Lower back pain is one of the most common complaints we hear from clients seeking medical massage therapy, especially here in New York City. Chances are you or someone you know has experienced back pain to the point of needing to see a chiropractor, or back pain specialist, have physical therapy and receive medical treatments for pain relief.
In fact, the National Institute of Health estimates that 80% of people have experienced some sort of low back pain or condition at some point in their lives and that at any given point in time the prevalence rate for low back pain is 50%. Chronic lower or upper back pain is part of life for a lot of New Yorkers because many of us sit long hours at desks, walk and run on hard surfaces consistently and are generally active people. Thankfully, it doesn't have to be if you know how to counter the problem.
Why is back pain so common?
Our lower back, anatomically known as the lumbar spine or lumbar spine region, supports most of our upper body weight and is used in so many of our daily movements, including sitting, standing, walking and running as well as in pretty much any sport or movement. Not only that, but we often rely on the weight-bearing capability of our lower backs when we perform heavy lifting so wear and tear of this region of our bodies is all too frequent.
“I had chronic lower back problems and Mark helped me manage and reduce my pain over the past two years with Active Release Techniques and massage therapy. His expertise in both personal traioning and massage therapy are what make him great at what he does.” - Marc
Want to know which of these conditions apply to you? Get a free health consultation HERE
4 Causes of Back Pain:
Unless there is direct trauma to the lumbar spine from, for example, a car accident, collision during a sporting event or a bad fall, the chances are that there can be many contributing factors to low back pain. A sedentary lifestyle as well as an active one both create wear and tear on joints, ligaments and muscles throughout the entire body, including the low back. It is to a large extent unavoidable.
One of the challenges to getting rid of low back pain for New Yorkers and non-New Yorkers alike is to have a firm understanding of what is uniquely causing your low back pain. Do you have a structural leg-length discrepancy? Does low back pain run in your family? Are you struggling to maintain a healthy weight? Do you sit for countless hours at your desk, on the train and slouching the couch? Do you do squats and deadlights with heavy weight? Are you an avid kick-boxer? Some or all of the above.
There may not be just one cause to your low back pain? Often times there are several. And some factors may be more important for you than others. The key is understanding how your posture, your unique anatomy, your weight, your lifestyle and other factors are affecting the health of your musculoskeletal system and in this case your lumbar spine with all of its intricate joints, crisscrossing muscles and dense connective tissue.
Below are four factors that are often at the heart of low back trouble. But it's important to note that they may exist for different reasons. For example, you may have short and overactive hip flexors because you sit a desk for 8 hours a day or because you do aggressive kickboxing classes 3 days a week which jack up your hip flexor muscles. Perhaps you may have weak abdominal muscles because of a c-section or because you aren't doing the best exercises to support your low back, as you'll see below.
Every person is unique, so while these 4 causes apply to many people, it's not always so easy to understand which ones are most pressing and why as well as what other issues they've led to and thus compounded the problem..
1.) Short and Tight Hip Flexors: When you sit at a desk, in cars and on the couch as much as modern humans do, the muscles in the front of our hip and spine shorten, weaken and create a comprehensive force on your lower back (lumbar spine) and in the hip joint.
This problem is made worse by the fact that so many people reinforce this pattern by doing the wrong abdominal, back and lower body exercises.
For example, if you have low back pain and do lots of crunches, sit-ups and leg lifts thinking this will help, in all likelihood all you are really doing is exercising and thus shortening your hip flexors, most notably the Illiopsoas, which are already short and overworked. The Hip Flexors often times (not always) need to be stretched (a lot), not tightened.
2.) De-activated and weak glutes and hip muscles: The Gluteal muscles (Maximus, Medius and Minimus) and Hip Rotators (There are 6: Piriformis, Obterator Externus and Internus, Quadratus Femoris and the Superior and Inferior Gemelae) are very important muscles that are weak and under-activated in so many people.
Why?
The reason is the amount of time we spend sitting, which shuts these muscles off. In addition, many people do lots of squats, cycling and running without focusing enough on activating and strengthening the smaller (and in the case of the Gluteus Maximus which is the largest in the body) muscles in the back and side of your pelvis and hip. To activate these muscles requires doing very specific and not glamorous or impressive exercises.
Too many of us overlook the importance of these muscles for lack of knowledge and/or in favor of more fun and exciting exercise choices. To avoid knee, hip and back pain, spending some time and effort on targeted exercises for these muscles is essential.
3.) Weak Abdominal Muscles: A lot of people have weak abdominal muscles that fail to stabilize the trunk and move the abdomen in an optimal way, and for so many people it is not for a lack of trying.
The problem is that people fail to do the correct exercises (or they do the correct ones improperly).
First of all, as one of my mentors, Brent from the Brookbush Institute, always says, “there is no such thing as the lower abs”. What he means is that when you do leg lifts on the ground or while hanging from a pull-up bar, you are only working the abdominals partly. What you are really doing is working the hip flexors which can makes things worse.
And second, in doing countless sit-ups on the floor or yoga ball, and crunch after crunch, what you are doing is working only the top (superficial) abdominal muscles. This causes two problems, one being that it fails to target the deepest muscle known as the Transversus Abdominus (TA), one of the most important muscles in the entire body because of its primary role of stabilizing the lumbar spine. Not only that, but doing these crunches and sit-ups actually de-activates the TA which makes it much less effective and harder to activate.
"A client came to me with chronic shin- splints, a painful injury experienced by many runners. By targeting the 3 most common muscles indicated in this condition, the Tibilais Posterior, Flexor Digitorum Longus and Flexor Hallucis Longus, she was running pain-free within 4 sessions." - Mark
4.) “Weekend Warriors” – have you heard this term before? It refers to the people who have the 3 problems above created by sitting all day and either not exercising or exercising incorrectly. Then on the weekends, these same people go play aggressive sports, lift heavy machinery while re-organizing the garage or moving the entertainment stand or go to the gym to do intense strength training.
So in essence they go from a sedentary week at work and on the train to a very active and demanding lifestyle for which their bodies are not properly trained. It’s like trying to run your best 5K race without doing any training or trying to write a 20 page academic paper when you haven’t been in school for 15 years. Your body and mind just aren’t ready. That is a recipe for injury and your lower back is almost always the most common and serious victim.
Some of the most common back pain and spine conditions are:
Bulging/Slipped Disc - intervertebral discs wear down and “bulge,” or protrude, into the small spaces in the spinal column where the nerve roots that exit the spinal cord are located. The pain and discomfort can be confined to the site of the nerve root or it can radiate to other parts of the body, including the hips, legs, buttocks or even the feet.
Herniated Disc - more severe than a bulging disc because the inner fluid material that makes up the disc center ‘spills’ out of the nucleus causing pain, inflammation and further disc degeneration. It can lead to other conditions such as Sciatica which affects the buttocks and legs as well.
Osteoarthritis - degeneration (often from age or injury) of the vertebral disc and/or the facet joints. As the degenerative process continues, the spine is more vulnerable to many types of back injuries.
Spinal Stenosis – narrowing of the spinal canal. The spinal chord travels through the spinal canal and can get impinged causing severe pain and dysfunction.
Spndylolisthesis – when one vertebrae moves forward in relation to the adjacent vertebrae, putting pressure and strain on the discs, facet joints, the surrounding muscles, the spinal nerves and potentially the spinal chord.
Muscle Strains – low back muscle strains can occur on their own or as a secondary response to injury in the spinal column. Addressing the muscles and connective tissue alone can sometimes be enough for significant pain relief.
Scoliosis – a lateral bending and rotational curvature of the spine. It can be functional or structural. Structural cannot be reversed by adulthood. Scoliosis can lead to other issues such as significant muscle imbalances, disc degeneration, facet joint arthritis and chronic pain.
Radiculopathy – compression of the spinal chord and/or nerve roots which cause any one or combination of the following: numbing, tingling, pain and weakness in the limbs. One example is sciatica.
Kyphosis – an excessive forward (flexion) bending of the middle and upper (thoracic) spine. It is the result of a life-time of poor, hunched over posture. It can be corrected and reversed in young adulthood but eventually becomes permanent if not corrected. This can affect the lumbar spine as well.
Lordosis – This occurs in the lumbar (lower back) spine and it is an excessive curve. It can be structural or a functional result of poor posture, repetitive movements and muscle imbalances.
While it is common for some of these spine conditions to co-exist and share some of their painful symptoms, often times the treatments for pain relief and resolution of a particular back pain disorder are very different. So as with any medical conditions and symptoms, it is crucial that you get an accurate diagnosis by a medical back pain specialist such as an orthopedist, osteopath or physiatrist.
How to get Relief from Back Pain:
Physical Therapy, Chiropractic care, Active Release Techniques (ART) and other therapies like acupuncture/dry needling, corrective exercises and rehabilitative personal training, non-impact cardiovascular exercise may be needed to relieve pain and correct the underlying causes. Sometimes further treatments like over-the counter and prescription medications, injections, as well as heat, ice, short-term rest, ceasing certain activities entirely and perhaps psychosomatic/mental health/pain management may become necessary as well.
"Peggy came to me with severe lower back pain, numbing and burning sensations in her legs, indicating a disc herniation and nerve impingement. I was careful in treating her, relying on myofascial release and tractioning. She came to see me a few weeks later and reported that her symptoms had completely resolved less than 24 hours after seeing me." - Mark
Managing and resolving back pain may take several months and may require a combination of treatments from different types of sports injury therapists. Most importantly, if the initial pain is severe and/or lasts more than 3 days, you should be examined by a back pain doctor.
For more on injury therapy, view our full NYC Injury Therapy article.
Surgery should be your very last resort and your spine surgeon should be able to make a very specific and extensive case as to why you should have the surgery, what the legitimate chances for success are and also a clear definition of what “success” actually means in this specific context. Bring someone with you to your surgery consult so you have an extra set of eyes and ears helping you as you consider your options.
Experts estimate that about 600,000 Americans opt for back surgery each year and there are many studies which conclude that surgery vertebrae fusion surgeries in particular have a less than 50% success rate and in some studies as low as 25%.
With that said, if the right surgery is performed at the right time by the right spine surgeon, the results can be life-changing. New York City has some of the best back pain specialists in the country, many of them located at the Hospital for Special Surgery (HSS) but also at other hospitals such as NYU, Lenox and Columbia.
Regardless of what your diagnosis and symptoms are, in pretty much every spine condition, it is vital to stretch and strengthen the appropriate lower body, hip and pelvic muscles to correct the biomechanical patterns contributing to and created by the back pain. Having a thorough assessment by a sports injury therapist of some kind is vital in directing which exercises and which stretches are needed.
Getting this wrong can just make things worse.
Make sure your injury therapist is thorough and is able to explain how and why he or she came to the conclusions and can justify the treatment and/or exercise program moving forward. Going down the wrong course of treatment because of a mis-diagnosis can make you spin your wheels for months (or years) and can make things worse.
Do you have back pain? Take a free phone Health and Injury Consultation with On Your Mark specialists.
