Low Back Problems Can Be a Real Pain in the Butt

After suffering a low back injury a few years back, I realized I needed to make some changes. I had always been very active and strong. I could lift far more than the average person. I played multiple sports as a youth and continued through my young adult life. I worked hard labor jobs from an early age and always heard from the older guys “Take care of that back when lifting. You don’t want to hurt it and be broke down like me.” Well… now I know what they mean. I had to find the answers to the question I had as many of you now do… “How do I fix it?”

Now… Before we can answer this question, we need to get to the cause. Back pain is a broad term as there are many causes, many of which seem to have the same symptoms. I pulled this quick explanation list below off of WebMD. I did this to give you some reference to just how many “low back pain” conditions there are.

The most common causes of low back pain are:

• Injury or overuse of muscles, ligaments, and joints.
• Pressure on nerve roots in the spinal canal. This can be caused by:
• A herniated disc, sometimes brought on by repeated vibration or motion (as during sport activity or when using a machine or lifting in the wrong way) or by a sudden heavy strain or increased pressure to the lower back.
• Osteoarthritis, usually caused by getting older. When osteoarthritis affects the small joints in the spine, it can lead to back pain. Osteoarthritis in other joints, such as the hips, can cause you to limp or to change the way you walk. This can also lead to back pain.
• Spondylolisthesis, a defect that allows one vertebra to slide over another.
• Spinal stenosis, or narrowing of the spinal canal, which is usually caused by getting older.
• Fractures of the vertebrae caused by a lot of force, such as from an auto or bicycle accident, a direct blow to the spine, or compressing the spine by falling onto the buttocks or head.
• Spinal deformities, including curvature problems such as severe scoliosis or kyphosis.
• Compression fractures. These are more common among post-menopausal women with osteoporosis and in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

Less common spinal conditions that can cause low back pain include:

• Ankylosing spondylitis, which is a form of arthritis that most often affects the spine.
• Bacterial infection. Bacteria are usually carried to the spine through the bloodstream. You may have back pain from an infection in the bone, in the spinal discs, or in the spinal cord. An infection may enter the spine from:
• An infection somewhere else in the body.
• Intravenous (IV) drug use.
• Surgery or injection treatments.
• An injury.
• Spinal tumors, which are growths on the bones and ligaments of the spine, on the spinal cord, or on nerve roots.

Don’t use this list to diagnose yourself. Always consult your medical professional when back pain occurs. This is just a reference.

When starting a post rehab program for back pain, understanding the difference in conditions play a significant role. For example, if you have spondylolisthesis, your program would need to keep you from back extension exercises due to the anterior slippage. If you have a herniation, you may need to keep from back flexion exercises if it is a posterior bulge. Not understanding this may cause more harm than good.

Staying in a spinal neutral position is always a good start when beginning a fitness program. What is spinal neutral? It’s the range at which you stay pain free. Pain is your body talking to you so it is best to stay away from extreme ranges. It is also wise to learn what is muscle soreness and what is actual pathological pain. It is easy for many people to confuse the two, and this may become a psychological barrier that could prevent you from reaching your goals. If it is pain, it will feel like a stabbing or radiating sensation down the buttock or leg. Proceed with caution and contact your medical professional if this starts.

(Left) Thepars interarticularis is found in the posterior portion of the vertebra. (Center) Spondylolysis occurs when there is a fracture of the pars portion of the vertebra. (Right) Spondylolisthesis occurs when the vertebra shifts forward due to instability from the pars defect. (Courtesy of John Killian, MD, Birmingham, AL)

Here are do’s and don’ts to help manage back pain

Do’s

1. Drink plenty of water. It helps connective tissues to stay hydrated and reduce stiffness.
2. Frequent massage helps relax stiff muscles.
3. Proper strength and conditioning 3-4 days a week will help build stability in the core and gives you core endurance to manage your back pain.
4. Get plenty of sleep. Rest is needed to help spinal regeneration. Rest also allows muscles to recuperate from microfiber tears and allows the rebuilding process to occur.
5. Try longer walks for cardio and concentrate on softening your heel strike. Be fluid with your motion to help reduce sheer and compression.
6. Spinal neutral circuit training with short rest also has cardiac benefits.

Don’ts

1. Abs classes at your local gym are a big no no. They almost always are too long and have too many exercises with excessive flexion and extension.
2. Avoid high impact activities. Running and plyometric activities create sheering and compression on the joints.
3. Avoid power lifting or Olympic lifting due to the flexion and extension created in some lifts that increase sheer and compression. Especially with poor form.

Managing back pain for the long term can be frustrating and require lifestyle changes. It does not have to get you down though! Be patient and do not give up on your goals to feel better and stronger. I personally have changed what I do for recreation from high impact sports and heavy lifting to long walks, bike rides, swimming, and proper circuit training to keep me healthy and active. My best advice in making these changes is to exercise with others or hire a qualified medical fitness professional. Having a support system can go a long way.

Back problems do not have to be a “pain in your butt.” I know… I have been there.

By Phillip Godfrey, MES PFT