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What Doctors Don't Tell You

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November 2018 (Vol. 3 Issue 9)

Easing low back pain

About the author: 
Charlotte Watts

Easing low back pain image

Most of us suffer from all kinds of low back pain at some point, and much of it has to do with the little understood bottom of our spines. Here's how to ease pain and restore flexibility, says Charlotte Watts.

Experts estimate that up to 80 percent of people will experience low back pain at some time in their lives,1 and this issue is only getting worse as we spend more time sitting on chairs.

It is no surprise that movement is an effective antidote for this debilitating condition,2 but the pain involved can create a vicious cycle. The fear of exacerbating their problem can leave people avoiding exercise, becoming confused about their capabilities and what can benefit and what can worsen their symptoms.

Here are some simple tips and exercises that can help.

The sacroiliac (SI) joint

Understanding some lower back anatomy can help us make sense of why this area may become a source of tightness, pain or inflammation. Many issues arise at the SI joints, the two sites where the lowest bone in the spine—the sacrum—fits into the bowl-like bone of the pelvis (see below).

These joints are calibrated to the uniquely human bipedal standing and walking, so the sacrum acts like a keystone, supporting the spine above and distributing the weight of the upper body down through the legs. All movement stems from around this part of the spine. The SI joints can become loosened, such as in pregnancy, or fused with age or sedentary habits. If the pelvis is tipped to one side, for the spine to compensate and lift vertically, one joint will become more open and the other more closed. Any of these effects on the joint can lead to pain.

Stability between your ribcage and pelvis

There are of course many variations to how we stand, and there is no one-size-fits-all solution. Paying attention to your own patterns and any shifts you have away from your design can help find the posture that your lower back needs.

Looking at the image on the right, we can see that in the left-hand example (A), the person's ribcage is easily above their pelvis, with these 'bowls' facing each other. This is where we rise up most effortlessly through the S-shaped curve of the spine and the lower back sits comfortably.

The other examples show how this relationship can commonly go off course. In B, C and D you can see the pelvis moving further forward from the midline, and the head also moves forward to compensate for the change in center of gravity.

Each of these shifts affects the natural curve of the lower back, that optimal 30° (A) where the psoas is not stressed. When the curve is exaggerated and compressed (a banana back or hyperlordosis , as seen in B), there is a need for psoas release, alongside support at the abdominals.

In C and D, the curve is flattened, which can also occur from 'tucking the tailbone under' when standing—not a helpful physical instruction for the posture over time. Allowing the tops of the thighs to move back can help re-establish the curve in the movements that follow. This situation can also come from over-gripping the stomach, collapse in the chest, too much core work, or a combination of these.

Abdominal awareness

Standing with your knees bent, feet hip-width apart, you can move between really tucking your tailbone under (where you lose upward lift through the inner legs) and really sticking it out (where you lose upward lift through the belly).

Investigate where you find your natural curve in between—sitting bones moving forward, without drawing the tailbone under, and belly drawing in and up.

You can then investigate the curve of your lower back with your belly in this exercise where you feel your breath in your 'abdominal box.' This is the area you enclose when you place your fourth (ring) fingers on the top of each hip bone (bony protuberance to each side of the groin), each thumb on the bottom rib.

As you breathe, feel this area becoming smaller at all four points with the exhalation, larger with the inhalation. Here, you are feeling the point that stabilizes the rib cage and the pelvis and where the lower back is supported at the point of the navel, particularly with the exhalation. Honing awareness here can help you breathe into this area, which can be held in tension from pain or self-protection.

You can then feel this area as you open the front body (and psoas) in a lunge. This can feel 'pinchy' in the lower back for many, but if done intelligently, it can inform and strengthen the support you need from the belly.

Fascial release

We need to keep moving generally, and specifically around the mid-torso (such as by walking) for lower back health, to retain what is referred to as 'slide-and-glide' in our fascia. The fascia is the web of connective tissue that runs throughout the whole body, connecting every part and linking the lower spine and SI joint to digestive and pelvic organs at the center, and ultimately out to the periphery of the body.

As we age, fascia can become less mobile, drier and more prone to 'stick' or form lesions or adhesions. This restriction and inflammation can lead to pain, as the fascia cannot 'give' as we move. Add in physical trauma from accidents, abuse, surgeries, infection or radiation, which can create fascial distortions, and this whole mid-section of the body can easily become more rigid and less adaptive within the normal range of motion.

Tightness in one area of the body ripples out into others, and the site of pain very often transfers from its point of origin, so a lesion in the digestive or reproductive organs can easily transmit out to the SI joints (where the right and left sides of the colon attach) and other areas in the lower back, reaching out to hips, upper back or shoulders.

Low back pain, pelvic issues and digestive disorders go hand-in-hand-in hand—especially when the sacrum is out of place due to unevenness in the pelvis, which can be a result of habits such as repeatedly crossing your legs in one direction.

The medical route for adhesions can involve surgery to cut them out, but this can cause its own trauma and more scar tissue. Plus, lesions tend to grow back. Abdominal massage and sensitive movement in this area can help restore the hydration and slide-and-glide needed for function and even may give the scar tissue more flexibility, which can lessen pull on the lower back.

Exercises that create small, rhythmic and pulsing movements through the body help all fascial slide-and-glide, and those that move through the belly support ease of movement in the low back.

You can do these lying down, moving the knees to twist side-to-side; on all fours rotating the pelvis; or standing, to engage the feet, which are extremely important for low back health. Foot arches that have dropped can leave a person more prone to low back and neck issues, as they lose their natural uplift through muscles at the insteps, leading to difficulty.

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References (Click to Expand)

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