Notice the Lower Spine Forward Bending
“Yesterday morning I was sitting down lacing up these boots, and all hell broke loose.” (Sudden onset LOWER BACK PAIN broke loose) “I don’t know how I could get in such bad shape without doing anything.”
“… last time it was brushing my teeth.”
These are the opening comments of a patient seen in our office today. It describes the so-called natural history of back pain which I have spoken of here previously.
Here are some of the issues we know about. First, it’s early morning. The body isn’t warmed up. It may be, and probably is stiff (this patient is 72 years old). Second, at night while horizontal in sleep, the discs between the vertebrae expand and fill with water (if they are healthy enough). That increases the pressure inside the disc making it even more vulnerable to damage if stressed by postural alterations. Thirdly, even if none of that were the case, you still need to know when you are not maintaining the Neutral Spine posture.
Sitting in a chair leaning forward to lace shoes is a classic example of when folks violate the Neutral Spine rule without realizing it. (Kinda like the lady in the lawn chair in the photo.)
Imagine the pressure on the lowest lumbar disc. Even when it’s perfectly healthy disc (which is rare), it’s still a high risk move.
So How Do You Tie Your Shoes Safely?
Instead of sitting on the chair and bending over to tie your shoes, stand up. Put your foot on the chair. Keep your spine straight and bend your knee and hip to reach your shoes. Now, I know, not everyone has that kind of flexibility, and not everyone is going to have it. But if you still do have it, or you can get it, that is one way to avoid the risk of injuring or re-injuring your back. Keep it straight (or in Neutral Spine if possible), but try not to bend the lower back forward any more than you have to.
BTW, maintaining Neutral Spine while brushing your teeth is also a good idea. It’s like doing dishes. That little bit of forward bend – if you are at risk or in recovery – can put you over the edge into a relapse or new episode.
There are ways and times when you want to bend the lower spine forward to stretch out the back muscles. That’s not what we are talking about and is a different conversation.
I hope this helps.
You can take some of the pressure off you back by tightening your abdominals, so your tummy is doing all the work. It’s important to do everything you can to prevent back pain in the future, so what better time than when you are not in pain? It’s also a great trick to try when lifting is unavoidable too.
Comment by Dr. Olsen — January 31, 2012 @ 7:06 am
Well said. The first “exercise” that we teach patients when the goal is stabilization is “bracing,” which is tightening all of the trunk muscles. This is a way for a patient to get familiar with what it feels like and re-connect with those muscles – to learn control and gain awareness. Increasing that consciousness allows a patient to then engage these same muscles when they need to whether lifting or bending or getting up out of a chair or off the bed.
Comment by doctordilday — January 31, 2012 @ 11:26 am