People sometimes ask me what types of injuries I see in the clinic and if there is anything I see regularly, to which I reply, shoulder and low back problems from repetitive stress and I see them all the time. They’re my bread and butter really at this stage.
Why am I seeing this so often? Simple answer is that we are all sitting down for too long and often with a poor slouched posture.
Now I can appreciate most people don’t really have a choice and have to sit down for long hours in work. That's fair enough but there are some small changes you can make to combat repetitive stress injuries that come about from being stuck in a chair all day.
Now these injuries are slow burners, you’re not going to one day suddenly pull up in pain like a sprinter pulling a hamstring!
I’ll address low back issues first and talk about the shoulder in the next blog.
Your pain gradually gets worse and worse to the point where an ‘ache’ that you have most likely been living with for quite some time and learned to ignore is now more noticeable than before and it’s not going away. And that’s what it usually is, a chronic ache, it’s rarely sharp pain but it can become sharp if ignored. Take the low back for instance, if you’re somebody that sits all day, with poor posture and have an achey low back and just put up with it or learn to ignore it, you are putting yourself at risk of doing some serious damage.
What serious damage can be done?
Well you could be simply bending down to tie your daughter’s shoelaces and rupture a disc in your lower back. This actually happened to a patient of mine, and this is the problem. Repetitive stress on the lower back leads to wear and tear and eventually the most insignificant thing like bending forward to tie a pair of shoelaces will be the straw that breaks your back!
Now this patient was an active person who exercised regularly and played football. So don’t go thinking , ‘well I exercise all the time, this only happens to people who never exercise, so I’ll be fine’.
That’s not the case at all and I see athletes regularly that have, and have had disc issues. In fact I just took a break from writing this to work at a hurling match where I had to treat a 19 yr old student who was complaining of 'achey' low back pain, and low and behold it was due to an excessive amount of sitting in class, studying and in this case cycling. If left untreated this could easily lead to serious lumbar disc issues.
This brings me back to sitting, because the damage you do sitting all day outweighs the benefit of the few hours exercise you do during the week.
Also let’s not forget to take into account the people who exacerbate the situation by doing the wrong exercises, like those of you killing yourself trying to get a six pack by doing hundreds of crunches! Crunches don’t work people, give it up, but that’s a whole other blog.
So how exactly is sitting causing my back pain?
It boils down to imbalance in muscle tissue around your lower back. Namely a muscle called your psoas. (Pronounced SO-AS). You have two of them and they both attach to either side of all five vertebrae and lumbar discs in your lower (lumbar spine) back and travel down through your pelvis and attach on the inside of your thigh bones (femur).
Their main job is hip flexion. So if you stand up and lift your right knee up, standing on your left foot, your right psoas is working to bring your right knee up in flexion at the hip.
When seated, both psoas’ are in a shortened position, and when in a shortened position all day every day this shortened state becomes the normal length for the psoas over time. The psoas wasn’t designed to be in a shortened position for extended periods of time.
So what effect does this shortening have?
It eventually gets to a point that when you’re standing up you feel pressure in your low back and it can feel like you can’t quite stand as tall as you used to. Or you might feel like your lower back is very ‘arched’ with your pelvis tilting forward. This is because your psoas is so tight it pulls on your lower back. It’s not a strong enough muscle that it will make you walk around hunched over, so it’s your lower back that takes the brunt of it. The psoas pulls the lumbar spine into an over extended position and causes an exaggerated lumbar curve and an anterior tilt in your pelvis. This over extended lumbar curve can lead to serious damage as I stated earlier and I’ll explain how issues such as disc ruptures and facet joint problems can occur in a moment.
The anterior tilt in the pelvis as a result of tight hip flexors can also have a knock on effect, especially for people involved in sports.
With the pelvis anteriorly tilted the hamstrings are put under excess pressure and the reasons for this are two fold.
1; You can not recruit your glute muscles (your butt) fully if your pelvis is anteriorly tilted. This means that now your hamstrings have to start taking on some of the leg extension work that your glutes should be doing and as a result the hamstrings get overloaded, fatigue quicker and become susceptible to tears.
2; You know the bones you can feel in your butt when you sit down?, especially on a hard chair, that’s where your hamstrings attach to your pelvis. the bones are called your ischial tuberosity incase your interested. When the pelvis is tilted forward these bones lift up slightly. This results in the hamstrings having to stretch further to their attachment point to those bones. So naturally your hamstrings are going to be tighter due to the stretch being put on them and this over time can weaken them and tears are an inevitable result.
Now the other effect of the psoas shortening is compression of the lumbar spine due to the over extended lunmbar curve I mentioned a moment ago and this is what usually causes your pain.
Picture an accordion player squeezing the accordian closed in a curve as they often do when playing. The short side of the curve on the accordian is what is happenning to your lumbar spine. The lumbar spine is put into an over extended (lordotic) position. Each joint (facet joints) of each lumbar vertabrae gets compressed and this continueous compression results in pain. If not dealt with it can lead to excessive degeneration of the joints resulting in osteoarthritis of the facet joints down the road. This will also lead to neural implications as the space for the nerve root is diminished due to joint deteriation resulting in radicular pain travelling down the legs.
The other more immediate risk of being stuck in this over extended position is disc problems. You have 5 discs in your lumbar spine. They sit between each lumbar vertebrae. They are filled with a fluid and help absorb pressure through the spine. They are designed to absorb equal amounts of pressure between them and this is achieved as long as the spine is in a neutral position.
So when you are over extended in your lumbars your putting excess pressure on one side of the discs. Often what can happen is the lumbars get stuck and all movement in the lumbar spine is done through one joint as opposed to 5 moving in sync with each other. This is called ‘hinging’ and is a recipe for disaster as one disc takes all the pressure. I’ll use a couple of analogies here to describe what happens.
Imagine your disc is a water balloon. If you squeeze one end of that water balloon where does all the water go? It gets pushed and squeezed to one side of the balloon right? So this is what happens to the fluid in your lumbar disc causing massive pressure on the walls of the disc, (the annulus), and can result in a rupture of that wall. This is extremely sore and can lead to serious neural complications in some cases.
Now the other analogy is if you imagine a wire hangar. Now if you bend that hangar in half and then bend it back to its correct position, no major harm done right? But if you do this repeatedly its eventually going to snap, and this is what happens when you have a hinging movement in your lumbar spine and the result is a disc rupture due to excessive wear and tear to the disc in question.
So whats the moral of the story?
Well the moral is, and especially for you desk jockey’s, is to try and break up your routine of sitting all day. Get up and walk around for a minute or two every hour. I actually had one patient who would have her alarm on her phone go off every hour in work to remind her to get up and move and stretch a bit. She found it very useful and I always tell people about it as its a great idea, because we can all appreciate that 3 or even 4 hours can disappear while your seated engrossed in your work.
I highly recommend stretching your hip flexors regularly, even a couple of times a day. Check out the numerous ways you can do it on youtube. You will definitely find one that suits you. If you are at a point where you are past the point of no return, and are chronically tight in your hip flexors, and have low back pain well then get an appointment with your health care practitioner and go from there. Its an easy fix if you seek treatment early doors and literally a stitch in time will save you a whole heap of pain down the road!
Richard McDonald B.Sc. MIAPT