This episode is entitled “Why does my lower back hurt when I sit down?” and the topics covered are:

  • Duration
  • Position
  • Association

There is heavy reference to The Pain Equation. You can find out all about The Pain Equation here: https://backpainandsciatica.com/5-why-does-my-lower-back-hurt-so-much-part-1-being-stung-by-a-wasp/

Pain = Nociception – Movement Without Pain + (Negative Outlook – Positive Outlook) + Attention To Body Part + Previous Volume of Pain

Gavin rounds off with 3 Golden Rules.

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The year was 1988 and a young man hurt his back, doing an awkward lift in a gym. He didn’t think much about it before, because he’d had pain before. But as you know, initially over a few days, the pain gradually settled down, but, but then it flared up again. And increasingly as the weeks and months rolled by, he had more and more lower back pain. When he sat, sitting became a nightmare. This was me in 1988. I was 19 years old. I was an osteopathic student. So it was a learning how to help people who had pain. And yet here was I sometimes debilitated by pain, frequently triggered by sitting, sitting in lectures and became a nightmare.

I used to sit at the back for about five minutes, which is about as long as I could tolerate before I’d have to stand up and sort of pry all around at the back of the lecture hall. Obviously I had four warned all my tutors and lecturers that this would happen. They were very understanding, but you know what? I approached a number of osteopathic tutors, experienced osteopaths, some of whom were willing to try and help me, but none of whom provided me with a lasting solution to mine or back pain, which also started to develop into sciatica. And that was my, my professional beginnings. I was puzzled, frustrated, uh, both with my own problem, but also the lack of any real clarity that the profession provided. Why was sitting such a big problem? Now, I now understand exactly why, or at least I think I do as best as I can.

This is based on years of experience and, um, some serious studying of the mechanisms of pain and biomechanics. So why does my lower back hurt? When I sit down, I would refer you back to the first few episodes of this podcast, episodes one to six, which are our foundational episodes, but in particular episodes, five and six, I elaborate the equation for pain or the pain equation as I often call it. And we’re just going to dive into this briefly because this framework, the pain equation is a really, I think a and by all means, question me, challenge me if you think I’m wrong. But I think it’s a useful framework through which to analyze why you have the amount of pain that you have at any given moment in time. So why does my lower back hurt? When I sit, let’s look at the equation pain PE, so he made it P new experiences P equals and we’ll come back to this end, meaning new susception minus movement without pain plus negative outlook, minus positive outlook, plus attention to body part plus previous volume of pain.

Now that may all sound gobbledygook to you at the moment, but please go back to episodes five and six, or I dive into this in detail, but I’m just going to use that framework just to break down why your lower back hurts when you sit down. So P P that’s what we’re trying to establish. Why do you have the amount of pain that you have at any given moment in time now, an nociception, if you’ve not listened to my stuff before you may have missed the fact that there are no such things as pain nerves, when you refer to pain nerves, really the nerves are out there in your body are actually called nociceptors. They detect noxious events, noxious inputs, inflammation, trauma, high, or very low temperature. These sorts of things cause your nociceptors to fire. Now, in your case sitting, what is it about sitting that could cause your nociceptors to fire?

Well, it will come down to two things position and two duration. Those two factors will determine whether you’re a nociceptors fire and of course other elements, but I’m telling him at the biomechanics, but okay. It would be fair to say, if you have inflammation in the area of the nociceptors they’re are more likely to fire as well. So if you have inflammation in your lower back, your nociceptors may very well fire, but why, when you sit so for this, we’ll go back to the old game of take your forefinger and push it back with the Palm of the other hand. So let’s take the Palm of one hand push back on your forefinger to the point where you have a little bit of discomfort. So push it right back now that’s positional. So if I hold my finger in that position, my nociceptors may very well be firing.

Yeah. Nociceptors are there to say stop doing that. So there’s a positional element. So if you’re sitting in a position that puts your back under him, a degree of mechanical strain, as you’re doing with your finger there, your nociceptors are likely to fire and they will fire before you actually cause any damage. Now, the second one is duration. So if you hold that finger in a position of that extreme position, the longer you hold it for the more loose, no susceptive or likely to fire, but you could back off a little bit. So you could take the strain off a little bit, but still hold it there for a prolonged period of time. And again, eventually the noose receptors will start to fire because they’re telling you that your tissues are fatiguing. And if you keep doing that, buddy, you are going to strain something.

You’re going to do yourself some damage. So the nociceptors are there to say stop. Okay? So they’re in your body. Nociceptors as the first variable in how much pain you’re likely to experience. So why does my lower back hurt when I sit down, either poos, you’re staying in that position for a prolonged period of time, or you’re in a position that essentially is causing your nociceptors to fire. Okay. All right. I don’t know if that’s over simplifying things or over complicated things for you, but for me, duration and position are crucial. So secondly, movement without pain is one of the factors. Um, one of the variables in the pain equation. So this relates to duration. Again, the longer you sit still means that you are not moving and moving without pain is one of the ways of reducing your pain. So if you don’t want to hurt when you sit down, try not to sit still.

So I have a fever exercise called the seated wobble. So as you’re sitting in your chair, just wobble from cheek to cheek and your back will thank you for it. It likes movement. And particularly as in this variable movement without pain. So, so far we’ve got P equals and nociception minus movement without pain. Next, we have negative outlook. So if you are stressed, if you associate sitting with AF I’d rather not be sitting, then you’re likely to experience more pain. And I’m not going to go into this in great depth, but take it from me. Your emotional centers are closely intertwined with your pain pathways. So negative eight. Look, if you’re stressed that all increase your pain minus positive outlook. So if you’re feeling good and positive things, if you’re really engaged in something you enjoy doing, you have positive outlook, then you’re likely to have less pain.

Okay. So P equals and minus MWP plus or minus PO plus attention to body parts. So the more think about your back being sore, the more sore it’s going to be. And that can be a vicious cycle because it’s kind of difficult not to think about something when it’s sore, isn’t it. So the more attention you Peter that sore bit, the more sore it’s likely to be. And I certainly did this when I was an osteopathic student, I used to really sort of ruminate is the word ruminate over how sore my back was when I was sitting, I would sit there thinking about all the things that could possibly be wrong with it, and that definitely aggravates your pain. And then finally, the last variable we have is previous volume of pain. So that refers to both the amount of pain you’ve had in the past a cumulative cumulative amount, but also the severity of the pain.

So the more severe European has been in the past. And then this context when sitting and the more total, uh, amount of pain you’ve had, the worse your pain will tend to be. And this was definitely a vicious cycle for me. So the more often I sat and experienced pain, the more I was essentially wiring my nervous system for pain when sitting. So the more you do an activity that results in pain, the more your brain associates, the two and here. So I’m just going to leave advice for the last stage of this podcast episode. But basically I want you to know that I still, to this day, associate sitting with pain 30 years plus later, the most common trigger for me for lower back pain. And I very, very, really get it now. But the most common trigger is sitting because my brain was so exp uh, exposed to so much pain on so many occasions when sitting that fundamentally I became to associate, I came to associate sitting with lower back pain.

So even though nowadays sitting for half an hour, it’s very unlikely that my nociceptors are firing at that point, especially the way I sit. I sit in of what we call an active seated style. So I sit nice and tall. I do a little bit of wobbling while I sit and so on, but I can still get mild, low backache if I sit for a long time. And I think this is less to do with the nociceptors so less to do what’s happening out there in my body and much more to do with what’s happened in the past. And this previous volume of pain, there is a free, uh, seeing a freeing, uh, seeing in neurology that nerves, that fire together wire together. So the more frequently those nerve pathways fire, the more they become hardwired into your central nervous system. So in summary P the amount of pain that you experience is equal to no susception minus movement without pain, plus negative outlook, minus positive outlook, plus attention to body part minus rather plus previous volume of patients no less make it simpler still.

What is that pain trying to tell you? So remember the biological purpose of pain is an alarm system. So if you do something and it hurts, guess what? Yeah. If you were looking for advice from your body, I think the advice it’s offering you is don’t do that or don’t do it in the way that you have been doing it. Yeah. Because otherwise you’ll end up like me with an overly sensitive, um, pin processing system. Yeah. So the more you expose your body and your nervous system to painful stimuli, um, whether that’s due to nociception out there in our body or central processing, what’s happening in your, in your, in your brain, the more pain you experience, the more likely you are to experience pain in the future. Yeah. So you’ve become, you’ve come to associate that activity with pain. Okay. So advice, I have three, the pillars here, or three golden rules.

The first one is that your best posture is your next posture. This idea that there is a perfect way of sitting is fatally flawed because when people think there’s a perfect way of sitting, they tend to try and sit in that way repeatedly and for long periods, because, you know, that’s what people do. They sit for long periods. So they put this concept of, and it’s very commonly in this one promoted, particularly by health and safety people. This idea of sitting at 90 degree angles. And I have comments on that, not for this episode, but I’ve certainly commented on how you might choose to sit. But if you’re focused on sitting at writing goals all of the time, then the problem is that is a prolonged posture. So we’re back to duration. Remember the longer you sit, the more likely those no sectors are to fire, especially the longer you sit in one position.

So rather than thinking, there is an ideal posture, stick to that golden rule that your best posture is your next posture. Variety is the spice of life, okay. Say him a second ago or use it or lose it, but don’t abuse. It don’t abuse. It means don’t do things that hurt. Don’t do things that cause you more pain. But on the other hand, if you don’t use it, you will lose it. And this ties in a whole number of these, um, um, variables in the penis region, but especially the movement without pain. So use it or lose it, but don’t abuse it. So a move without pain. The third, excuse me, the third golden rule would be start low and build slow. So if you are having problems with sitting, don’t, um, don’t eliminate it entirely. Now. You may need to for a very short period, but you want to get back to sitting in some sort of seated posture without pain at a low level.

So low duration. I don’t mean physically law. In fact, for most people sitting low down is a bad idea, but certainly start low and build slow. So do a little bit of setting. Maybe it’s a minute, maybe it’s two minutes sit for as long as you can, where they it’s increasing your pain. And then slowly build up the duration of your sitting. This is one area I went completely wrong in. When I was an osteopathic student, I used to sit for as long as I could tolerate, which believe me got less and less and less time. I was dying to maybe sitting for 3, 4, 5 minutes at a time before I suddenly had to get up because the pain level was kind of, you know, eight and nine out of 10 at times. So don’t sit for as long as you can bear it, start low and build slow.

And that way you will be able to gradually rehabilitate back to being able to sit for more prolonged periods. Don’t end up like me with a kind of overly sensitized back. That really doesn’t thank you for sitting. Okay. Uh, there, we have it. Why does my lower back hurts? When I sit there and go back to the pain equation, episodes five and six of the podcast. It has a lot to do with duration and position and ultimately association. The longer you have pain for, it becomes kind of associated in your nervous system. The sitting with the pain and, and advice pieces, our best posture as your next posture, use it or lose it, but don’t abuse it and start low and build slow. And by the way, if you’d like a free assessment of your lower back pain or center, it’s good to go to back pain and sciatica.com, do the free assessment there. It will also, um, what we call triage. You sort of work out whether you ought to be seeing a clinician or not, but it will then give you what we call a functional assessment that you can then take and help to rebuild your back and build it back to being the back that you want so that you can ultimately be active for life.

If you’d like a free online assessment of lower back pain / sciatica, click the link.