In physical therapy there are numerous methodologies and theories regarding low back pain, including prevention and treatment strategies that can be quite different from each other. One approach is the McKenzie Method. Robin McKenzie, from New Zealand, began looking at the effects of sustained and repeated movement stresses on the spine as far back as the 1960’s. At the time there was very little research on acute low back pain episodes and also conservative treatment methods.
McKenzie began to notice that some patients felt pain relief when their backs were rounded or slouched, while others felt better when they sat up straight and kept a slight inward (extended) posture. Over time he began to categorize these patients based on how their pain responded to different movements and postures. Some patients reported decreased pain with back rounding exercises (flexion), while others felt worse with this motion. Other patients felt better with back arching movements (extension). The key was that each patient had a unique movement preference that offered them relief.
Ultimately McKenzie developed a movement based evaluation method that clearly allowed the patient to understand how sustained and repeated movements affect the stress to their lower back. Once the patient understood the “pattern” to their problem they were able to self-treat their condition with specific exercises, thus allowing them to be independent and in control, basically preventing their recurrent back pain attacks. In a famous quote, McKenzie stated that 80% of people with lower back pain should be able to self-treat their condition and prevent future episodes if properly taught. He felt just 20% needed the skilled ongoing care of a medical professional. So how does this relate to your spring projects and your lower back?
Most patients who suffer a sudden, acute episode of low back pain will tell you the exact move that “threw their back out”, and many times it is a motion involving forward bending, or forward bending with a slight rotational twist to one side or the other. We hear over and over the story of simply bending forward to reach for a towel after a morning shower, or putting the dog’s food dish down, or even sneezing as the “straw that broke the camel’s back”. Further investigation often reveals that during the previous two days (Saturday, Sunday) before the episode, that the person was involved in a home project that involved either sustained or repeated forward bending. Think gardening, yard work, staining the deck or some other similar task.
Since many of us don’t do these tasks for a living, our bodies are not conditioned for this weekend warrior task that involves so much rounding of the back. A great but simple analogy of spine mechanics is that of the Oreo cookie. Think of the top and bottom of the cookie as being your spinal vertebrae. The space between each vertebrae is our shock absorbing disks, which are like the cream filling of the cookie. When you bend forward, either sustained or repeated to do these home projects you are compressing the front of the Oreo cookie which forces the cream filling to be pushed toward the back. The problem is that the back side of the disk (cream filling) is richly innervated with pressure sensitive pain receptors, and if enough of the center of the disk is pushed backwards, there can be sudden and acute low back pain accompanied by muscle spasms and an inability to simply stand up straight. Clinically we call this condition a bulging, or if worse, a ruptured disk that potentially can push out far enough to push on a spinal nerve and create radiating leg pain, numbness and tingling (sciatica).
Keys to preventing this type of injury include the following.
- Body Mechanics: Pay attention to your body mechanics. Could you perform the task safer by squatting or another method that keeps your back straight? Could you pot the plants with them up on a work bench or table that limits the need to be bent over forward? Could you kneel on one knee such that you aren’t so forward bent and rounded in the low back?
- Movement Therapy: Considering the Oreo cookie model, once you’ve been bent forward excessively, try bending the other direction. McKenzie’s model would have you put hands on your hips and bend backwards 10-15 times, reversing the curve that has been rounded with your home project. Another trick is to lie face down and then prop on your elbows and let your lower back “sag” for 1-2 minutes, again reversing the mechanics of the rounded back posture. Try this for 3-4 bouts; you’ll know once you stand up and walk if it was of benefit. Both of these should produce a “hurts good” type stretch to the lower back.
- Physical Therapy Consult: If you have had recurrent “back attacks” over the years, the kind that you typically recover from with rest and modified activity, then you are a perfect candidate to go through an evaluation and customized back-care exercise instruction from a PT even if you are not currently experiencing a bout of low back pain. Learning how to self-treat can be an empowering learning experience and something you can apply the rest of your life.
Lower back pain is the 2nd most common reason for people to see their family doctor, just after the common cold. 80% of adults will at some time be afflicted with an episode of low back pain. Being proactive and caring for your back seems like an obvious smart move, but for some reason most people don’t take action until they’ve suffered yet another episode of pain. Our dentists have done a wonderful job convincing us to do “maintenance” on our teeth twice a day to keep good healthy teeth. It would do us all a great benefit if we applied that same strategy to our spinal joints, disks, and muscles with a simple exercise strategy.
This post written by Brad Ott, owner, MSPT