MOVE: May 15, 2015

Intersections - proceed with caution

Spoiler summary - Intersections can leave you injured and in pain if you're not paying attention....and it's not only when you're driving.  

In 2007, 40% of crashes and more than 20% of fatalities happened at intersections (reference) - that's 2 out of every 5 incidents - which is pretty staggering if you think about how many different types of controls (stoplights, signs, traffic control officers, etc) are in place.....but since the brain/body doesn't do nearly as well with multi-tasking as it does with a singular focus, maybe it shouldn't surprise anyone.  

In many ways, the lower back is the intersection of the body - something like a 5 way stop: The torso, left and right upper extremities as well as left and right lower extremities all coming together, often doing their own thing.  Somehow, not unlike the police officer directing traffic at a complicated and busy intersection, it's the job of the lower back to keep things under control but still moving with a predictable flow.

The lower back is made up of 5 bones sitting atop the pelvis (a platform made by the lowermost section of spine and the hips).  To successfully manage the intersection, it needs to be both flexible and stable, so the upper body can be positioned to do work and not crumble in the process. To make it even more complex, it is built to do this while the lower body is doing something entirely different.  Think about a person dribbling a basketball or, say, a hockey player skating backwards while generating enough power to put-in an overtime game-7 goal (congrats Rangers fans): the upper body is doing one thing, while the lower body is doing something else.  If the lower back is too flexible in this case, the upper body crumples forward and timing is off (often a source of pain); but if not flexible enough, the strain and shear of moving with force or speed causes pain.....so the balance is critical.

Generally speaking, it is in this balance (or perhaps imbalance) that most frequently see issues when people ask us to evaluate their lower back.  Either things are a bit too flexible and muscle timing is off, or things are not flexible enough and tissues strain which causes compensations in movement and eventually pain.  The tricky part is, that although entirely different, both can cause the similar discomfort.  This is one of the reasons back pain is one of the most perplexing (and disheartening) ailments faced by adults all over the world -- statistically almost every single one of us will have at least one episode -- that's the bad news.  The good news is, over the last 20 years, the research has clearly shown that if you pay attention to the signs/stop-lights and occasional traffic-cop, you can determine the pattern, act on it quickly (for best results do so in the first few days) and correct the movement-fault with no permanent impact.  The even better news, which wasn't always thought to be the case, is that most people, even those with longstanding back issues CAN improve by correcting the pattern and restoring normal movement.

Being able to recognize the pattern is not simple, but it's often the key to success. The following questions can help point you in the right direction:

1. Does your discomfort change with movement? Better or worse?

2. Does your discomfort change with sitting versus standing? Which is worse?

3. Does your discomfort travel or radiate?  To where and is it an occasional zap or steady?

4. Do you find that stress plays a role?

5. Is it impacting your sleep?  If so, more "toss and turn" or "it wakes me up"?

6. How long are you typically sitting each day (including commuting time)?

7. Is your discomfort "seasonal" (winter vs. spring)?

8. Does discomfort come in "episodes" (lasts for 3 days vs. weeks vs other)?

9. Was there a specific trigger or was it gradual?

10. Do you know your pattern and how best to control it?

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What about Prevention?  What about a person who doesn't ever want to experience back pain (or had an episode but never wants to have it again)?

Like most things - prevention is less complicated - but it takes consistency.  Here are some considerations:

1. Movement is key - the more you sit, the more you compress your lower back like a spring.  Even "good posture" can produce significant force at the lower back.  Movement helps distribute the force to other areas and give the stressed-tissues a break while improving circulation and lowering emotional stress (all good things for the back). Move frequently (at least a few minutes every hour) and consider a walking program (ideally 40 minutes per day).

2. Maintain flexibility - however this DOESN'T NECESSARILY mean "touch your toes".  In fact, this common stretch (perhaps the most common) can be the source of pain (see # 6 below).  If you're not sure what you're doing, let us know - or try this dynamic warm-up that some of your colleagues are doing daily and getting great results.

3. Maintain strength - however this DOESN'T NECESSARILY mean "sit-ups and crunches".  In fact, these common abdominal exercises can make things worse depending on your pattern.  Let us know if you need guidance.

4. Stay hydrated - the soft tissues of the body rely on water; this is especially true in compressed tissues of the lower back.

5. Avoid smoking - the connection between smoking and lower back pain is well documented.  It's a circulation thing and more.

6. Get your sleep but minimize forward bending first thing AM - we are often stiff in the morning as our tissues rehydrate when unloaded during sleep - this is good; however, since forward bending places a significant stress on the tissues, doing-so while stiff can be a trigger for discomfort.  Giving the body a warm-up period prior to aggressively flexing forward in the AM has been shown to lower "pain-days" in even the most disabling back pain cases.

7. Fuel better - if vessel damage is happening in the heart, it's also happening in the vessels that supply the lower back (and everywhere else for that matter).  Gradual onset lower back pain is considered by some as an early warning sign of circulation disorders.  Consider a fueling strategy (more plants!) that lower inflammation and improve vessel health - you might be surprised by the results.

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Of course, with as common an issue as lower back health can be, this is just the tip of the iceberg.....please don't hesitate to reach out to the team with questions.

Have a great weekend,

Mike E.