Move that back to avoid chronic pain

This story was first published in The Straits Times on Jan 23, 2014

When lower back pain becomes a permanent problem, even walking can hurt.

Heavy lifting, sitting at work for long hours and sports injuries can trigger lower back pain.

Studies have shown that workers who sit in front of the computer for long periods and who adopt "restricted" postures appear to be at higher risk of musculoskeletal complaints, said Ms Leo Yiru, a senior physiotherapist at Changi General Hospital.

Restricted postures frequently involve kneeling, stooping and squatting, she added.

While there is no magic bullet for this problem, studies have shown that exercise can prevent chronic lower back pain, said Mr Lian Guojie, a physiotherapist at the Singapore General Hospital.

But it is unclear which type of exercise is most effective, he said.

Since all types of exercise help to reduce pain, this made researchers think about the effects of exercise, one of which is that it turns the "volume" knob down in a nervous system which already has a heightened sensitivity to pain.

Research has shown that chronic lower back pain is driven by both physical and non-physical factors.

A big physical factor is the adoption of "mal-adaptive" movement behaviours.

When one suffers a back muscle strain, he compensates by moving in a way which is less painful.

This is "adaptive" movement and it protects the musculoskeletal system, explained Mr Lian.

Take, for example, a person who sustains a back injury.

Every time he needs to bend over to lift an object, he moves cautiously, keeping his back straight and stiff to avoid further strains. If the injury is not serious, he will eventually recover. In an ideal scenario, this person will be able to gradually bend his spine again.

However, not everyone will recover so well, said Mr Lian.

This is because they maintain the "adaptive" movement patterns throughout their recovery phase.

In other words, they avoid bending their backs.

Many may harbour beliefs or have misconceptions reinforced by other people that their backs are permanently injured, making them incapable of lifting or bending again, and that they must keep their spines straight all the time, said Mr Lian.

This prolonged state of "adaptive" protection now becomes "mal-adaptive".

Such movements now drive a vicious circle of over-activity of the abdominal and back muscles.

This puts additional strain on a spinal column that is already sensitive to pain.

Because of his fear of bending over, the person then starts to avoid daily activities, such as grocery shopping, and becomes physically weaker.

Studies have shown that such people are unable to relax their abdominal and trunk muscles, which include core muscles that stabilise the body during movement.

While people who are less seriously affected can gradually return to their normal day-to-day activities, they will still continue to complain of pain, said Mr Lian.

Psychological and social factors, as well as emotional distress, can also affect how well a person recovers from lower back pain.

They include inaccurate beliefs about lower back pain, depression or anxiety, job dissatisfaction and disputed compensation claims.

In fact, many studies have shown that these factors play a bigger role than the actual severity and duration of the injury, said Mr Lian.

That is why some people report pain while walking, jogging, bending and lifting even though their physical injuries have healed.

Physiotherapists are trained to identify physical and non-physical risk factors with the use of screening tools, said Mr Lian.

The best way for people to avoid developing chronic symptoms is to seek help early. For example, when they do not seem to recover after sustaining an injury, when their symptoms are affecting their daily activities, or when they feel so crippled by their pain that it starts to affect them physically or emotionally.

He added that they should not be afraid to exercise. They should choose an exercise that they enjoy the most and aim to do it for 30 minutes every day.

If this is too demanding, he suggests starting with 10 minutes of exercise a day, and increase this gradually by 10 per cent to 20 per cent every week.

Regular exercise, rather than the type or intensity of the exercise, is more important, said Mr Lian.

Examples include brisk walks in the park, a light swim in the pool or a leisurely bicycle ride.

Stretching and flexibility exercises also help to ensure that muscles and other supporting tissues are less prone to injury. Office workers who have to spend long hours sitting and people who work in jobs that require prolonged standing or repetitive bending of the back will benefit from these exercises, said Ms Leo.

Ms Vanessa Lange, senior physiotherapist at CGH, demonstrates some stretching and flexibility exercises, which focus on improving the flexbility of the lower back and hips.

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Trunk rotation

  • Sit on a chair.
  • Place the right arm on the back of a chair.
  • Rotate the upper body left and right to feel a stretch in the mid-back area.
  • Hold the stretch for 30sec and do the exercise three to five times with each arm.

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Lower back side stretch

  • Stand with one hand on the hip (Photo 1).
  • Bend over with the opposite hand stretching overhead (Photo 2), keeping the pelvis level to the ground.
  • Feel a stretch at the side of the trunk.
  • Hold the stretch for 30sec.
  • Do the exercise three to five times.
  • Switch hands and repeat the steps.

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Hip flexor stretch

  • Stand with one leg behind the other (Photo 1).
  • Push the buttocks downwards to feel a stretch along the front of the back leg’s thigh. Keep both hips facing forward and do not arch the lower back (Photo 2).
  • Hold the stretch for 30sec and do the exercise three to five times.
  • Switch legs and repeat the steps.

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Hamstring stretch

  • Sit on a chair and stretch out one leg.
  • Keep the stretched leg straight.
  • Bend the upper body forward to feel a stretch behind the thigh.
  • Keep the trunk straight and bend through the hip.
  • Hold the stretch for 30sec and do the exercise three to five times.
  • Switch legs and repeat the steps.

This story was first published in The Straits Times on Jan 23, 2014

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