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Wednesday, May 14, 2008

Why Your Back Hurts

A Mind-Body Problem
Our backs buckle under a puzzling array of stresses and strains, both major and minor. We can hurt ourselves as easily bending down to tie our shoes as we can digging ditches. A muscle can tighten in extreme pain or a disc can pop as we mow the lawn or bend down to a toddler, as we stoop to pick up a heavy bag or a dropped “Post-it” note, as we exercise and play sports, or as we stand up from sitting in the same position too long. Something as trivial as a sneeze or cough can contort us with low back pain. (In fact, sneezes and coughs subject the torso to very high levels of torque, so here’s a tip to reduce the strain: Lean back slightly when you sneeze or cough, instead of bending forward.)

Being in good shape does not guarantee a pain-free back. Elite athletes are as vulnerable to low back injuries as the rest of the population. And just like the rest of us, the world’s best athletes can hurt themselves as easily taking out the trash as they can in competition. The sports pages regularly report on athletes who are sidelined by ruptured discs from a variety of causes.

A disc herniates when its soft inner portion, the nucleus pulposus, pushes out through a hole or tear in its tough outer portion, the anulus. Then leaking disc fluid can inflame surrounding tissues, a condition known as chemical radiculitis. If the herniated disc hits a nerve, it can send electric shocks of pain through the back, buttocks, and legs. Thereafter, because of the body’s complex, interconnected structure, the pain can spread to seemingly unrelated areas, such as the neck, shoulders, middle and upper back, abdomen, hips, thighs, and even heels.

Because we felt fine right up until the moment when we turned in an awkward way, lifted a heavy box, sneezed, or bent down to pick up a pencil, we tend to think of that single event as being the one that caused our pain. But far more often than not, the lift or the sneeze is not the ultimate cause of the pain, but only the incident that triggers a painful reaction to accumulated physical, mental, and/or emotional stress and overuse. If you focus solely on the trigger incident, you risk putting your recovery on a shaky footing. If you look back further, you’ll usually recognize that prolonged stress has been making you feel increasingly vulnerable for some time. You’ll see, too, that your body has been trying to signal you all along—possibly with subtle symptoms like tightening muscles, increasing tiredness, and minor aches—that you need to slow down and relax a little. But you’ve been too wound up and distracted by daily obligations and worries to pay attention. Instead of listening to our bodies when injuries are small and can heal quickly, we tend to ignore them until they reach the breaking point.

No doctor can take away your stress. But if you learn how to listen to your body better, you can treat small injuries before they became big ones. You can even avoid injury entirely. In short, the most important treatment you receive for low back pain is not what others give you, but what you give yourself in the form of heightened self-awareness and better self-care.

Good habits of self-care build physical, mental, emotional, and spiritual resilience. In putting self-care front and center, however, I don’t mean to suggest that you must heal your back pain all by yourself. Everyone can benefit from others’ help in healing. When I hurt my own back, I looked for care and help from others at home and in the doctor’s office. In Chapter 3 and Chapter 11 I’ll explain how physicians and other caregivers can help you heal your back. But I can’t overemphasize that proper self-care—like the Back Rx program—is the foundation for all healing from low back pain.

A Lifestyle Problem
One of the things that all of us in the modern world need to pay better attention to is how we punish our backs with chair-sitting. Our backs evolved in a world without furniture to suit a lifestyle of intermittent movement and rest. The best way for our early human ancestors to sit, and surely the most common, was to sit cross-legged flat on the ground. Much has changed for the better since then, but the healthiest way to sit remains the same. Sitting cross-legged flat on the ground or floor with a straight back engages the whole core body structure—head, neck, shoulders, abdomen, back, and hips—in active harmony. Maintaining a relaxed, balanced posture while sitting cross-legged requires continual micro-adjustments that align the spine, tone muscles and tendons, and perhaps most important, maximize flexion and range of motion in the hips.

Try it for a while, and you’ll see. The sooner you feel a telltale strain in your hips, the more vulnerable your back is to injury.

By contrast, sitting in chairs disengages some of these core body elements and puts enormous strain on others. As I mentioned in the introduction, my research indicates that chair-sitting contributes to measurable deficits in hip flexion and range of motion, even in highly conditioned professional athletes. Worst of all, chair-sitting maximizes pressure on the discs and decreases their oxygen supply.

Remember, the discs breathe by taking in oxygen from blood vessels at their periphery. But we suffocate our discs by sitting in chairs too often and for too long. We sit in chairs, in a disc-freezing posture, even when we’re “relaxing,” while watching television, surfing the Internet, reading, or playing a video game.

It would be a saving grace if we at least walked from one daily activity to another. Instead we sit down in chairs to travel in trains, planes, and automobiles. Most car manufacturers now describe their car seats as ergonomic. Luxury car makers, in particular, like to boast about their body-friendly seats. Unfortunately, even an ergonomic car seat will not significantly reduce disc pressure. The basic chair-sitting posture defeats every ergonomic tweak that the car companies devise.

Back health is much better in the Third World, where many people still grow up sitting cross-legged on the ground or floor and walking from one activity to another, and where relatively few people spend their workdays in a desk chair. In the Third World, backs breathe better.

The final piece of the low back pain puzzle is age-related. In Chapter 1, I mentioned that the discs are 80% water at birth and gradually dry out as we grow older. During midlife, at least in the developed world, prolonged chair-sitting constitutes a form of overuse that predisposes us to disc bulges and herniations. From about age fifty on, the spinal canal begins to narrow, a condition known as spinal stenosis. Not all stenosis produces problems. But stenosis can cause back pain by putting undue pressure on the nerves that lead out from the sides of the spine. In addition, the increased pressure it puts on the bones of the spine, especially the facet and SI joints, can lead to arthritis. As I’ll explain in the next chapter, disc problems and stenosis affect the back differently and require different treatments.

These three Magnetic Resonance Imaging (MRI) scans (Figures 3–5) show the discs at three stages of the life cycle. The first shows a young person’s healthy, well-hydrated discs. The second shows a middle-aged person’s discs with dehydration under way and a herniation of the disc at L4–L5. In the last, age-related stenosis is beginning to become problematic.

Fortunately, proper exercise that increases the back’s flexibility, strength, and endurance, and thus makes good balance and posture possible, can dramatically retard these natural aging processes and moderate their effects.

The bottom line is that low back pain needs a recovery program that will give first aid to injured muscles and discs; tune up poorly developed muscles and tendons in our hips; and help us learn to listen to our bodies to enhance proprioception and body awareness throughout the life cycle. Back Rx treats both sides of this complicated mind-body puzzle. Its combination of physical therapy exercises with medical adaptations of yoga and Pilates can reset the balance between core muscle groups. At the same time, its calming breath control can reset the balance between the body and the mind.

Now let’s look closely at how Back Rx can help you progress successfully through every stage of low back pain care and recovery.

Excerpted from

Back Rx: A 15-Minute-a-Day Yoga-and Pilates-Based Program to End Low-Back Pain
by Vijay Vad
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