Low Back, Disc Health

Back Pain, a Pain in the Ass

Low back pain plagues many of us. For most of us, it grumbles as a stiffness in the background. Sometimes for years on end. Making it difficult to jump out of bed or even get out of the car with energy and flexibility. Making us feel twice our age.

And, to be honest, making us grumpy and even snappy! It can erode and define us as a grumpy old ####… before we even realise why. And some people think it is “normal”, or worse still “just ageing”.

For some, it becomes a show-stopper. For a while it has been an aching back, hip and buttock pain. Now it is acute, wincing pain, hard to put words too. Eye-watering. Or worse still, it now spreads down into your buttock and even into your leg, turning into “sciatica”.

It made us grumpy, now it makes us cry. And cry for help too… Here we explain the key to a healthy, strong, flexible back. We look at what goes wrong, and how to fix it.

Anatomy

In your spine there are 26 bones with 220 ligaments holding them together, and over 120 muscles controlling their movement. The co-ordination of the position and movement of each of those bones, muscles and ligaments is done by your… brain! And without clear communication from your brain to those levels, things WILL go wrong. It’s not a question of IF it will go wrong, it’s a question of WHEN will it go wrong.

Your spine is a MARVEL of ENGINEERING. Your pelvis is like a bony “Ring”, sitting on top of your legs, protecting your sex organs while transferring the load from your low back via the SACRUM. Your Sacrum is a triangular bone which sits in the pelvis. It only moves a small bit, but its position is CRITICAL because it has to transfer ALL of your upper body weight into the pelvis. And on top it holds the lowest of your five LUMBAR VERTEBRAE. An uneven sacrum angle WILL EVENTUALLY cause spinal troubles, often SCOLIOSIS.

We hear a lot of talk of the discs of your low back. They are super-strong “cushions” with a tough layered skin (Annulus fibrosus), and a softer “toothpaste-like” core (Nucleus Pulposus).

They shock absorb, allow mobility, but most importantly keep the space between the bones so that the SPINAL NERVES, which exit between each bone, have space. These nerves are the LIFELINE from your body to your brain.

Any pressure on them and the communication to your sex organs, blood circulation, or muscle coordination could be in danger. Pain is only the tip of the iceberg.

No matter the state of your back, this is what you ask of it everyday…

  1. Hold most of your body weight, and more! In a seated posture the peak force in your low back may be around 100kg, and in some gym “abdominal” exercises, these forces rocket to over 250kg!
  2. Shock absorb when you move, supporting any extra weight you decide to pick up.
  3. Contain, protect and “passively pump” the CSF (the “brain and nervous system irrigation”) from reservoirs in your sacrum and up your spine. See this video.
  4. Protect and pass the NERVES and their SIGNALS to your lower digestive system, sex organs, legs and circulation.
  5. And still be able to move freely and flexibly!

It is no wonder that injuries to this area quickly become chronic and life-changing, limiting our activities and making us feel old. But you can only blame your age IF EVERY other joint in your body is in the same condition… nearly all spinal problems are due to PREMATURE AGEING of one area more than the others. So what makes one body part age faster than the rest?

Three Keys to a Healthy Low Back

There are THREE KEYS to having a healthy low back, everything else follows:

Healthy Alignment

This is the most important, yet overlooked part of spinal health. Your low back should share your weight between the discs and the joints at the back (the facets). In order to do this, it needs an optimal curve. Changing the angle of the sacrum, low back, or both, can shift the weight all onto the disc, or one side of the disc. With uneven loading, disc hernias become more likely.

As the base of your spine, small misalignments can become magnified higher up. It is common to see a small imbalance in this area provoke a major SCOLIOSIS higher up.

Think about all that time bent over a computer or mobile phone, and imagine how those thousands of hours of “abuse” will affect your low back discs, and ultimately your health. You may not feel this “abuse” at the beginning, but often decades after you started the damage…

Healthy Mobility

Your low back should allow you to touch your toes, lean back, tip side to side AND rotate, WITHOUT PAIN OR RESTRICTION. The mobility needs to come from ALL levels of your back. This is the key.

We often see patients who have certain areas which are heavily SUBLUXED (link). They don’t move well, they may be degenerated, and the nerves are under stress. But they have other areas which are HYPERmobile- overly flexible. For example they can still touch their toes, because their hips are flexible (a common problem among Yoga practitioners). They think their spine is fine, as they appear flexible. In fact no amount of core or strengthening work can fix this, until the underlying subluxations are corrected. The problem is not their flexibility, but the QUALITY of their movement.

Because the SUBLUXATIONS cause major nerve stress, poorer health, and eventually spinal damage. Being flexible OR strong does not guarantee a healthy spine, each level needs to “do its bit”.

Without good mobility, you cannot have good blood supply and good tissue drainage. Your spine literally becomes malnourished. And the discs suffer first.

Light Load

There is simply no escaping that the more weight your low back has to carry, the more likely it will have problems. This goes for being overweight as much as it does carrying loads or working out in the gym, with one big caveat. The strength work done in the gym involves huge amounts of rest (between each session), whereas being overweight means your spine and discs never rest.

But it may surprise you to hear that a LIGHT PERSON in a BAD POSTURE can have MORE SPINAL STRESS than an OVERWEIGHT PERSON in a GOOD POSTURE.

This is because certain postures (such as sitting) can increase the internal pressure by 3-4 times. So while weight counts, Alignment is still the true KEY to spinal health.

Some people may be surprised that CORE STABILITY or CORE STRENGTH is not on this list of the three most important things for a healthy low back. It is very, very important, especially if you are asking a lot of your spine. But with good alignment and healthy mobility it is unlikely that your core should be weak. If it is, it is either because you just don´t move enough (eg you sit too much), or more probably because a previous injury did not recover, causing subluxation and abnormal nervous control of the area. In any case, Core training on a dysfunctional (subluxed) or poorly aligned spine can only help so much. Tightening things around an unstable structure can stop pains, but longer term problems will arise again. In fact, doing core stability work when we have removed your subluxations becomes far easier, indeed can become very rewarding.

Two Categories of Low Back Damage

We mostly think of damage in terms of accidents- like slips or falls, and these are certainly important. However we all suffer far more trauma from something far less accidental…

CHRONIC POSTURAL TRAUMA by far the most common cause of back injury

  • Sitting

    You may think that you are “resting” while sitting on the sofa, or reading a book, however your back can only rest when you are lying down. And even then, not always! Sitting in a flexed posture (the way we mostly sit) will produce pressures of over 100kg compression in your lumbar discs. This is because the natural curve, which shares weight between the back of the spine and the discs, is flattened. In some people this factor will rise up to 3-fold your weight. Meaning that a 70kg person has 210kg of compressive forces on their discs! Humans are simply not designed to sit for long periods of time. So modifying your sitting posture and getting up regularly RADICALLY reduces risks not just for back pain, sciatica and disc hernias, but also for a number of other health conditions, including heart disease. Put simply, sitting too much is extremely bad for you.

  • Sleeping

    Although sleeping should be a time of “rest”, too often our low back ends up in a twisted or compressed position, meaning that it cannot recover overnight. In fact, the discs in your back literally “feed” overnight in a process called “imbibition”, where the disc “sucks” fluid and nutrients from the vertebrae above and below. This means that it literally swells overnight, causing you to wake 1-2cm taller than you went to bed! 

    Tightnesses and poor postures can cause this to happen unevenly, meaning that as you wake in the morning your low back feels anything but “refreshed”. It makes you feel a hundred years old, and takes 30-90 minutes before you “warm into your day”. This is a likely sign that your discs are suffering, and you may even have disc instability. A good sleeping posture, plus knowing how to decompress your spine as you lie down, can make a big difference. In this video we explain how to decompress your spine when lying down.

  • Car

    It is no surprise that car seats are a big culprit for causing back problems. Not only do they force you into a very flexed position, often for prolonged periods, but the additional road vibrations into your spine have been shown to increase the load and fatigue on your low back. The less “car-like” your driving posture, the better. For example, a more “van-like” or upright posture often helps people who are suffering from back pain while driving. Either way, apart from trying to improve your posture, the best solution is taking regular breaks. Planning longer journeys to include a walk, lunch stop etc… can really help to lessen the fatigue.

  • Digital Devices (Phones and Tablets)

    When you watch our videos, you will realise that “digital devices” are one of the greatest threats to our spinal health. Regular laptop use is INCOMPATIBLE with a healthy spine. They are designed for short-term use only. Working from a laptop long-term guarantees spinal stress and problems!

    Mobile phones are at least as dangerous, as we don´t realise how long we are using them for. “Text neck” is a known neck injury from using the phone, but it extends to your low back too. We commonly see patients who have lumbar disc problems including hernias, hunched over their phone. Being conscious and changing these postures is important if you want to be healthy and well.

  • Standing

    Standing and walking are our natural states. And so should be friendly to our low backs, right? Well yes, but… Any activity with poor alignment, poor mobility, or excess weight can still be bad for our backs. 

    In particular, standing STILL for a long time can cause what we call “Cocktail Party Syndrome”… where a poorly aligned back forces you to “hang on your ligaments”. This results in increasing pain and discomfort, and you find yourself looking for a chair. If standing for a period causes you back pain, then it is possible that you have deeper alignment issues or Subluxations.

LIFTING, FALLS AND SLIPS  – often the “final straw” on a back which is already struggling.

  • Lifting

    When people think of “trauma”, this is what usually comes to mind. It is certainly possible to tear a muscle from overloading your back. And if indeed it is muscular, it should recover within a few weeks. If it lasts beyond that it is NOT “just muscular”. Although you may finally feel your “back go” when you pick a pen from the floor, or slip slightly, the reality is that a healthy back should be “immune” to all but the greatest slips and falls. If you are fit and playing a sport, and someone lands on you, that is bad luck. 

    But the truth is that so many of us have fragile backs from chronic postures, that even small loads have us “on the edge”. 

    Although very common, it is NOT NORMAL to go around “protecting” our back from loads…. It is just a sign that we need to act now.

    This “accident”, like picking something heavy, may be the final straw for a struggling lumbar disc. The overload causes it to rupture its walls, herniating its nucleus and bulging into the spinal canal. With luck there is enough flexibility and space for it to not fully compress a nerve. If not, then you are likely dealing with sciatic or leg pain. 

    Many people “get past” these episodes with pain medication or rest. But the scarring continues inside. 

    In fact, some of the worst degeneration we see is when people have not had enough pain to act sooner!

  • Falls ans Slips

    But MINOR falls can sometimes cause longer-term damage, by changing the positioning of your pelvis or sacrum. 

    For example, a common injury among cyclists is to fall onto one side of the hip. You recover quickly, but after a while notice you cannot produce power, or start getting back pain. Your low back sits ON the sacrum, and the sacrum is VERY sensitive to side-loading. In fact it is not designed to support a fall from the side, and so its subtle position can change. This sort of subluxation can wreak havoc on your low back.

    It should be noted that if you have a fall which results in sudden radiating pain, especially if it causes changes in your bladder or bowel habits, then you may have had an acute disc rupture, and should seek Emergency Medical assessment as soon as possible.