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[PATIENT ADVISER]

Extend Yourself for Low-Back Pain Relief

Louis Kuritzky, MD with Jacqueline White

THE PHYSICIAN AND SPORTSMEDICINE - VOL 25 - NO. 1 - JANUARY 97


Your back may have "gone out" the moment you leaned over to pet your pooch, but don't blame poor Rufus for the agony you're now in. Most likely, your back has undergone years of abuse as you slouched in front of the TV and hunched over a desk.

Though you may hate to admit it now, Mom was right when she pestered you to sit up straight. For most of us, low-back pain is a cumulative process, resulting from chronic poor posture and sedentary habits. A flexed (or hunched over) back is bad news—it can stress or damage the disks that cushion the bones in your spine. Poor lifting and bending habits can also contribute to low-back pain.

Practice Proper Posture

But it's never too late to heed Mom's advice. Practicing proper posture is crucial to prevent future bouts of back pain (figure 1). And it may very well take practice. You will likely find that you tire easily in this new seated position.

[FIGURE 1]

[FIGURE 2]That's because the lumbar extensor muscles you use to keep the arch in your back are probably the most underused in your body. Most people with chronic low-back pain can dramatically increase the strength of the lumbar extensor muscles, sometimes even tenfold. That's a pretty impressive gain when you consider that most women can only increase their bench press strength 50% and most men can only double theirs.

So if you can only hold a correct seated posture for a few minutes at a time, that's OK. You can work up to longer sessions as your extensor muscles gain strength. Keep in mind that they can powerfully maintain the stability of your spine.

Another option when you sit is to use a lumbar roll or cushion to help keep the curve in your lower back. This kind of passive conditioning can reduce your symptoms. But only active conditioning—when your muscles are actually working—will let you develop the muscle tone you need for maximum spinal stability.

Extension Education

When back pain strikes, your first impulse may be to take to your bed. But recent studies have found that activity is the better antidote. For most people, low-back pain results from too much flexion, so exercises that place the back in the opposite position (extension) are best.

But that's not true for everyone, so be sure to have your back evaluated by a physician before you begin an exercise program. For example, pregnant women usually have back pain because the baby's weight causes them to hyperextend their back. So extension exercises can make their pain worse. Extension exercises are also inappropriate for people who have spinal stenosis. For whatever reason, if an exercise increases your pain you should stop it immediately and consult your doctor.

That many people with low-back pain do benefit from extension exercises was first discovered by Robin McKenzie, a New Zealand physical therapist (1). Perhaps you've felt the urge to counter the effects of sitting slouched over by getting up and arching your back (figure 2). What you're doing is an extension exercise.

[FIGURE 3] [FIGURE 4] [FIGURE 5]

Extension exercises have many variations. The most basic extension exercise starts from a position lying on your stomach (figure 3). As your lumbar extensor muscles grow stronger, you will be able to do more advanced versions of this exercise (figures 4 and 5). Another exercise to try is in a standing position (figure 6).

[FIGURE 6]

Back in Business

Keeping your back healthy is something you want to work on every day—not just when pain strikes. And remember that regular aerobic exercise is an important part of any conditioning program. A regular walking or swimming program is an excellent choice for someone who has low-back pain. Of course, if exercise increases your pain, stop and consult your physician.

Reference

  1. McKenzie R: Treat Your Own Back, ed 6. Waikanae, New Zealand, Spinal Publications, 1996

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Dr Kuritzky is courtesy clinical assistant professor of family medicine at the University of Florida in Gainesville. Ms White is a contributing editor for The Physician and Sportsmedicine.


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