Low Back Pain (LBP) is a common problem and frequent cause of disability. As healthcare providers we should be taking measures to prevent the development of chronic LBP. In order to prevent chronic LBP we need to better understand what causes LBP to develop. The majority of individuals we encounter in the clinic are unable to identify a specific incident that caused their symptoms. This leads myself and many other like minded healthcare providers to believe that our life styles and habits play a major role in the development of these disorders. The 2 most common predisposing factors in our lifestyles that are believed to most often provoke an episode of LBP are the frequency of flexion (bending) in our work and play habits, and poor habitual sitting posture. A recent study on the triggers of back pain episodes identified working in awkward postures, being fatigued, and distracted as placing individuals at greater risk of developing LBP. The same study reports that the risk of developing LBP is greater between 7 am and 12 pm. Many healthcare providers believe the reason for increased risk of LBP in the morning hours has to do with the tendency for the lumbar disc to imbide fluid overnight making it more prone to bulging with excessive bending or sitting slouched early in the day.
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:
The guidelines do not recommend any specific exercise for the prevention of back pain. Two well-designed studies shed a glimmer of light on what specific exercise may prevent LBP.
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:
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Thanks for visiting my blog page. My name is Don Stover. I am a seasoned physical therapist in Oklahoma City OK. with over 20 years in the biz. I have a lot of knowledge and training in orthopedic PT and spine care. I will be sharing my thoughts on physical therapy for orthopedic problems such as spinal pain, extremity joint pain, sports injuries, health/fitness, and life in general. I hope you enjoy reading!
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