How to prevent lower back pain / sciatica? Part 2
This episode is entitled “How to prevent lower back pain / sciatica? Part 2 ” and is episode four in a series of six pillar episodes. If you have not listened to episodes one to three, please do yourself a favor and go back and start at the beginning. In the last episode, I focused on the How, that was all about big goals and small steps, but in this episode we’re focusing on the What, so exactly what steps should we be taking in order to get right back from the edge.
I have an acronym for you. I love a good acronym and so the acronym is get back from the messy edge. Now I’ve got a little bit of artistic license with my use of letters here, but here it goes: MESSY. The M stands for moving. Then we have eating, sleeping, and here’s the messy bit, psycho-socializing. Now I know that psycho starts with a P, but for the purposes of our acronym, and it’s going to start with an S because the P is silent after all. And we’re going to attach in the second letter the Y. So get back from the messy edge!
M is for Moving
What is the relevance of moving? Moving is exceptionally relevant when it comes to lower back pain and sciatica. It is very, very commonly the trigger. The last thing that pushes you off the edge of that cliff is often a movement. People say “All I was doing was bending over to do this or that, lifting the shopping out of the car”, whatever it may be. Movement is not only very often a trigger, but also one of the factors that pushes you towards that edge in the first place.
Think as well in terms of loading. The amount of load that you put through your lower back, not just on a one off effort -which is often the thing that knocks you off the cliff-, but cumulatively. We know that cumulative loads of all you do on a repetitive basis build up over weeks, months, years to push you closer to the edge. One of the most common of these is sitting. You might see sitting isn’t a movement, it’s a posture and you’d be right. I am extending the “M” of moving to all things related to how you use your body. It’s not just about the moving bit, it’s also about static postures. Sitting is something that you do for long periods is sustained and that puts a constant load on your lower back and you do it repeatedly or at least many people do! You’ll sit for long periods and you’ll sit Monday to Friday perhaps, but not just in your office work -if you’re an office worker-, but also, on your sofa, on the bus, on the tram, on the tube, wherever it may be. Sitting is very common.
In fact, in our practice the latest stat is it’s 74% of our lower back pain and sciatica sufferers say they are worse on getting up from sitting than they are when they first sit down. So that tells me that the loading related to sitting is a factor. It might not be sitting for you but standing, bending over a cot or the way you run round the 400 meter track. However, movement is a big factor when it comes to pushing you closer to the edge of the cliff.
One of the things we focus on in the clinic to prevent lower back pain / sciatica, is teaching you how to move well, how to have good movement hygiene, teaching you good postural alignment and so on. There are those in the scientific community who say there’s no evidence that sitting causes lower back pain or that posture is related to lower back pain. I have read the literature and I’m fully aware of those reviews. However, my argument and that of many researchers is that the problem with that kind of review literature is that you are pulling a huge number of very diverse lower back problems and just calling them lower back problems. There has been no attempt to differentiate between one type of back problem and another. I’m not going to dive into the technicalities of the perils of research, but take it from me clinical practitioner for nearly 30 years, lots of people are made worse and their back problem is maintained and predisposed to by the way they move and the postures they adopt.
Second one is Eating. I know, that might be a surprise to you, but an under eating I really meaning anything that you put in your mouth, and that includes cigarettes and no, you don’t eat cigarettes, but you do put them in your mouth! There is lots of evidence that people who smoke suffer more lower back pain. No smoking, no drinking and eating, all can have an impact. Push you closer to the edge. A number of foods are what we call pro-inflammatory increase your risk of inflammation. Of course a number of foods and drinks lead to weight gain and weight gain is a factor for lower back pain. Particularly, if you have a very large belly that puts a sustained load of a particular type on your lower back and makes it very difficult for it to recover.
The third factor that pushes you to the edge is sleeping. Now, I don’t just mean the position that you’re in, but the lack or loss of sleep is a risk factor for pain, including lower back pain. How does that work? Well, there may be an element of not being physically comfortable in bed, not being able to get into positions that ease your back, but when we dive a little bit deeper into the physiology of sleep, we know that getting insufficient sleep increases the alarm in your nervous system and things start to go wrong in your immune system. Lack of sleep can have a huge bearing on your experience of pain.
Psycho-socializing to prevent lower back pain / sciatica
Finally, the S-Y one, the psycho-socializing. I’m going to get technical again here. The strongest predictor of becoming a long term sufferer of lower back pain and sciatica is we call psycho-social factors. It’s all about your beliefs, your moods, your relationships with others. Those are the strongest predictors. So if we took two people who had, if that were possible, identical, mechanically identical, lower back injuries leading to pain, the strongest indicator that would predict which of those is the most likely one to have long-lasting pain as compared to the other one recovering.
If you’re interested in this, I will cover that in how that works in much more detail in the next episode. Anxiety, people who have anxiety and depression, these are psychological elements, tense experience, more pain, not just lower back pain, but headaches, RSI, all sorts of pains. So the psychological and the social. For instance, people who are stressed at work experience more lower back pain than people who aren’t stressed at work. As a social element, people who are very supportive partners tend to recover better and people who have over-solicitors partners. So by that I mean, “Oh dear poor you darling here and go to bed for three days”. Those people don’t recover as well and are more likely to experience long term pain. Interestingly, at the other end of the spectrum, if your partner is someone who says “You’ll be fine” and just ignores you or disregards your pain, again, you tend to experience longer-lasting pain. Oh, the perils of relationships! So what you want is a very understanding partner who acknowledges your pain but encourages you, helps you with your goal setting, helps you to achieve those goals, and so on. So the psycho-socializing element is very important, perhaps the most important in many people.