Low Back Pain During Government Lockdown From Coronavirus
Covid 19 and the effect it has on posture and pain
The Coronavirus pandemic has grounded the world almost to a halt. With new laws being introduced such as social distancing, severe restrictions on travel, and even how much exercise we can get outdoors, people are having to spend a lot more time at home.
As an Osteopath, one of the most common presenting Symptoms to my clinic, is low back pain (LBP). There can be hundreds of different causes, however, an increase in sitting and a decrease in exercise are up there with the most common. This will be discussed and broken down to highlight some of the main causes of LBP to allow the reader to understand why he/she is feeling the symptoms of LBP worse than before the pandemic.
Covid19 therefore, has presented us with more than just a horrible virus. It will increase the levels of musculoskeletal injury through sedentary living throughout the “lockdown period”. Thankfully there are things you can do to combat this including; exercises, posture corrections and simple changes to your lifestyle in quarantine. This article will explore and give examples of these beneficial techniques.
If you would seek health, look first to the spine— Socrates
The low back curve and why it’s important
When you stand, run, swim, lay down or move in a usual functional way, your low back normally presents itself in an inward curving (lordotic) position. This is to maximise shock absorption, flexibility, and to positively contrast with the thoracic spines (kyphotic) curve, which in turn further strengthens the tensegrity of the spinal structure.
When we sit however, the low back begins to arch in the opposing direction to become kyphotic, and the thoracic spine (upper mid back) needs to slightly alter its arch also, to balance and not be fully slumped forward.
So what does this mean in terms of pain? It’s all to do with the intervertebral discs of the low back. Observe the image below. You’ll see cylindrical structures of a different material to bone in between each vertebrae. Notice how they get slightly bigger and wider the further down they get. This is because as they get lower down the spine, they need to take more weight (anything on top of it). When we stand or move the discs are loaded with fairly evenly distributed amounts of weight, and therefore can remain strong, flexible and work as a unit.
Sitting begins to arch the back in the opposite way (kyphosis), which therefore shifts The majority of the weight onto the anterior portion of the disc. The inside of the disc (nuculus pulposus) is soft and slightly viscous. This means that when the anterior disc is pinched by the vertebrae above and below due to its new kyphotic posture, the nucleus pulposus is pushed toward the posterior disc wall. Just imagine squeezing one side of a balloon. where does the air go?
Studies have shown that the posterior wall is more susceptible to pain sensitivity than the anterior wall. Over time it can also gradually lose its strong structure and small fissures can appear, leading to a weakening of the disc wall and sometimes a small bulging of the disc posteriorly. Due to the location of the nerves, usually either the femoral or sciatic. These bulges or worse, herniation, can cause inflammation around the nerve root leading to the common pain condition known as sciatica. Which involves pain radiating down from the buttock and down the back of the leg.
Quadratus Lumborum or "QL" as it's commonly known as, is a muscle which spans the space between the iliac crest of the pelvis, the transverse processes of the low back and the last ribs. It gets its name from its shape and position. Quad (quadrangle) and Lumbor (lumbar). Humans have two of these muscles, one on each side of the body as shown in the picture below. It functions to rotate and side bend the trunk as well as stabilise it. It works best, just like any other muscle, when it is used. Stretched and contracted, twisted and pulled, whilst continuously working together with its brother on the opposite side.
Picture what this muscle looks like when we're doing something active such as running, as the right leg moves back the muscle contracts to slightly elevate and rotate the pelvis, its responds thousands of times to control the upright position and stability of the torso, and its dragged up and down as the ribs move to help us breathe quicker. In other words, its extremely used to activity and can tolerate and thrive off high amounts. Now picture these muscles, one on each side in a person who's been watching a film for the last hour and a half, slouched to the left over the arm of their sofa. What would it look like? One side would probably be stretching, the other probably scrunched up. Regardless of position, the key factor is that they've been in this position now for 90 minutes. So when the same individual leaps up after the film to make a hot drink, is it any wonder that one or both sides of the low back feel tight, guarded and sore?.... In this situation, sitting slouched to the left on the sofa is absolutely fine. What isn't fine, is not moving for 90 minutes. Simply breaking the time up and either standing up or adapting one of the postures we will discuss below, as well as swapping sofa sides can make a huge difference.
What can be done?
There are plenty of great exercise to be doing which will keep you moving and negate the effects of sitting for longer than you usually would.
Below is a list of exercises I’d recommend and a video of me performing the exercises with good form! I’d recommend doing these exercise morning and night and sometime throughout the day, particularly if you’ve just spent a long stint on the sofa.
Adding a form of exercise which is good for the mind can also help with pain. Stress has been shows to directly correlate with pain and Coronavirus certainly doesn’t help the situation. I would suggest either choosing an audio book to listen to as you do gentle exercise like jogging or cycling, or something like yoga and pilates, that gets you into different positions, challenges you, but also calms the mind. You’ll find your low back feels better for it.
Sets/Reps or Times
2 sets of 10 alternating
2 sets of 8, 1 sec pause at top
Knee to chest
Hold for 30-45 secs x3
Sphinx or cobra pose
Hold for 30-45 seconds
Lumbar spine rotations
2 sets of 10 alternating
2 sets of 10 alternating
Different postural positions
Sitting is the modern day way of relaxing and socialising, TV is watched whilst sitting on a sofa, work is done sat at a desk and games are played sat at the table. However, humans we’re evolved to adapt more dynamic positions, such as:
- The squat
- Sitting on the floor with legs outstretched
- Sitting on the floor with legs crossed
- Laying in A sphinx position
Alternating between these 4 positions and sitting on your sofa throughout the day will give your body the stimulus it needs to keep loose and mobile. A good way of challenging yourself, is to alternate positions every time there’s a commercial break the programme you’re watching.
Making a daily routine timetable like the one pictured below will keep you from sitting or laying in one position for too long. It will also help you be productive and feel better both physically and mentally during these unusual routineless times. You can also try to incorporate the above exercises and postural positions into your timetable.
Low back exercises
Read a book in a new postural position
Go for a run
Free unplanned time
Learn a new skill in a new postural position
TV, Hobby or craft
Prepare and eat dinner
Watch a movie sitting. Stand and move every 20 minutes
Low back exercises
Ice and NSAID's
As well as the aforementioned methods of reducing low back pain, there are also some common methods such as ice and non-steroidal anti inflammatory’s.
Ice is useful as it lowers local inflammation. This can be useful if your back has become inflamed from sitting for long periods. Make sure you wrap the ice or frozen peas etc in a tea towel to prevent direct contact between the ice and skin. If this leaves you feeling good but a little stiff, try alternating between hot and cold. Apply cold for 5 minutes then heat for 2 minutes. Alternate this as many times as you feel necessary, finishing with heat to re-warm the muscles up. This will hopefully contract and relax the muscles for you resulting in less of a dull ache.
Hopefully this has been a useful resource to you. Feel free to leave feedback or message requests for further articles similar to this one.