Low Back Pain Prevention
Since low back pain (LBP) is such a common human condition, impacting an estimated 80% of the US population, addressing prevention is a bit challenging. Adding to the challenge is the lack of clear scientific evidence related to the cause of low back pain. However, we can apply what we do know about factors associated with back pain to suggest reasonable steps to either lessen the likelihood of experiencing an initial episode of LBP, or to decrease the chances for recurrence following an initial episode.
Mechanical causes of LBP reflect the body’s response to a particular type of stress. These stresses can be short-term, high intensity loading, for example lifting a very heavy object or experiencing an unguarded movement – or they can be lower-intensity stresses over longer periods of time. Lower intensity stresses often occur during normal, everyday activities.
High intensity stress is considered frank trauma. Understanding that some forms of trauma cannot be anticipated or avoided, the best way to prevent injury is to use proper body mechanics in daily activities and to know your limits. Using the lifting example, there are many ways to improve the mechanics of the lifting maneuver such as keeping objects close to the body, maintaining the arch of the low back, and using the lower extremity muscles to power the lift. In this way, the structures of the lumbar spine are more protected and less likely to become injured.
When spinal structures do get injured, residual movement impairments can result. Movement impairments include decreased range of joint movement, decreased muscle strength, decreased muscle length, loss of movement awareness, and diminished control of muscle function. If these impairments are not corrected, the injured individual will be more susceptible to re-injury or recurrence of LBP.
In the more common case of repeated stresses over time leading to LBP, the mechanics of movement and the integrity of the structures of the spine also play a role. However, in many cases, impaired function of the lumbar spine actually precedes tissue injury linked to repeated movements. Movement impairments render the spine more susceptible to injury; correcting impairment becomes part of the formula for prevention.
One area of focus in back pain research is the role of the deep stabilizing muscles of the spine in movement health. These muscles, unlike the more superficial muscles of the spine, are critical for controlling excessive movement between the individual segments of the lumbar vertebrae. Loss of strength and control of these muscles is a common type of movement impairment, often due to general deconditioning. The resulting loss of stability can lead to excessive wear-and-tear, which in turn manifests as one of potentially many specific conditions under the general category of degenerative joint disease. These muscles are found to be smaller in size among people with chronic low back pain.
The above is just one specific example of the relationship between impairment and LBP. The simple take-home message is that there are ways to improve movement function and in doing so, not only help the injured spine heal, but also establish conditions that will protect the spine from injury in the first place.
Marcia Miller Spoto, PT, DC, OCS