In a normal healthy spine you are 2cm shorter at the end of the day than you were when you woke up. This happens because you lose fluid from your discs during the day. You lose 50% of this within the first 2 hours of sitting. This means you spend more of your day with less shock absorption padding between your vertebrae.
When your spine is stiff and has been for some time, even if you have no pain, your body struggles to replace the fluid in the discs and slowly the disc dehydrates. It’s a little bit like a car tyre slowly going flat. The longer you go without treating to cause or the stiffness the more the disc will dehydrate and the higher the chance of a disc bulge. As a car tyre goes flat you will see a bulge start to form. The same thing happens in the disc.
When you sit for long periods it causes tightness in a variety of muscles around the lower back and hips that can make it harder for your spine to move well.
When you sit with poor posture for long periods you add extra strain and load to some joints and it can significantly increase the tightness in some muscles. How fast this catches up with you is directly related to the amount of time you spend sitting in that bad position adding load to your joints and increasing the strain on the muscles and how active you are when you’re not in a chair.
What we hear all the time from patients is ‘I thought it would go away on it’s own.’ The trouble is they leave it weeks, months and sometimes years before they go and see someone.
The longer you leave it the more it impacts your movement strategies (which muscles you use to do a movement). The longer you do nothing about stiffness the more it interrupts the normal metabolic process of the disc. This means that you wont replace the fluid you lose from your discs every day as effectively and this adds up over time.
Think about the difference between a grape and a sultana. A sultana is a dehydrated grape. A degenerated disc as seen on e.g. an MRI is a disc that has slowly dehydrated over time because the fragile disc metabolism was interrupted. You don’t want that shock absorbing padding between each vertebrae to breakdown and degenerate.
Some warning signs that you need help include:
- A grumbly lower back that persists for more than 24 hours after significant physical effort
- Significant pain with or without pins and needles, numbness, muscle spasm and/or difficulty moving normally.
- Pain getting up from a chair or coming up from a bent position
- Difficulty bending
- Pain with activities requiring you to be slightly bent forward for a period of time e.g. cooking, vacuuming, and washing the dishes.
- Persistent stiffness with or without pain.
- Back pain that is still present 72 hours after injury.
There is a small muscle in your back (multifidus) that wastes away by 30% within the first week after the first time your back really “goes”. It’s important to know how to get this muscle to come back as it’s part of your core muscles and often ends up neglected. If neglected for long enough fat starts to take the space the muscle used to use.
When there is pain your deep abdominal muscle (transversus) which is part of your core is often inhibited which means it can’t activate well anymore. If you don’t actively recover this then long term there will be reduced strength in the muscle designed to support your spine and pelvis and help you cope with loads like lifting, sitting, pushing and pulling.
Getting your core strength and proper muscle activation patterns back is vital.
A lack of flexibility can create compressive (squashing) loads on your spine. It can also reduce your hip function. When this happens people often start trying to compensate in a way that increases the loads your lower back has to take.
What Should You Do?
The first thing you need to do to get relief of back pain is seek out expert help.
Your spine needs to move through a full range of motion to get enough pressure change in the disc to allow it to refill.
This means that to keep the disc thick and healthy, like a grape, you need your vertebrae to be able to move so the disc doesn’t slowly dehydrate. In other words, you need to get the spinal joints moving and you need to remove any muscle tightness that might be compressing the spine or impacting how well it moves. Part of this process involves correcting, where possible, any alignment issues that might have contributed. It is very common to see twists within the rib cage that are not from a scoliosis that are hugely contributing to lower back pain.
The key to long term success in treating backs is recovery of core strength, proper glute activation (good bum muscles) and adequate flexibility for the tasks you want to do.
Pilates is a great way to recover the strength, control and flexibility you need and it can be tailored to suit your needs. Talk to an expert about whether Pilates would be an appropriate form of rehabilitation for your back.
The other thing you should consider is the way you sit if you have an office based job. If you can get someone to sneak up on you and take a photo of you sitting at your desk so you can get an idea what you really look like when you’re sitting.
They could also take photos of you sitting as you think you might after an hour or so. If they take it from a few different angles it gives your physio an insight into changes that could be made to reduce the load on your spine.
It’s really important to remember that it is highly unlikely that you got into the situation you’re in overnight. It is likely an issue that’s been slowly getting worse over time. It will take time to fix it.
If you would like specific advice about things you could do to improve your back or sitting posture then come in and chat to our physios or email firstname.lastname@example.org.
Alternatively we are holding a free information session – 3 Steps To Rapid Relief From Back Pain – September 18th at 6.30pm in our clinic. This session is 50 minutes in duration and is run by our Principal Physio Pip Coomes. She will be available after the session if you would like to ask any questions. There is limited seating for this event so please call 9416 4410 if you would like to attend.
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