Low back pain is one of the most common orthopaedic disorders in the world. Today, around eight out of 10 people experience low back pain (LBP) at some point in their lives. Of these, 40-60 per cent will have a recurrence within a year. The great majority (90 per cent) will get better in three months no matter how-or if-it is treated. The remaining 10 per cent will begin an often lengthy and expensive journey to seek help.
In an estimated 70 per cent of acute cases of back pain, no specific cause is found (Ahrens W, Pigeot I, eds. Handbook of Epidemiology. Berlin: Springer Verlag, 2004). My own clinical experi-ence, supported by an extensive body of research, suggests links with poor posture, prolonged sitting, degenera-tive changes to the lumbar spine and/or frequent bending, twisting or lifting without enough strength, endurance and/or coordination to prevent pain or injury.
More people today work in a seated position than any other posture, and chronic sitting leads to desiccation, or drying out, of the lumbar discs. Chair-sitting also changes posture-the lumbar curve flattens, the thoracic curve increases, the angle
at the first rib increases as the shoul-ders curve forwards and the head protrudes-and creates imbalances in the musculoskeletal system that increase the risk of pain and injury.
The arrival of chairs into our lives has done nothing but increase back pain. This was demonstrated by Dr Harry Fahrni, who studied the Bhil tribe of India, who didn't use chairs at the time (Fahrni WH. Backache Assessment and Treatment. Vancouver, BC: Mosqueam Publishers, 1976). Fahrni took X-rays of the lumbar spines of 450 Bhil tribesmen, who ranged in age from 15 to 44 years. He then took a comparable series of X-rays of people who did heavy labour in Sweden and an additional series of X-rays of workers who did light physical work in San Francisco, CA.
Fahrni's studies confirmed what he already knew from experience-the more active Bhil who didn't use chairs had healthier spines than the two other groups. By age 55, the Swedish labourers showed an incidence of lumbar disc narrowing of 80 per cent, while the US workers showed 35-per-cent disc narrowing. In contrast, the Bhil showed disc narrowing of only 9 per cent.
Dr Fahrni's findings indicate that avoiding chairs and maintaining an active lifestyle may be significant contributors to a healthy spine. How-ever, being active alone is not enough to avoid back problems.
My own clinical experience is that, in the case of heavy labourers, their patterns of movement are probably repetitious whereas the light workers may simply not be getting enough exercise to maintain musculoskeletal strength and endurance. Among the Bhil tribesmen and -women, their hunting and gathering activities ensure a myriad of movements. Such consistent, dynamic activity would pump fluids through the spinal discs, keeping them well nourished.
In addition, when squatting the way native tribesmen do, the torso is supported by the thighs, allowing relaxation and decompression of the spinal column, which helps to keep the discs hydrated and healthy.
No escape from the chair
When you sit on a chair for hours each day, the spine does not get enough movement, so fluid leaches out of the discs. This minimizes the incoming nourishment because the discs will then have no direct blood supply
and are instead fed by a process of absorption, facilitated by pressure changes in the case of the spine. As the primary constituent of a spinal disc is water, it only makes sense to keep yourself properly hydrated to prevent the discs from drying out. A good estimate is to take your body weight in pounds and divide that number in half. That gives you the number of ounces of water per day that you need to drink (Batmanghelidj F. Your Body's Many Cries for Water. Falls Church, VA: Global Health Solutions, 1992) For example, if you weigh 120 lb, you should drink at least 60 oz (or 1.7 L) of good-quality water daily.
If we sit through much of the day, we typically also won't be getting enough movement or exercise to keep the muscles and ligaments of the spine healthy. As our spinal discs dehydrate, they become thinner, causing the ligaments of the spine to become progressively more lax. This condition is a common cause of spinal instability, which typically leads to more serious lumbar pathologies
such as pinched nerve roots, disc herniations or arthritic changes that crowd the spinal cord and/or nerve roots. The following symptoms are suggestive of spinal instability.
- Feeling the need to manipulate or adjust your own joints (popping your back or neck).
- Pain or discomfort that is relieved by adjusting your spine, partic-ularly when the same or similar symptoms return and are again alleviated by self-manipulation or by a trained manipulator. As well as pain, any tingling, numbness, muscle spasm or weakness, or tension around a joint that is alleviated by manipulation suggests spinal instability.
- Popping or clunking sounds coming from a spinal joint(s) when per-forming a characteristic move-ment, such as rotating the spine in one direction, but not with rotation in the opposite direction.
- 'Washboarding', or hyperactivation of the deep spinal stabilizers in the region of the lax joint, most likely only noticeable to a trained professional.
The Swiss ball solution
There is a solution that will minimize the detrimental effects of too much sitting-the Swiss ball. Being a sphere, a Swiss ball has a reduced base of support, moves easily beneath you, and requires the activation of both your postural muscles and your balance mechanisms.
A randomized, controlled pilot study conducted by Swedish napra-path Dr Joakim Dettner-who treats diseases by manipulation of the joints, muscles and ligaments-and his colleagues at the Kroppsinvest Clinic in Ronneby, Sweden, found that, compared with massage therapy, simply balancing on a Swiss ball in a seated position for one minute, followed by 30 seconds of rest, seven times in a row-in place
of any other form of treatment-significantly decreased pain and disability.
To get the most benefit from a Swiss ball used in place of a chair, the following tips should prove helpful.
- Usually, an exercise ball is inflated until it is firm and, when you sit
on it, your thighs should be parallel or slightly inclined in relation to the floor, with the hips no more than 10 degrees above the knee. However, to use a Swiss ball as a chair, always choose a ball that is one size bigger than an exercise one, and inflate it only
to the point that your hips are slightly higher than your knees when you sit on it. This will give you a soft ball to sit on. Sitting on a fully inflated ball may cause compression of the sciatic nerve and, thus, much discomfort. In general, if you are less than 155 cm (5'2") tall, you should sit on a 55-cm ball; if you are between 155 and 170 cm (5'7") tall, you should sit on a 65-cm ball and those taller than that should use a 75-cm ball.
- Use only a burst-resistant ball. There are several brands now available to choose from, so make sure the burst-resistant limit is greater than your body weight. Cheaper Swiss balls can explode if punctured by a staple or sharp object, and you may then be injured by hitting the ground, the wall or other furniture. Burst-resistant balls deflate slowly when punctured, giving you time to get off the ball safely.
- Always check the floor daily to remove any potentially offending objects such as staples, pins and other sharp objects.
- Don't get rid of your chair just yet. Sitting on a Swiss ball requires
full activation of your postural muscles and, when they become fatigued, you will only be someone sitting on a Swiss ball with poor posture, which defeats the whole purpose. For this reason, I recom-mend only sitting on the Swiss ball for as long as you can maintain a good posture. When you're tired, switch to a chair for an equivalent amount of time, and shift back and forth between the Swiss ball and chair. For example, you may sit for 15 minutes on the ball and 15 minutes on a chair. As your postural muscles get stronger, you can sreduce the amount of time you sit on the chair.
Exercise as you sit
While sitting on the ball as you work, you can pump nutrition into, and remove waste from, your spinal muscles, ligaments and discs by doing the following fun and effective movement exercises.
- Seated Posture Training. While sitting with a good posture, simply lift one foot off the ground for a second or two, then the other foot for a second or two, and alternate from left to right repeatedly for 30-60 seconds intermittently throughout the day.
- Seated Balancing. When you are comfortable with lifting one foot and then the other, and can do it with good posture, try lifting both feet off the floor and balancing on the ball. Work at keeping a good upright posture during these movements. The first few times you attempt this, I suggest moving the ball away from furniture to give yourself room to move if you lose your balance. Remember, the harder you find it to balance on a Swiss ball, the more you need the exercise.
- Forward and Backward Pelvic Tilting. Imagine the pelvis is a bowl and that you are pouring its contents out over your belt buckle and then backwards over the back of the belt. As you do this exercise, keep your head and shoulders as still as possible to encourage the pumping motion in your lower back region. This is also a good abdominal and back muscle exer-cise, too. Doing 20 repetitions two to four times every hour can be very beneficial.
- Side-To-Side Tilting. Keeping your head and shoulders still and level, rock your pelvis side to side 10-20 times, two to four times every hour.
- Pelvic Circles. Moving your pelvis in circles is also very effective. Again, keep the head and shoulders very still to encourage lumbar pumping and muscle coordination.
- Pelvic Figure 8s. You can make movements in the shape of a figure 8 in a front-to-back motion or a side-to-side motion. This is a great coordination exercise. You may choose to perform this at random or complete 10-20 figure 8s in each direction every hour for great results.
Paul Chek is founder of the C.H.E.K Institute in Encinitas, CA, and an internationally recognized lecturer and educator in the fields of orthopaedic rehabilitation, and corrective and performance exercise. For more information, call 0208-874-6942 (UK) or visit his website at www.chekinstitute.com.
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