Pop quiz! What are the top 3 most common reasons why people visit the doctor?
If you’ve listed flu, fever and cough as your answer, all of those are incorrect — sorry.
The correct answers, according to various studies, point towards skin disorders, joint pains and back pain.
Though the title of this article might’ve given it away, were you surprised that back pain landed on the top 3 list? Well, back pain is such a common problem that ACA stated that at least 80% of a population would have encountered it.
Things have only been made much worse after the pandemic hit, with work-from-home (WFH) policies being implemented to curb the spread of Covid-19.
With more time spent at home, the chances of people becoming more sedentary, sitting hunched over their desks the whole day, and even utilising improper home office furniture can lead to unwanted discomfort and back pain. Sometimes, even stress can cause back pain.
Anyway, enough about the problems. What we want are solutions, right?
We hear you, and so we enlisted the guidance of physiotherapist Resshaya Roobini, who is also pursuing a Ph.D. in Health Sciences (Physiotherapy).
Roobini, whose work involves the promotion of an active lifestyle to avoid any future health and physical problems, discusses how we can have our own backs at home.
Do you think people are still unaware of bad posture and back care in general?
There has been a lot of emphasis on back care in recent times, especially among corporate departments. I’ve seen many circulating infographics encouraging intermittent movement and stretching during predominantly sedentary desk jobs, which is a step in the right direction.
The level of awareness has increased over the years, but back care is often neglected despite knowing the potential risks or consequences.
Based on my experience, back care is usually sought after an injury when some of these injuries could have been prevented with some simple lifestyle changes or exercise.
And the various lockdowns and WFH policies just added to this, right?
Absolutely. Our research team conducted a study among older adults during lockdown, which found that older adults who were generally sedentary reported a significant increase in back pain (which they did not have before the lockdown), just three months after.
Although the study we conducted was among the older population, the root cause remains the same. Existing evidence points towards sedentary behaviour and physical inactivity as a cause for the rise in back pain complaints.
The lockdown has forced most of us to stay at home, as groceries and food can be delivered, and there were also strict regulations regarding outdoor physical activity. Even the most active individuals would have faced a decline in their activity levels.
Although health organisations like the WHO have been promoting methods of remaining active at home, I suppose being comfortable (we are at home, after all!) may have influenced many to remain dormant (myself included).
What are the common causes of back pain?
Most individuals are or have been away from the office, working at home with existing furniture. They’d usually create a makeshift workspace, which may have contributed to the increase in back pain complaints.
The lack of ergonomics in home-work spaces, habitual sitting positions, not taking intermittent breaks to just get a bit of movement in are all possible factors of back pain.
There is a misconception that sedentary behavior is associated with the common couch potato and the “Netflix and chill” stereotype.
Even if you are lying in bed with your favorite book, sitting while knitting a blanket, completing an assignment on the computer for more than 2 hours without moving, that’s just as sedentary.
In my opinion, the decline in physical inactivity is one of the leading causes of increase in back pain reports during the lockdown, but there are other causes like:
- Structural problems of the spine
- Deterioration in the cartilage
- Vertebral fracture
- Lifestyle causes such as slouching, lifting heavy objects, being overweight, physical inactivity, wearing high heels, even stress; all of which put a lot of pressure on the spine to maintain posture and alignment
- Fungal or bacteria infection, or infection to the spine (osteomyelitis),
- Kidney stones
- Loss of nerve function
- Cancer or tumours in the spine
Tell us about the many types and symptoms of back pain.
Back pain is a huge umbrella term that ranges from ignorable, tolerable to debilitating in nature. It has been labelled the leading cause of disability on a global scale.
Back pain itself is a symptom of an existing medical problem. It could involve the ligaments of the spine, muscles, nerves, vertebrae (bony structure of the spine), or intervertebral discs.
The most common cause of back pain is muscle strain or muscle spasms which may have occurred due to misuse or overuse of the muscle, improper sleeping position, sports injury or lifting heavy objects. These symptoms should resolve over a few days or weeks.
However, symptoms that are present for longer than a few months are considered chronic.
The common symptoms of back pain include:
- Aching pain
- Sharp shooting pain radiating down one or both legs.
- Inability to maintain straight posture due to pain.
- Decreased range of motion (especially bending backwards)
How can one tell if the back pain could be something serious?
Usually, mild back pain that is muscular in nature may gradually resolve with self-care over time. I would recommend seeking medical opinion if:
- Your condition has persisted over a few weeks
- The pain has increased and did not resolve with rest
- The back pain presents with a fever
- The pain is radiating to one/both legs
- You are experiencing weakness, numbness, or “pins and needles” in one/both legs.
- Loss of bowel or bladder control
- Severe pain which worsens at night
- Presence of fever
- Abdominal pain
- Unexplained weight loss
If you are experiencing back pain after a fall or traumatic accident, you must seek medical attention immediately.
Individuals who have been experiencing backaches or have already been diagnosed might be able to gauge themselves based on their pain pattern.
However, it is always best to seek help when it starts to feel unfamiliar. Back pain is not something to dismiss lightly as it could become severely painful and disabling.
I would recommend going to a doctor first to confirm if any investigatory scans (X-ray/MRI) would be required. If so, bring these scans along with you to your rehab specialist to enable them to identify and treat your condition with precision.
What are some helpful exercises for back pain?
Before partaking in any form of self-administered exercises, know the cause of your back pain. Some exercises are contraindicated for certain causes of back pain as they may aggravate the condition.
I would suggest carrying out these exercises on an exercise mat for comfort and safety:
- Wall sits are a good exercise to carry out in between prolonged sitting.
Stand a width apart from a wall. Lean carefully on the wall so that your back is against it. Bend your knees and slowly slide down with your back against the wall till your knees come to about 90 degrees. Hold this position between 10 to 15 seconds. You can repeat this exercise several times a day.
- The ‘cat and camel’ is my favorite back exercise for its name and action.
Start on all fours on the floor. Inhale deeply and arch your back by lifting your lower rib cage as high as possible, forming a camel-like hump. Slowly exhale and lower your chest towards the floor, while looking upwards slightly to create a dip in your spine. Repeat 3 to 5 times, twice daily.
- The superman stretch is important for strong back muscles that support the spine and pelvis.
It also aids in maintaining good posture. Lie on your belly with hands and legs outstretched but on the floor. Lift both your legs and hands above the floor as high and stretched out as possible, like superman in flight. Hold for about 5 seconds and return to the starting position. Repeat this exercise 8 to 12 times for 3 sets.
- Bridging is a core strengthening exercise.
Lie on your back with both knees bent and feet planted on the floor. Inhale, squeeze your buttocks as tightly as possible and lift your hips. Knees, hips and shoulders should form a straight line. Hold for 10 seconds and return to the starting position slowly. Repeat 8 to 12 times for 3 sets.
- Pelvic tilt is a very specific exercise to the pelvis.
Lie on your back with both knees bent and feet planted on the floor. Space your hips apart and relax your body. Your lower back must be firm on the floor and try to squeeze in the abdominal muscles. Tilt the pelvis back and forth in a slow rocking motion. You will feel an arch forming and diminishing in your lower back during the movements. Repeat 8 to 12 times for 3 sets.
- The spine stretch is one of the best back stretches for the lower back.
Lie flat on the ground with your knees bent and closed together, feet on the ground. Relax your upper body with your hands outstretched to the side.Roll your knees and pelvis to one side while keeping your upper body and shoulders firm on the floor. Breath in and out deeply. Return to starting position before rolling to the opposite side. Repeat about 8 times a day.
- Partial curl-ups are a simple exercise for a strong core and increased stability to the spine.
Lie on your back with your knees bend and feet on the floor hip-width apart. Cross hands over your chest, lift your head and shoulders off the ground while keeping your neck and spine aligned (no curling of the body, just lift).Hold for 5 seconds and return to the starting point. You may repeat this 8 to 12 times for 3 sets. The aim is not to meet your knees, feet should remain firmly on the ground.
- Child’s pose is a good stretch for the upper body and pelvis.
Start with all fours on the floor. Touch your feet together and slowly lower yourself till your knees are apart and your buttocks rest on your heels. Bend your torso forwards simultaneously with your hands outstretched in front of you. Hold this pose for about 15 to 30 seconds and repeat it 5 times.
- Aerobic exercises are a good way to improve endurance and circulation in the body.
Brisk walking, jogging, running, biking, swimming, and dance aerobics are a few workouts to choose from. Play your favorite songs and dance them out for at least 15 minutes a day at home.Swimming is an excellent exercise for not just improving endurance and muscle strength, it also provides pain relief as the water will support your body weight and relieve pressure on the spine.
These are a few of the home-friendly exercises which can be carried out with ease. Always create a safe environment to carry out your exercises and stretch before and after your workouts.
If you happen to have a deep tissue massage gun like HYDRAGUN, then use it to enhance your exercise performance before and after working out.
Exercise aside, what tips do you have for preventing back pain?
- Proper lifting techniques are so important.
Most people bend their spine over to pick or lift something off the ground and that’s the trigger for back injuries. I constantly remind my clients, friends and family to always bend with their knees to reach the ground, not the back.
- Change your shoes. Wearing high heels frequently has been linked to back pain and the suggestion is to swap your stilettos for a maximum of one-inch heel height. Now I can empathise for I do enjoy wearing my heels as well, my personal suggestion is to mix it up. Choose one or two days in a week to wear your heels and not for prolonged hours.
- Maintaining good posture is a simple and effective way of preventing back pain. Remind yourself to roll your shoulders backwards every once in a while and sit upright in your chair. A good chair with good lumbar support is key in back pain prevention. Yoga is also an excellent method of improving posture and core strength, which will help with back pain prevention and management.
- Sleeping positions play a big role in alleviating or aggravating back pain. It is important to ensure that your pillow is not too thick that it strains the neck when you are lying down. When lying on your back, it is suggested to place additional support below your knees (pillow/bolster/rolled towel). This will keep the curve of your lower back whilst reducing stress to the spine.
It also improves the alignment of the spine and internal organs.As an alternative, you may also try lying on your side with a pillow between your knees. The pillow between the knees keeps the hips, pelvis and spine aligned.
For those who have a habit of sleeping on your abdomen, though it may be comfortable it can lead to or aggravate existing pain. This is due to the stress this position may place on the cervical spine (neck).
Modifying this position by tucking a pillow under the lower abdomen and pelvis will relieve any stress that is placed between the discs of your spine.
For those who are experiencing disc herniation of the spine, it is advised to sleep in a curled-up fetal position.
Simply tuck your knees towards the chest and curl your torso towards the knee. This position alleviates any pressure placed on the discs and opens up space between the spine.
Do not forget to switch sides intermittently to avoid muscle imbalance or postural scoliosis.
What can people do to alleviate or relieve the pain at home?
Prevention is key! Do not wait till you have back pain to relieve it.
Always remind yourself to take a 2-minute walk-about break every hour. It could be just walking within your workspace, walking to and from the washroom or getting yourself a snack from the fridge — anything really, as long as the prolonged sitting cycle is interrupted every now and then.
In addition, there are always a few quick ways to relieve pain. If your pain is acute or has occurred due to an injury, applying a cold pack to the area.
If you don’t have a cold pack, it’s always good to have a bag of frozen peas to use as a substitute. Ensure that you place the ice pack over a towel or cloth and not directly on the skin as it may result in ice burns.
However, if you have been diagnosed with chronic back pain then you may use a hot pack to soothe the pain. Again, it should never be directly on the skin but wrapped with a towel first before applying to the affected area.
Applying pain relief ointments may also be soothing. If you are experiencing muscle aches or have exerted yourself after a day of continuous activity, then self-massaging the area would be a therapeutic pain relief measure.
The HYDRAGUN deep tissue massage gun is an effective tool to not only relieve pain but also improve blood circulation in the targeted areas which will speed up the healing process.
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Excellent article. A concise coverage of back problem. Well documented. Valuable information and very practice. Looking forward for more well written articles blike this. Syabas.
Thank you for your informative article Resshaya. You covered off on a lot of important points and I just wanted to dive a bit deeper into sleeping postures and waking spinal pain, which was the topic of my PhD.
Historically sleep posture has been defined as supine (chest facing ceiling), prone (chest facing floor) and everything else as side lying. Consequently around 60% of the time adults are classified as sleeping in side lying. Due to this large side lying grouping and wide range of side lying postures, we sub-classified it into supportive side lying (ie spine neutral) and provocative side lying (ie spine rotated/extended) based on plausible tissue loading. We found that participants who spent more time in prone (as you mentioned) and provocative side lying experienced the most morning symptoms. In our follow up study, we found that following an educational session, participants were able to change their sleep posture and at the same time, experience a reduction in their waking spinal symptoms. Interestingly, it wasn’t a reduction in time spent in prone that we observed, rather a decrease in time spent in provocative side lying and a corresponding increase in supportive side lying.
Best wishes – Dr Doug Cary PhD | Musculoskeletal Physiotherapy Specialist
Thank you for sharing your interesting research findings Dr Cary! Education and awareness play such important roles in improving health outcomes!