Low back pain is probably one of the most common cause of pain and loss of work. Episodes that occur infrequently, can occur more often and be more debilitating as we age. Some of the reasons behind this rest in the amount of time that we spend sitting, working. There is a direct correlation with sitting and back pain. The muscles that are used to help stabilize your back, your core muscles don’t function well or at all while you are sitting. The psoas muscle shortens, which makes it increasingly hard to straighten up. I’ve seen this in mechanics, who spend hours bent under a hood of car and in truck drivers, who sit and drive for a living. Standing straight for these people, over time, occurs by bending their knees. They may or may not have pain. Weakness of the multifidi, small muscles deep to the prominent back muscles control motion from one vertebra to another. When the spine is not supported during sitting, these muscles stop firing normally and may not fire well at all.
Injections that scar up the nerve to the facet joints in the back, a service covered by insurances, can permanently weaken these muscles, leading to weakness of the muscle and postural abnormalities. Back pain is also linked to weak abdominal muscles. The TVA muscle (transversus abdominus) can get injured or fire at the wrong time or can be cut in a c-section, appendix, or hernia scar. All of these things can affect the way that our back is supported. Think of the abdominal muscles as corsets. They attach to a fascia layer, called the lumbodorsal fascia, which attaches directly to the spine. The direction of the fibers creates a web or mesh of intertwining fibers that can cinch up, like a Chinese Finger Toy, when they contract. This gives support to the back.
Getting up and walking each hour while working has been shown to be beneficial. Moving in general is beneficial. Taking the time to park farther and walk into the grocery store or to work is a way to get more steps in and less sitting. Exercises that move your whole body in different planes of motion, such as yoga or pilates or gyrotonics, offers a way to develop the core and move the body through all aspects of motion. If these are hard for you to do, because your hamstrings are tight, then you really should consider doing them. Breathing thoughout the day thru your nose, both in and out also helps restore motion in the chest wall. Sitting on a Swiss ball or balance stool without a back rest, helps keep the core working all day. A sit to stand work desk is ideal and should be considered even if your workplace will not pay for it. It’s time to start taking care of your health, no one else is going to do it for you.
There are lots of variations in what people experience as back pain. Debilitating back pain needs to be evaluated with MRI. If the spinal canal is narrowed, it is possible that this is a reason for your pain. Other considerations are discitis or tears in the disc. Most people have some degree of disc protrusion or herniation, and don’t have pain. If your MRI shows this, you need to make sure that the doctor that is evaluating you can provoke the pain with certain physical testing while in the office. If this is not possible, it is not the disc. Some disc protrusions or herniations will recover on their own over the course of the year. Make sure that you know if you are someone who needs to wait it out. Surgery, especially fusions, have no great long term benefit.
Eventually, the areas that were not fused will break down as they take up the burden of the fused segments. Remember, your body was meant to move. It wants to move. If one area is not moving, it will compensate by moving more in other areas. This will create more wear.
There are ways to treat the spine without surgery. Prolotherapy with dextrose, or platelet rich plasma offers a benefit that is tried and true. Even if your back pain is disc, there may be a benefit from this. Osteoarthritis, anywhere in the body, is a sign of ligament, fascia, joint capsule, tendon, or muscle injury. These soft tissue structures need to be treated in addition to the joints. Don’t scar or burn nerves, they will regrow and typically the pain will be more severe after. These nerves also innervate or supply the multifidi muscle, as described above, which is important for back stabilization. This is effectively like, removing a support footing from a bridge.
With Ultrasound evaluation, there are other structures that can be evaluated that x-rays and MRI can not be picked up. Ultrasound can be used to evaluate nerves, fascia, tendons, and muscles of the back both with and without movement. Someone skilled in ultrasound, as I am, can see small tears in the fascia or where nerves are entrapped and can treat these in addition to the joint and deep muscles during a prolotherapy or platelet rich plasma injection session. Injectable stem cell use in backs has really been reserved for disc issues.
I am sure that if you suffer for low back, even if it is only once a year, that there would be a benefit to be evaluated by me. Sometimes it is simple muscle training issues that if treated early can prevent progression of back pain. However, if you have back pain more frequently or with more intensity or have daily morning back pain or have a scoliosis, there would be a benefit to be seeing you soon!