When sitting with a kyphotic or rounded back posture LBP patients have demonstrated higher levels of pain and poorer sitting tolerances, than LBP patients who sit in a posture that maintains the lordotic curve (inward curve) in the lower back (Williams M., Hawley J., McKenzie R., Van Wijmen P.,1991). It has also been determined that the fluid like nuclear substance in the intervertebral disc migrates backwards or posteriorly during the rounded back or kyphotic posture, and the reverse occurs while sitting in the lordotic posture. It is likely that those who do not have LBP may be less likely to develop the symptoms if they maintain the lordotic sitting posture as well.
In 2000 Hoogendorn and colleagues demonstrated that greater exposure to flexed positions and rotated positions during work tasks place workers at moderate risk of developing back pain. It is safe to say that decreasing the frequency of flexion and rotation of the low back by modification of our lifting and work habits may prevent LBP from developing.
One of the few guidelines on prevention of back pain was done by a group of experts in Europe in 2004 (www.backpaineurope.org). The main recommendations for prevention of LBP were the use of regular physical exercise and education about back problems. The European guidelines also mentioned several interventions that are not recommended for the prevention of back problems, they are as follows:
- Back Belts/Braces
- Specific brands of Chairs and Mattresses
- Shoe Insoles
- Maintenance Manipulative Treatment (Adjustments)
The first study was a randomized controlled trial of 249 military conscripts who were randomized to a group who performed daily press up exercises following a 40 minute lesson on back problems. The control group went through their military service as usual. The press up group reported less back pain during their military service, and had fewer physician visits for back related problems during their military service (Larsen K., 2002).
The second study was a randomized clinical trial of 39 patients who sought medical attention for the first time ever episode of back pain. The control group was advised about LBP, encouraged to remain as active as possible, and was prescribed medication to cope with the pain. The study group received the same advice and medication but were referred to Physical Therapy (PT) 2 times weekly for 4 weeks and received a strengthening program that targeted the stabilizing muscles of the back in particular the multifidus and transverse abdominus muscle groups. The patients were encouraged to continue the exercise program upon discharge from PT. The exercise group had significantly fewer recurrent episodes of LBP compared to the control group at the one year follow up (30% compared to 84%)(Hides J., Jull G., Richardson C.,2001).
LBP is a common part of life that can be recurrent, progressive and cause disability. The condition may be prevented with some simple lifestyle and habit changes such as:
- Regular exercise to include daily press up exercises, and core stabilization exercises 2-3 times/week.
- Decreasing the frequency of activities that flex the spine by sitting correctly and lifting properly.
- Williams M., Hawley J., McKenzie R., Van Wijmen P.(1991) A comparison of two sitting postures on back and referred pain. Spine, 16:10, 1185-1191.
- Hoogendorn WE, B. P. (2000). Flexion and rotation of the trunk and lifting at work are risk factors for low back pain. Results of a prospective cohort study. Spine , 25, 3087-3092.
- General Research Committee (2004). European guidelines for prevention in low back pain. Retrieved April 24, 2009, from http://www.backpaineurope.org
- Larsen K., W. F.-Y. (2002). Can passive prone extensions of the back prevent back problems? A randomized controlled intervention trial of 314 military conscripts. Spine , 27,2747-2752.
- Hides J., J. G. (2001). Long term effect of specific stabilization exercises for first episode low back pain. Spine , 11, 43-48.
- McKenzie R., M. S. (2003). The lumbar spine mechanical diagnosis & therapy volume one. Waikanae, New Zealand: Spinal Publications New Zealand Ltd.
- President's Council on Fitness, Sports & Nutrition. (n.d.). Physical Activity Guidelines For Americans. Retrieved January 31, 2015, from http://www.fitness.gov/be-active/physical-activity-guidelines-for-americans/