Over my 27 years of physical therapy practice, one constant has remained true: lower back problems are, by far, the most common problem I see. But what causes lower back problems? Essentially the causes can vary by individual, but we do know of several common risk factors. Here they are, based on both epidemiological and tissue based studies:
-Static work postures, particularly if you are forward bent (like roofers and floor installers), or twisted at the trunk (like a dental hygienist) for long periods.
-Seated work postures- sitting is the new smoking, and should be avoided whenever possible.
-Frequent, fast twisting at the trunk (yes, golfers, I'm looking at you).
-Exposure to whole body vibration (especially when sitting, like truck drivers).
-Slipping, and falling; watch those work surfaces and work areas to keep walking paths clear!
-Repeated full lumbar flexion (so why do we still use sit ups during fitness tests?)
-Inactivity- the spine relies on adequate trunk muscle strength and endurance for basic function, so too much time on the couch can lead to back pain even without injury!
-Increased spine mobility- This one is interesting- being too flexible actually increases your risk for lower back pain. Pain pain often has an element of "feeling stiff" to it, and this symptom often leads people to seek some type of stretching to ease their symptoms. This is often a mistake, as the "stiffness" is really muscle guarding, and is usually best managed by a well designed corrective exercise program.
-Low trunk muscle endurance- the theme repeats itself, but exercise (and the correct exercise) is essential for lower back health.
-Awkward motor patterns. This is why we frequently get injured doing motions we are not familiar with. The real danger here can be with exercise classes, where people are often challenged with motion patterns they have never done before. If it new to you, please go slowly!
So there you have it. By now, we all know most of the risk factors for heart disease. It is time we started to pay attention to risk factors for a problem that is far more common.
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