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.
Lower back pain is a very common ailment affecting a large portion of the population at any given time. It’s also generally accepted that we are suffering from an obesity epidemic in South Africa and in many other countries across the world.
I have had many patients who have come for treatment report that their doctor has blamed their lower back pain on their weight. Being overweight is often a touchy subject for people carrying the extra pounds, so I’ve never been very comfortable making those types of associations or discussing weight issues with these patients. Moreover, I’ve also had so many skinny patients with severe cases of lower back pain that I preferred to focus on the structural causes of the presenting lower back pain in these individuals rather than any weight issues.
However, is this the correct approach? Does one’s weight impact on one’s experience of lower back pain and should it really be swept aside like I tend to do out of deference to people’s feelings? I thought it might be useful to look at the research to see what studies have found, but first of all, we need to define the parameters of our discussion.
What does it mean to be overweight, and what does it mean to be obese? According to the Obesity Organisation, a body mass index (BMI) of 24.5-29.9 will place you in the overweight category, a BMI of 30-39 will mean that you are obese, and a BMI of 40+ will mean that you are morbidly obese.
How do you go about calculating your BMI?
To calculate your BMI, divide your body weight (in kilograms) by your height squared (in centimeters).
Bear in mind, however, that if you’re very muscular, pregnant or breast feeding, your BMI will not be a proper indication of your health.
Use this BMI Calculator to easily workout your BMI.
Right, now that you know your BMI and in which bracket you fall, let us return to my original question: Does being overweight or obese have an influence on your lower back pain?
Some researchers did a literature review of all studies performed in relation to body weight and lower back pain up to 2009 (click here to access the article) and found that there was an association between carrying extra weight and a higher incidence of lower back pain. They also found that obese people (BMI of 30+) had more lower back pain than overweight people (BMI of 25-29). This shows an increasing correlation between your weight and your experience of lower back pain. In other words, the more weight that you carry, the greater your risk of experiencing lower back pain.
A more recent study published in 2015 (click here to access this article) also probed the associations between body weight and the experience of lower back pain. Unfortunately this study only focused on men, however, they did look at the associations of weight gain and lower back pain over time (decades). They found that an increasing BMI of overweight and obesity was linked an increased risk of experiencing radiating lower back pain (in other words lower back pain that has pain going into one or more legs). What was interesting though, was that they found that generalised lower back pain (known in the medical community as non-specific lower back pain) was not linked to weight gain at all.
This implies that not all lower back pain is affected by your weight, which from experience as a clinician, I know to be true.
So, after all of that, what is the ‘take home’? Basically, if you are carrying extra weight and are either overweight or obese, you are more likely to experience lower back pain. However, (and logically), not all lower back pain is influenced by weight gain.
What types of lower back pain are influenced by being overweight? I will explore this in a future post.
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?
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.
So, you’ve discovered that your monitor (laptop, tablet or desktop computer screen) is positioned too low on your desk (read my post about 4 monitor positions that cause neck pain) causing you to bend your neck for too long, straining your neck. How can you go about correcting this and ease up the strain on your neck causing your neck pain?
Well, firstly, the changes to your monitor are entirely dependent on the type of technical device that you use. There are, however, certain principles that apply to all types of devices with a monitor that you might use that you need to be aware of in order to adjust your monitor correctly and reduce your neck pain.
3. You will need some assistive device (see what assistive devices we have in stock) to help raise your monitor to the correct height. Some desktop monitors have a built-in system that allows you to move the monitor up or down as desired, but most do not.
Let’s consider each scenario separately:
If You Use a Desktop Monitor
If you are using a normal, old fashioned desktop monitor, this will be one of the easier scenarios to raise your screen to the correct height. Just use books (it’s cheaper), a monitor raise or an adjustable monitor arm (check our our monitor raise and adjustable monitor arm in our shop).
If You Use a Laptop
People who use laptops sit in terrible postures unless they use a laptop raise (check out our laptop raise) or books to elevate the laptop monitor to eye level and use a second keyboard and mouse. Please ensure that you purchase a proper laptop raise that elevates the monitor sufficiently and doesn’t do a half job and leave you bending forwards over your machine.
You absolutely cannot use the monitor and keyboard on your laptop at the same time unless you’re lying backwards on your couch or bed.
If You Use a Tablet
Tablets are an even greater ergonomic risk than laptops. Their screens are small and their keyboards laughable. If you’re crazy enough to use it like a working computer, you will have to get a tablet stand (and more than likely need to raise even that up on books to get it to the right height) as well as a second keyboard and mouse (check out our tablet stand).
This tablet raise/stand allows you to use your tablet like a computer, however, it will still need to be raised further on books etc to get the screen to eye level. In addition, you will also need a keyboard and mouse to allow for proper ergonomics and to avoid unnecessary back and neck pain.
Are you an office worker suffering with neck pain? If so, you’re not alone. Office workers are one of the population groups most at risk of developing neck pain, with an incidence of around 55% in some countries.
If you are an unfortunate office worker suffering from neck pain, is there something that you can do yourself to reduce or prevent your neck pain rather than popping pills or going to see your OMT trained Physiotherapist?
The answer is, yes, of course there is!
The first and simplest things that you need to consider is where your monitor is positioned in relation to yourself on your desk (check our our desktop software designed to help you correct your computer ergonomics). A poor monitor position is one of the most common reasons why office workers suffer from neck pain associated with poor posture. It’s happily also one of the easiest things for to change to help improve poor posture that could be causing your neck pain.
Consider the following 4 monitor position scenarios. Do you see yourself in any of them? All of these poor monitor positions are high risk postures for creating neck pain.
2. In this second scenario, your screen is positioned too high for you, causing you to raise your chin and compress the joints in the back of your neck causing you both neck pain and headaches. This monitor position will cause neck pain faster than any of the others and is one of the worst postures possible for a computer worker. This posture is common in people who are aware that a computer monitor often needs to be elevated, but are unaware of their own posture and what the correct position for one’s head and neck needs to be to prevent or reduce neck pain. Correct your position asap (You can use our desktop software to help you correct your computer ergonomics).
3. Here, your screen is positioned too far away from you, causing you to lean forwards away from your backrest and poke your chin out. This posture will cause both headaches and neck pain. Read this post on correcting a monitor positioned too far away to help you correct this problem and reduce your neck pain.
4. In this last scenario, you are working a lot from notes/papers/files and don’t use a document holder. This means that you are looking down too often during the day and this constant bending of your neck puts you at a very high risk of developing neck pain (check out our ergonomic software).
Alternatively, you’re working a lot from notes and have positioned them on your desk between your keyboard and monitor causing you to push your monitor too far away and take a poking chin posture.
Both of these postures will create neck pain and possibly headaches.
I will write about how to correct these postures and position your monitor correctly in the near future, make sure you come back to find out how you can help yourself reduce your neck pain.
One of the worst things about lower back pain is that it stops you doing a lot of your normal activities, sports or exercises. From experience, I’ve watched lower back pain reduce some very active people into couch potatoes due to their lower back pain preventing them from following their normal sporting routines. These individuals often struggle to find other ways to keep fit until their lower back pain settles.
A definite exercise no-no for lower back pain is sit ups (read my post on sit ups and lower back pain), or some form of them. Since core exercises are an integral part of any training program, many people must ask how they can exercise their abdominal muscles while they’re suffering from lower back pain and until their lower back pain settles?
Enter: The Plank.
The plank is one of my favourite exercises. It’s easy to perform at home and it will give you a good overall work out. The plank is a lot harder than it looks.
In addition to working your abs, the plank is also a very good exercise for protecting your shoulders against rotator cuff injuries. It accomplishes this by working your shoulder stabilisers while simultaneously working your abs. The plank has another added benefit of strengthening your spinal extensor muscles at the same time as well. It’s an excellent overall core strengthening exercise and should routinely be a part of any training programme.
When Performing the plank, there are a few things to keep in mind:
McGill S. (2010). Core Training: Evidence Translating to Better Performance and Injury Prevention. Strength and Conditioning Journal, 32 (3), 33-46.