6 minute read
MotoPT: IMPROVE YOUR MOVE
Do You Have Low Back Pain? Just Walk it Off!
Hello FTR Family. Let’s start this month’s column by discussing something that 80% of us will deal with at some point in our lifetime, low back pain (LBP). LBP was the number one reason for missed work days in the United States. More work days were missed for LBP than for any other condition, including the common cold.1 I am sure you can imagine in the pandemic world we now live in, LBP is now the number two reason for missed days of work in this country. I need to define the type of LBP we will discuss today: non-specific LBP. This means the LBP is not attributed to a known pathology such as infection, fracture, or nerve root compression. Non-specific back pain is located below your ribs and above your pelvis without radiating nerve symptoms that go down your leg.
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The anatomy of the lumbar spine consists of five lumbar vertebrae (L1L5) that interact with one another as adjacent motion segments. Between the central portion of each lumbar vertebrae is the intervertebral disc. We consider two adjacent vertebrae and the disc in between them to make up a complete lumbar spine motion segment. For example, L4-L5 and the disc between those vertebrae would be named the L4-L5 motion segment. Each motion segment has an individual synovial joint, one for each side. These synovial joints are similar to most joints in your body (elbow, knee, etc.). The joints in your lumbar spine are the type that slides on one another or gap/compress. They don’t bend like most synovial joints, such as your knee, for example.
With the multitude of joints in your spinal column, the gliding (sliding) of all these joints cumulatively causes movement in the four cardinal planes or rotation if the joints are compressing on one side and gapping on the other. It’s easiest to put your hands upright in a football field goal position and move your body to mimic the biomechanics of how your lumbar spine moves. For example, if you hold your arms in the field goal position and rotate to the left you will notice that your left forearm goes straight backward (gaps), and your right forearm goes forward (compresses). If you bend directly sideways to the left, you will notice that your left forearm dips downward toward the ground (downslide), and your right forearm slides upward towards the ceiling (upside). These motions occur at multiple motion segments in your lumbar spine each time you move. When you consider the robust anatomy and structure of the lumbar spine, you can see our spines were built to absorb forces and move with the rest of our body. Movement is the best medicine for your lumbar spine. Researchers consistently study the benefits of medication versus physical activity and other non-medication type treatments such as pain education and physical therapy for LBP.2 When you look at the multitude of studies, you can draw several conclusions about the long-term management of LBP.
The first and most crucial lesson is that movement is medicine for our spine. We have learned that the type of movement or activity matters less than we used to think. Still, when you consider movement or exercise type approaches against other medical approaches, exercise is usually the long-term winner for non-specific LBP. I meant what I said in the title, if your back hurts, walk it off, and keep walking daily. Start going for daily walks, and work from a low time of 10 minutes up to 30-minute walks. Even a generic group exercise program can benefit you tremendously if you have chronic LBP.3 There are so many benefits that a simple exercise like walking provides us if we have LBP, it would be difficult to do them all justice in the space of this magazine. And suppose you maintain moderate or vigorous exercise as part of your healthy lifestyle. In that case, you are significantly less likely to experience LBP again for the next four or more years.4 Trust me, exercise works!
When should you not walk it off or perform some other type of physi-
cal activity, you ask? Well, when the movement seems to increase your symptoms linearly. For example, if your LBP is due to stiffness of the joints or muscles along your spine guarding (protecting) your back, it might be uncomfortable when you first walk. You might notice that your steps are shorter, and your overall feeling is that you don’t want to continue for the first 5-10 minutes. That is ok; you will gradually loosen up over time. Once you get over the initial discomfort, your body will warm up your muscles, your joint surfaces will become better lubricated, and you will begin to feel better. But if your pain or discomfort did not diminish, or your LBP is acute, you might want to give a few days rest before trying again. Don’t forget this excellent advice is valid for 90% of the LBP you are likely to experience, not the type of low back pain where you are compressing on a nerve root or directly after a traumatic accident.
The second conclusion we can take from all the literature on LBP is that understanding the facts about LBP and how our body interprets the feedback from the environment is a vital piece of the rehabilitation process. We call this pain science education, which is simple to explain and understand. Suppose your physical therapist or medical doctor takes 5 minutes to explain why you feel a painful sensation. In that case, you’re less likely to have a chronic pain problem down the road and better manage the pain you are experiencing at the moment.2,5 When we train our body physically, we also train our brain. We have found that repetitively orienting the patient’s brain in the direction of lumbar movements using smartphone applications or flashcards can dramatically reduce both pain level and the firing of pain centers of the brain.6,7
Before you start any new exercise program, I highly recommend you consult a physical therapist or physician for a general health and physical activity readiness screening. If you are experiencing LBP, it is always beneficial to have a complete evaluation by a physical therapist or physician. If you have any questions or comments, please email me at contact@motopt.com. Let’s IMPROVE YOUR MOVE so you can ride better this season!
1. Catalin I, Mariana R, Iustina C. Systematic review on the incidence of low back pain as well as on the rehabilitation treatment methods used. Balneo Res J. 2020;11(4):417420. doi:10.12680/balneo.2020.371
2. Gül H, Erel S, Toraman NF. Physiotherapy combined with therapeutic neuroscience education versus physiotherapy alone for patients with chronic low back pain: A pilot, randomized-controlled trial. Turkish J Phys Med Rehabil. 2021;67(3):283290. doi:10.5606/tftrd.2021.5556
3. Oliveira CB, Christofaro DGD et al.. Adding Physical Activity Coaching and an Activity Monitor Was No More Effective Than Adding an Attention Control Intervention to Group Exercise for Patients With Chronic Nonspecific Low Back Pain (PAyBACK Trial): A Randomized Trial. J Orthop Sports Phys Ther. 2022;52(5):287-299. doi:10.2519/ jospt.2022.10874
4. Ikeda T, Cooray U, Murakami M, Osaka K. Maintaining Moderate or Vigorous Exercise Reduces the Risk of Low Back Pain at 4 Years of Follow-Up: Evidence From the English Longitudinal Study of Ageing. J Pain. 2022;23(3):390-397. http://10.0.3.248/j.jpain.2021.08.008
5. Joern L, Kongsted A, Thomassen L, Hartvigsen J, Ravn S. Pain cognitions and impact of low back pain after participation in a self-management program: a qualitative study. Chiropr Man Ther. 2022;30(1):1-9. doi:10.1186/s12998-022-00416-6
6. Sawyer EE, McDevitt AW, Louw A, Puentedura EJ, Mintken PE. Use of pain neuroscience education, tactile discrimination, and graded motor imagery in an individual with frozen shoulder. J Orthop Sport Phys Ther. 2018;48(3):174-184. doi:10.2519/jospt.2018.7716
7. Gandola M, Zapparoli L, Saetta G, et al. Thumbs up: Imagined hand movements counteract the adverse effects of post-surgical hand immobilization. Clinical, behavioral, and fMRI longitudinal observations. NeuroImage Clin. 2019;23. http://10.0.3.248/j.nicl.2019.101838
