Guilderland, NY – We hope you all had a great holiday and healthy start to 2017. Due to our activities this is the time of year that we tend to see an increase in lower back injuries. Lifting heavy boxes full of holiday decorations, shoveling snow, and spending more time sitting indoors to avoid the winter cold all put extra strain on the lower back, particularly the intervertebral discs.
The intervertebral discs are located between each vertebrae of the spine, allowing movement and flexibility, as well as to serve as shock absorbers. The disc is made up of a strong fibrocartilage outer edge called the annulus, and a gel-like inner core called the nucleus pulposus. In the lumbar spine, the back wall of the annulus is thinner than the front wall, and the nucleus is positioned slighted posterior to the center of the disc. Due to our normal anatomy, the back wall of the disc is much more susceptible to injury. Poor posture, excessive sitting, improper bending or lifting mechanics, and inadequate core and back muscle endurance make the back wall of the intervertebral disc vulnerable to injury. Sitting in a slouched position in a chair or recliner over time stretches and weakens the back wall of the disc; although it feels good to slouch or sit for long periods, we often stand up feeling stiff.
Imagine having a weakness in the back wall of the disc, then flexing forward and twisting while shoveling the driveway, or pulling a heavy box out of the attic. This combination forward bend and twist motion forces the gel-like nucleus to gravitate toward the weakened back wall, creating a bulge. At first, this might be painless, or cause short-lived back discomfort that resolves quickly on its own. Over time, the bulge may cause irritation to the nerves exiting the spinal column, causing more significant pain in the back that may radiate to the buttock or leg. A disc herniation in the lower back occurs when the gel-like nucleus breaks through the weakened annulus, further irritating or compressing a nerve root, often causing pain, numbness, tingling or weakness in the leg. Because these injuries can be caused over time by cumulative trauma of poor posture, excessive sitting, incorrect bending or lifting mechanics, or inadequate core strength, significant back or leg symptoms can appear with simple movements.
Patients with injuries to the intervertebral discs commonly present to chiropractic offices. Fortunately, the majority of disc injuries are treated conservatively. The key is to understand the cause of the injury, to make changes in your daily life to allow the injury to heal, and to avoid movements or positions that cause a spread of symptoms further away from the spine.
First and foremost, patients dealing with acute disc injuries must control inflammation to promote a healing environment. A disc injury can be compared to an ankle sprain: you would not want to stretch a painful inflamed ankle in the direction you twisted it in until it has had a chance to heal! Secondly, one must limit time sitting. Prolonged sitting, particularly with poor posture, increases intradiscal pressure and strains the already weakened back wall of the disc. Make it a point to stand up at your desk at work every half hour and try to maintain the natural curve in your spine while sitting. Good posture helps preserve the normal position of the nucleus which takes pressure off of the back wall of the disc allowing it to heal. Core stabilization exercises done in a position that maintains the natural curve of the spine helps you hold good posture at rest as well as to protect your back during movement.
Sleeping position is also very important to consider when dealing with a disc injury. Lying on your back, or lying with the painful side up with a pillow between the knees tends to be a safe, comfortable position.
When bending and lifting, make sure to contract your core musculature, maintain the natural arch in your lower back, and hinge from your hips and lift with your legs. Do not bend from your back. It is important to remember to look up and keep your chest up before you lift. Keep a wide stance if possible and hold what you are lifting close to your body. If you must turn, pivot from the hips instead of twisting from your lower back.
Make a resolution to protect your spine this New Year and don’t delay seeking out care! If you have any questions about this article, please feel free to contact us at the Sports & Spinal Wellness Center at 518-869-3415. Please visit our website for more information at www.sportsandspinalwellness.com. We would be happy to be a part of your healthcare team.