John Seivert: Hypervigilant posture & back pain
July 2, 2018
Try this experiment, hold up your fist in front of you and clench it hard. Keeping it clenched, see how far can you move it in all directions? It is not as much movement as if you did it with a relaxed wrist. When the body is relaxed and we move we get appropriate muscle activity needed to do the task.
For example, a golfer doesn't consciously turn on trunk (core) muscles while hitting the ball, they just do it. Your body's natural recruitment of muscles fire when needed. Now, back to your clenched fist that you have been holding for a few minutes, I am sure it is starting to feel uncomfortable and tired.
I would never tell a patient to protect their wrist injury by squeezing their fist in order to pick up an object. So why are we doing this for patients with low back pain?
Many people constantly turn on their core muscles. They pull in the belly and straighten the spine so it is in an erect position. It is a crazy posture to hold for prolonged periods of time but I see this strategy used often and it's not working.
Why do we do this? We want to improve our posture because we have all been told that slouching is bad and we should sit up straight.
Experts in health and fitness, healthcare and even our mom's have told us over the decades, "Sit up straight or you'll hurt your back." We are also told, "If you get a stronger core your back pain will go away."
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These rampant beliefs about stabilizing the spine by creating a stronger core is found everywhere in our communities. Fitness centers, social media, friends and most healthcare providers subscribe to these beliefs that we must keep our spine stiff and straight.
For most people with mild to moderate short term low back pain, getting stronger core muscles does help reduce or eliminate back pain. However, this article is focused on those people that have tried many exercise routines and healthcare providers and are still in pain.
The problem with this belief system that sitting or standing in an erect posture with a mild or moderate contraction of the core muscles prevents or decreases chronic low back pain is that there is no research that can support these claims. The same goes for improving core muscle strength and its ability to ease or eliminate non-specific chronic low back pain. Only 15 percent of all people suffer from non-specific chronic low back pain but they use over a billion dollars a year in healthcare resources.
Current evidence around posture & non-specific chronic low back pain
Researchers in Perth, Western Australia, have found that the hypervigilant patient may find relief with slouching for a few minutes every hour if you are suffering from non-specific chronic low back pain.
The erect posture of sitting at the edge of the chair with a straight back, knees together, shoulders pinned back and head held tall is similar to clenching your fist and holding it for hours. This causes fatigue and a feeling of weakness.
The act of holding your spine stiff for hours makes you feel weak when you are actually quite strong. Another study of adolescents aged 14-19 years old with low back pain found that a large majority of the patients with pain were females that had adopted a rigid straight back sitting posture.
The male subjects reported significantly less back pain and their preferred and regular posture was, slouched and rested most of the time. This study was able to show that even at a young age back pain can start and being hypervigilant about maintaining an erect sitting posture did not eliminate pain but actually caused more back pain due to the constant loading of the spine from the co-contraction of all the core muscles.
Advice on eliminating non-specific chronic low back pain
Having a strong core does help eliminate low back pain with subjects with short term acute pain. Subjects in most studies about acute pain demonstrate that the stronger the back extensors are the less back pain is reported.
If you have non-specific chronic low back pain and you find yourself sitting erect often and still have pain, try a more relaxed posture with letting your back rest against the backrest of the chair and let your belly muscles relax.
Patients with non-specific chronic low back pain should work on staying relaxed in the core muscles when sitting, standing or carrying light objects. It is not normal or advised to "turn on" your core muscles when walking around or doing normal day-to-day movements and chores. Turning on these trunk muscles actually creates more load on your spine just like clenching your fist makes your arm feel sore, tired and weak.
Spinal exercise programs should include more movement and motor control exercises. Most programs focus on static strengthening exercises like front and side planks and that may cause more spinal stiffness. You want a flexible and strong spine.
The founder of the Pilates method, Joseph Pilates once said, "If your spine is inflexibly stiff at 30, you are old. If it is completely flexible at 60, you are young." He also stated, "Change happens through movement and movement heals."
These healthy beliefs about a fluid and relaxed spine that is very robust and strong can handle all sorts of movements needed to work, play and rest without worry or fear of causing damage to your spine.
Remember, not everyone is the same. If you have low back pain seek out a qualified physical therapist to assess your back and exercise program to help you efficiently get rid of pain and find what movements are right for you.
John Seivert is a Doctor of Physical Therapy and he has been practicing for 34 years. He opened Body Logic Physical Therapy in Grass Valley in 2001. He has been educating Physical therapists since 1986. Contact him at firstname.lastname@example.org.
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