Much wider than you generally think you need to or even want to. And then jagger your legs so that one leg is more forwards than the other. Then, bend your knees. Can you feel how much easier it is on your legs and your lower back? And did you notice how much easier it was to reach the floor, while maintaining your lumbar curve? And did you also notice how much stronger you are in this position compared to all the others we’ve discussed above?
The interesting thing is, if you have lower back pain, you know that your back will only let you lift your child as in the photo above and not with you bending your back. Maybe we should all take a bit more time to think about our bodies and move to keep ourselves safe, healthy and pain free.
Do you feel you and your friends/family/carers need more help in correcting your postures when moving your children? Why not create a group booking for my back pain prevention class for parents and carers?
Anterior knee pain is a common injury for cyclists (read my post on cycling and knee pain). This injury is also present in the general population, typically amongst growing children and teenagers. Overall it affects 25% of the population at some point in their life.
Anterior knee pain occurs when the quadriceps muscles are unable to support the mechanical requirements placed upon them through activities in daily life (such as climbing up or down stairs) or sport and recreational activities (such as cycling or mountain climbing).
Mechanical failure of the quadriceps muscles results in compression of the underside of the knee cap (the cartilage) onto the thigh bone (femur) below. This results in pain and inflammation in this area and makes loading of the knee and knee cap as well as bending of the knee, painful. The result is a reduced ability to participate in previous activities, especially sport.
In cyclists, anterior knee pain is commonly created as a result of too rapid or too many increases to a training schedule, but, importantly, research also shows that anterior knee pain can also be due to your bike’s saddle height being set incorrectly.
From the research, it appears that the height of your bike’s saddle has an influence on the amount of compression that is placed through the knee cap, thus influencing the development of anterior knee pain or not. The lower the height of your saddle, the higher the compressive forces on your knee cap and the greater your risk of developing anterior knee pain.
Apparently there are a number of recommended ways to set your saddle height correctly, but not all are supported by scientific research. According to a research review published in 2011, the researchers determined that using the knee flexion angle method was the preferential method to determine the correct saddle height for your bike and that when using this method, your knee angle should be set at 25-30 degrees. Another benefit of this saddle height position is that it optimizes your oxygen consumption when cycling at a steady pace.
Now, how do you go about setting your bicycle saddle height according to the knee flexion angle method with the knee angles set between 25-30 degrees?
People who suffer from lower back pain often find it aggravated by driving, or some people who drive a lot find themselves experiencing lower back pain.
Either way, there are a few things to be aware of regarding your posture in the car that will help both scenarios reduce their lower back pain and improve their driving experience.
Your lumbar curve is there to help reduce the loading on your spine. When you slouch, you increase the pressure on your spinal discs and increase your risk of developing a spinal disc problem that may result in lower back pain. The backrest of your chair is specially shaped to help maintain your curve. To gain the benefit of your backrest, ensure that your buttocks are positioned right back against the backrest and that you are leaning backwards into it.
2. In order to sit properly while you drive and maintain your lumbar curve, you need to position your legs at the correct distance from the pedals to prevent tight hamstrings on stretch from flattening your lumbar curve (read my post on tight hamstrings and lower back pain).
Your hamstrings attach to the bottom of your pelvis and go on stretch when you straighten your knee. If you have tight hamstrings, when you straighten your knees to reach/press down on your car pedals, the stretch in your hamstrings will result in your pelvis being rotated backwards and your lumbar curve flattening, increasing the pressure on your spinal discs and increasing your risk of developing lower back pain.
In order to determine the correct distance of your car seat to the pedals, place one hand in your lower back and feel the curve of your lower spine, then move your seat forwards and back until you can comfortably reach the pedals while still maintaining your lower/lumbar spinal curve.
3. Incline your car seat’s backrest to -8 degrees to reduce the loading on your lumbar spine and reduce spinal fatigue.
There is more loading on your spine when your backrest is upright than when it is reclined backwards. You instinctively know this, and when you are tired from sitting upright for too long, you will intuitively move your buttocks forwards on the chair seat and lean backwards to take the strain off your spine. Thus, positioning your car seat too upright will cause fatigue of your back and increase your risk of developing lower back pain if you are driving for long periods of time.
4. Elevate/lower your chair so that your hips are 90 degrees or less. If your hip angle is too sharp, this will also increase your risk of slouching in your chair, which in turn will lead to increase pressure on your spinal discs and increase your risk of developing lower back pain. If your seat does not allow you to sit high enough, help yourself by sitting on a small cushion.
5. Move the steering wheel up/down/forwards and back until you find a comfortable distance from yourself to the steering wheel. Your elbows should be slightly bent. This will prevent your shoulders from fatiguing, which when it occurs, will also increase your spinal loading and spinal fatigue when driving and increase your risk of developing lower back pain or aggravating your current pain.
6. Stretch your hamstrings (read my post on how to stretch your hamstrings if you have lower back pain) if they are tight to help yourself maintain good spinal posture when you drive.
Neck and lower back pain are such common complaints that we all know someone (if it’s not ourselves) who has experienced at least one of these complaints. There are many causes for neck or lower back pain. These can include different types of injuries, disease processes, genetic predispositions, and most importantly and commonly of all, our posture. Our posture at work and our posture at home and at play.
Our work posture is getting more and more attention, especially since the advances in technology have relegated most of us to work behind a computer for long hours each day. There are a host of things to consider in our work environment that can negatively affect our posture and cause our neck or lower back pain.
Part of my job is going around performing office ergonomics for people. One of the most common things I hear is people blaming their chair for their neck or lower back pain. Most often, however, this is not correct and the real culprit is the monitor and where it has been positioned on the desk. Luckily, this is a much cheaper and easier solution to the problem.
Your poor monitor position (read my post on 4 poor monitor positions that cause neck pain) is definitely one of the first places to look if you suffer from neck or lower back pain and you think your work posture is to blame. There are a number of factors to consider in relation to your monitor position, but one very important and neglected element is the correct monitor distance that your monitor is positioned away from you while you work.
If your monitor is positioned too far away from you, you will find yourself leaning forwards in order to see your screen better, creating all sorts of problems in your spine (especially in your neck and lower back) and over activating your shoulder muscles, all leading you down the path of aches and pains.
So what is the correct distance that you should place your monitor?
Generally, your monitor should be positioned a lot closer to yourself than you think it should. And if you don’t believe me, ask yourself why you keep leaning forwards when you work.
How do you determine the correct distance that you should position your monitor at? I call it the “Frankenstein” test.
Closer than you think? Give it a try and remember to keep leaning back against your chair’s backrest. Your backrest is there to help keep you in good posture while you work. A combination of those two factors (leaning back in your chair and having your monitor at the correct distance away from you) will go a long way to reduce your neck or lower back pain associated with poor working posture.
Which one are you? The painstaking 2 finger typer or the smug finger flying touch typer?
Who would’ve thought that typing at school would come in so handy? Or are you kicking yourself because as it turns out you never had the foresight to take typing as a subject when you had the chance?
Does it really matter if you can touch type or not? What are the implications for your health in the workplace? How does something so seemingly insignificant make such a difference?
I’ve written a number of posts on computer posture (click here to read about how your monitor position can cause neck pain) and neck pain (Click here to read about correcting a monitor positioned too far or too low on your desk causing neck pain). One thing I haven’t discussed is how touch typing (or not) can influence your neck pain.
As I mentioned previously, 30-50 % of people will suffer from neck pain and office workers are at a greater risk than others for developing neck pain. One of the reasons that neck pain is so common in the office environment is that people bend their neck too much in an office job. Research has shown that individuals who bend their neck for 70% or more during the day dramatically increase their risk of developing neck pain compared to their colleagues who don’t.
What are some of the reasons that cause people to bend their neck for too in an office environment?
When I go around to companies and perform office ergonomics, helping people to sit correctly at their computer workstations, sometimes correcting someone’s computer ergonomics is not enough to resolve the problem. If an employee constantly still develops neck pain despite having their computer workstation setup correctly (click here to view software to help you correct your computer ergonomics) , and neck injuries such as whiplash, or arthritis, or any systemic diseases which may cause neck pain are not clouding the picture, the reason why they may still be developing neck pain is possibly due to the fact that they are 2 finger typers, constantly looking down at their keyboard.
What is the solution when an inability to touch type is the problem? Simple, but it does require some effort. Learn how to type properly. There are a number of FREE online typing courses:
I’m sure there are more, just google it if you don’t like any of the one’s I’ve mentioned above. If you do use any of the above, I would appreciate feedback to help with the recommendation to others. Please post comments to this article.
Learning how to touch type will help you to keep working in a healthy body posture, reducing your need to bend your neck so often through the day and therefore reduce your risk of developing neck pain. Another bonus to learning to touch type is that the increased fluidity and speed of your new found typing skills will also help you to work faster which may also help reduce some of the deadline stress associated with your job. Stress in and of itself can also be a factor in your neck pain (read my post about stress and neck pain). A double bonus. Good luck and please let me know how it goes.
Ariens G.A.M., B. P. (2001). Are neck flexionk, neck rotation, and sitting at work a risk for neck pain? Results of a prospective cohort study. Occupational and Environmental Medicine, 200-207.
Cagnie B., D. L. (2007, May). Individual and work related risk factors for neck pain among office workers: a cross sectional study. European Spine, 16(5), 679-686.
Guzman J., H. E.-J. (2008). A new conceptual model of neck pain linking onset, course and care: The bone and joint decade 2000-2010 task force on neck pain and its associated disorders. Spine, 33(4S), S14-S23.
Guzman J., H. S.-J. (2009, February). Clinical practice implications of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. Journal of Manipulative and Physiological Therapeutics, 32(2S), S227-S243.