Common causes of Lower Back Pain : Sitting and ... Physical Activity?
Finding the right amount of activity for you is key
Increasing our levels of physical activity has become a focus for some of Canada’s leading health agencies and experts. Recent guidelines have recommended that we perform at least 150 minutes of exercise per week at a moderate to vigorous intensity. These same guidelines recommend that we limit the time we spend sitting and the time we spend at screens. These recommendations are made with overall health in mind as we see a multitude of health benefits with increased activity and reduced sitting. What do these recommendations mean for people suffering from low back pain? We will look at the research on sitting and low back pain. We will also look at research on physical activity and low back pain.
For the purpose of this post, we have to clarify a few different definitions. Physical activity is any type of sustained physical movement, it can be work related, or exercise. Low back pain is pain that is reported pain by a person in the posterior (rear) region of the body between the areas of the lower rib cage and the hip joints. Sitting is time spent, not standing. These definitions will hopefully add to our understanding of these topics.
Prolonged sitting has been suspected as a risk-factor for low back pain for some time. Many health care providers will hear from many low back pain sufferers that sitting is worse for low back pain, especially in tasks like desk work and driving. When we examine the research in the area it is difficult to get a definitive answer that sitting causes, or is a risk factor in low back pain. A recent study (Gupta et al., 2015) called NOMAD (New method for Objective Measurements of physical Activity in Daily living) examined the relationship between occupation and leisure time sitting and found an association between low back pain and sitting time in blue-collar workers. Research known as the Young Finn study (Shiri et al., 2013) found that low levels of physical activity and obesity are both independent risk factors of radiating (shooting pain down the leg) low back pain. When we examine the physical relationship between a lack of activity and physical findings, Teichtahl and colleagues (2015) found that individuals who were less active, had thinner discs in their lumbar spine, and a higher incidence of high intensity low back pain. While it is difficult to say that sitting, on its own, would cause low back pain, there does seem to be a relationship with the length of time we spend sitting and the intensity of low back pain and an increase frequency of high-intensity low back pain.
Above we described sitting duration, which is often considered to be a lack of physical activity, and low back pain. Another important question to ask is: «Can increased physical activity lead to less low back pain? ». Physical activity as recommended (150 minutes per week, at a moderate to vigorous level of intensity). Some evidence suggests physical activity may protect us and help us recover from low back pain as well. The Young Finn study mentioned above found a U-shaped relationship between level of physical activity and radiating low back pain. This suggests that people who participate in very low levels of physical activity are at a higher risk of radiating low back pain, but also people who participate in very high levels of activity are at a higher risk of radiating low back pain. A randomized control trial compared the effect of walking and education on chronic low back pain with education alone (McDonough et al., 2013) found that functional scores, pain, and physical activity levels improved in the group that participated in the walking program. We have some evidence to suggest that physical activity is good for low back pain. Walking is considered a good form of physical activity for low back pain. Too much physical activity may be a similar risk factor as too little. Finding the right amount of activity for you is important.
While physical activity, alone may not be the total solution for all types of low back pain, it should be considered as an essential corner stone to all programs aimed at treating low back pain. Sitting too much may increase our risk of low back pain. It appears that sitting while at work, and while we are off work are both contributing factors to developing low back pain, especially that of higher intensity. While the intent of the recommendations made by groups like Exercise is Medicine Canada is to improve overall health, a pleasant side-effect is that following these recommendations is likely to improve low back pain as well.
Written by Ben Matheson
Mathieu Bélanger, MD, CCFP, CPSO Recognized Specialist (Chronic Pain), is the founder and President of Inovo Medical. Dr. Bélanger began his academic career by earning an undergraduate degree in kinesiology (i.e., the science of body mechanics) before enrolling in medicine at the University of Montréal. He is particularly interested in pain related to sports injuries and musculo-skeletal disorders. This interest led him to travel extensively for various types of training on pain treatment given by leading experts. Since then, his objective has been to play an active role in the development and delivery of the most sophisticated and effective treatments for chronic pain. By founding Inovo Medical, Dr. Bélanger hopes to deploy stem-cell technology in Canada, given that the results achieved with this technology are revolutionizing pain medicine.