Have you ever “thrown your back out” just bending over to pick up something completely innocuous – like a pen, or a shoe? Or maybe you’ve felt a familiar back pain act up just by rolling over in bed? Or doing the dishes? Maybe it feels like you’ve aggravated a back problem by doing almost nothing at all?
Unfortunately, this is an all too common story I hear. I tell people often that dealing with back problems is an issue that usually needs to be viewed from multiple angles in order to address the big picture.
For almost everyone, yes, we will need to find an appropriate set of exercises, tuned precisely for your body and capacity, that you will need to perform regularly. Many people will know this already from prior courses of Physical Therapy, or maybe from a good chiropractor that incorporates therapeutic exercise into their practice. Think of this as an additive component – we are adding some activities to your everyday routine. Often, however, we will also need to subtract certain activities that you may be doing, as well as work on improving how you already do some others. All in order for you to 1) gain the all-important core strength you likely need, and 2) avoid the habitual triggers that are keeping your back in a painful state.
Many, many clinicians miss out on some crucial ways to help their patients from continuing to hurt themselves. This is a very broad topic, but I will detail here some of the “low hanging fruit” of movement habits that you can incorporate into your life right now in order to help stop irritating that pain in your back that just keeps returning, no matter what exercises you seem to do.
I like the term coined by Dr. Stuart McGill called “Spine Hygiene”. These are some basic principles that can teach us 1) Good ways to move, 2) Movements we may want to avoid, and 3) How to choose when to do certain activities.
These choices, which we try to eventually mold into habits, will cumulatively place less stress on commonly injured parts of the spine, can be significantly beneficial. Most people are continually irritating their backs – without even knowing it! It is then difficult for them to escape this cycle of pain irritation, because no one has told them how to! People are not born programmed with this as a basic operating system, so one of my jobs when treating back patients is to show them how & why they will want to consider these choices.
Perhaps you are familiar with the metaphor “don’t poke the bear.” It’s hard for a hibernating bear (your back pain) to stay peaceful and sleeping if you keep provoking him with poor movement habits & bad spine hygiene. Another apt metaphor is “picking a scab” – that wound you have (again, your back pain) isn’t going to heal if it is constantly being picked at (poor movement habits). Hopefully you get the point – most people’s back pain will have predictable triggers, and if we can teach you to avoid some common ones, it stands to reason that we can reverse the pain cycle: less triggers → less pain → more capacity → more ability to move, train, & exercise → less triggers, etc.
Here’s an example of “when to move.” Many people’s backs are irritated after periods of prolonged inactivity, for example, after waking from a night’s sleep or after sitting or driving for a long period. Parts of the spine can become sensitized after this inactivity, especially if there is an underlying or recurrent problem. My advice for people after they have just woken up, or if they’ve been sitting for a long period, is to start moving gently. It is a bad idea to launch right into bending and lifting heavy items right away! This advice will apply in the morning to many people with back pain, but it is also worth noting for those people who have jobs or perform activities that punctuate long periods of sitting with significant loading (for example, think of someone who works unloading / loading a truck after long bouts of driving).
This is the time to introduce your back to some gentle motion such as the cat-camel stretch (referenced in the previous blog post titled “A Few Stretches to STOP Doing if Your Back Hurts”), or walking / pacing, or possibly some gentle standing extension stretching. As always, the caveat applies that not everything works for everyone, so start gently and get a feeling of what works for you. Stop if any of these appear to increase your pain. Even standing upright for a few minutes or pacing a bit before engaging in a lifting or repeated bending activity would likely be beneficial.
Sometimes, having a strategy to take breaks during a possibly provocative activity can also be helpful. Think about doing the dishes, or bending over a workbench. For just a few minutes, this may be just fine, but this is often a trigger for some people when done for an extended period of time. Time can be the multiplier that people forget about – a compromised position for 30 seconds may be tolerated without an issue, but do it for 30 minutes and you may have a problem. So, sometimes it is best to take a planned break from an activity like this – you may want to “just get it done” and complete the task, but your back might appreciate doing something in 3 bouts of 20 minutes, for example, rather than working straight through for an hour and triggering that familiar back pain.
Here is an example of “how to move”. At the start of this post, I asked if you’ve ever hurt your back doing something minor, like bending over to pick up something from the floor. Most of the time, and for most of our lives, we do this without thinking and without pain. However, once there is a problem, a simple activity like picking up a sock or a pen has the capability to reactivate it, and *BAM* – that familiar pain is back.
So: a good way to offload some of the force from your low back is to stabilize yourself with one hand – on a wall, a countertop, a sturdy chair – and then perform what is known as a “golfer’s pick up” or “golfer’s lift”. The stabilizing hand (a golfer would use his or her putter, for example) as well as lifting a leg, places significantly less loads on the lower back, and is suitable for picking up light objects to spare the spine.
Finally, there are some movements you may want to avoid altogether, or at least when you have the choice. As I mentioned previously, we often have enough capacity to get away with poor movement habits or choices… for a while – but maybe it’s that 50th time you tie your shoes, or work in the garden with poor mechanics – that flares up the familiar pain.
One recommendation I make with almost all my back patients is to learn the “log-roll” technique of getting out of bed (this also applies to getting up from the floor from lying down). Rather than doing a sit-up motion, you are far better off learning how to control your torso as a “block” – think about moving your hips and shoulders as one unit – and rolling to the side, before using your arms to push yourself up. This technique will probably feel robotic and awkward at first, but once you do it a few times, it can be done smoothly and quickly. This will help to avoid a known trigger for back pain, especially the first thing in the morning, when we know backs tend to be sensitive. As an aside, I also advise people to avoid sit-ups as a repetitive exercise. It’s not that you can’t or should never sit straight up in bed, but doing this motion over and over again (think of a gym routine, for example) is a known trigger for disc injuries and other spine pathologies. There are many, many safer ways of strengthening the same core musculature that don’t put the lumbar spine in that same vulnerable position.
All of these topics are multifaceted, and there are lots of other activities and movements to explore with regards to improving back health. I hope that this brief discussion of some of the most obvious and easiest to implement ideas can be helpful for you. As ever, for further discussion or to make an appointment, please feel free to email me roland@gunksphysicaltherapy.com or call the clinic: 845-579-5007
Dr. Roland Alley, PT, DPT
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At Gunks PT, we can provide you with a comprehensive plan of care to address your specific type of back pain issues. Call us today at 845-579-5007 to schedule an appointment with us. You can also set up a free discovery visit via phone or zoom so we can discuss your options and goals:
