Thanks for checking out our blog and keeping up to date with all things related to low back pain. If you haven’t read through our previous blog posts on the topic please do so here, and here. These blogs really set the scene for what we are discussing today and will help to place this post into context for you.
Now, we’ve all heard people say that we shouldn’t sit in a slumped position or that bending, and lifting is not good for our backs. However, have you ever thought critically about these sweeping statements. What if it was OK to sit in a slumped position? What if it was OK to bend forwards and pick up that box of leaflets? Today, we are going to address these questions and challenge some of the existing beliefs about these tasks.
I’m going to begin by talking about posture, movement and biomechanics when pain free. Sitting in a slumped position isn’t going to damage your back. Neither is bending in the vast majority of cases. In fact, your low back thrives on movement. Any movement. And usually, when people complain of low back pain after sitting it is because they have been sitting for a long period of time. Often, this sitting position is classified as being slumped because most people find that this position is comfortable in the short term. However, when sitting slumped for a longer period of time your back can become sensitised. This isn’t the fault of the slumped sitting; it is the fault of the duration of time. Let’s flip this around and imagine sitting in an upright posture for the same amount of time. Do you think you’d still get sore and achy? I know I would. So rather than blaming the position, we should be thinking more about moving regularly. Any idea why sit-stand desks seem to work well for some people? Simply, because they have the option of sitting or standing- in other words variation throughout the day. But you will rarely see a person standing at their desk all day because guess what? Their legs will get sore and achy!
Now this is all good and well when we are just talking about daily symptoms of achiness and soreness. But what about when we have someone who has injured their back yesterday? In this case, we keep things nice and simple. Find a position that feels comfortable. But don’t expect it to stay comfortable for long because your back will be sensitised far more easily now than it was before your episode of pain. This is a protective mechanism that your body puts in place to facilitate a pain experience. The same thing happens when you roll an ankle, strain a knee, injure your shoulder. Everyday tasks that seem fairly mundane suddenly become very painful to do. And if you stay in one position for too long the initiation of movement can be really difficult. So, the key is to keep moving regularly. Trying to find exercises or movements that alleviate your symptoms can be hard but check out our previous blog here for some ideas.
Bending is also a movement that has been demonised when it comes to low back pain. Again, if we start with pain free people there is no real risk when bending. Yes, there might be a slight increase in pressure through the spine- but your spine is designed to handle this- just like your knees are designed to handle the increased pressure of walking, climbing stairs and running. Bending and lifting is a slightly more controversial topic. We do know that bending and lifting can increase certain forces through the low back. But again, linking these forces to injury rates is notoriously difficult. And from personal experience of working for 10+ years as a physio I haven’t seen that many people injure themselves when bending and lifting. The other factor that should be included here is that many people can’t avoid bending when lifting. And I’m not talking about just Joe Public with tight hamstrings. Studies have shown that healthy individuals who perform lifting activities often drop into lumbar flexion (bending forwards slightly) despite actively trying to keep in a neutral position. So, maybe it is just natural for our back to behave in such a way. Now, time to put an important disclosure in here: I am not saying go to the gym and pick up that 50kg bar any which way you like! But I would say that if you are lifting things regularly at work or at the gym that perhaps a slow, steady progression of weights is more important than keeping your back straight all the time. By increasing the weight slowly, you are giving your back a chance to adapt- muscles, ligaments, discs, joint all have a chance to learn how to cope with the demands of lifting in a slow and steady manner.
Again, if we turn our attention to when we have someone in pain. Bending when in pain can be both good or bad. But quite simply it comes down to what you can tolerate. Some people will find that leaning backwards makes their pain better so that is what they day for the first few days. Others will find bending eases symptoms so… well you get the picture. A lot of people are just sore no matter which way they move, and this is a little more challenging. Being creative with movement often helps. Performing a child’s pose is exposing your back to a bending position but often people will tolerate it much better. A cobra stretch would be the equivalent for leaning backwards and knee rolls for twisting. But to throw bending out of the window just because we’ve heard a horror story from our brother in laws next door neighbour is probably not the right approach.
So, in summary, biomechanics and specifically bending and sitting have had a bad reputation for a long time. Maybe it’s time to start shifting our thought processes around these positions and actually have a little more faith in our backs. Movement is key. Bending and lifting can be achieved but its probably advisable to build some tolerance to this position first before yelling at your PT for changing your technique!
Look out for our final blog post coming out next week where we explore some of the lesser known contributors to low back.