Mechanical lower back pain peaks during working adult life, but there are steps we can take to manage it. Photo / 123RF
Research shows that low back pain is the leading cause of disability worldwide – here’s how to manage it.
Are you sitting comfortably? If you’re between the ages of 35 and 60 it’s never been more important to do so. A new systematic review of data has concluded that low back pain is the leading cause of disability worldwide. The review, conducted by the University of Washington School of Medicine and the University of Sydney, spanned the years from 1990 to 2020, and covered more than 200 countries. In 2020 it found 619 million people suffered from lower back pain globally.
By 2050, they project that 843 million people will fall into this unfortunate category. While the new study pinpoints an ageing population for this epidemic, “back pain actually falls after the age of 60,” says Caspar Aylott, consultant spinal surgeon and lead surgeon at the UK Spine Centre in London.
Episodes of mechanical low back pain (that’s pain from the joint, instead of nerve pain like sciatica) peak during working adult life, meaning that the majority of Aylott’s patients are closer to 35 than 80. Why? “Because we sit at desks for too long and exercise too little,” he says. “It’s in those early stages of degenerating that it hurts. After the age of 60 it degenerates more, but goes through a stiffening phase. As our backs stiffen, they also get less painful.”
Eighty-five per cent of people will suffer with low back pain at some point in their lives, believes Aylott. “It’s the most common cause of time off work.” And here’s the rub. The NHS is so overloaded, he suggests, that “it cannot deal with this tidal wave of back pain”.
In the absence of symptoms suggesting sciatica (pain down the legs, for example) or red flags that could be indicative of an underlying, more sinister cause (such as cancer), you are therefore vanishingly unlikely to be referred to a specialist for further investigation, Aylott suggests. Instead, you might receive advice about pain relief and limited physiotherapy.
In other words, as he summarises: “Learning to self-manage is absolutely critical.” So what do the experts suggest we do to manage back pain at home, or in the office?
“In terms of putting load on our spine, the very worst thing to do is to sit in a slightly forward-bend position,” says Aylott. “Sitting for hours like that is as bad for the back as it could possibly be, it doubles the forces that go through your spine.” It is also, he points out, exactly the position many of us adopt to take a Zoom call.
The fix? “Make sure you have a chair which allows for proper lordosis – the normal curvature we have in our lower back,” says Aylott. A good one will have a lumbar roll behind the lower back, to help maintain the natural curve in our lower back and reduce overloading of the discs at the front of the spine, he explains. Next: “Every 20 or 30 minutes, get up, walk round the room for 90 seconds, do a few stretches and then you can go again. Little things like that are really, really important.”
“The evidence supports doing simple core exercises, the ones that exercise your tummy muscles and back muscles,” says Aylott. The key is to do these little, often and with religious regularity: “10 minutes, morning and night.” There is solid evidence that yoga and pilates too can also help, he says. Exercises he recommends might include lying on your back and raising your head and body a little to feel the abdominal muscles contract. Plank exercises are also very good for abdominal strengthening.
“I get asked the question ‘what mattress should I sleep on?’ all the time,” says Aylott. “There’s no right or wrong answer here. The idea that you need a very firm orthopaedic one, or a memory foam one… I don’t think there’s any evidence for that. But do spend proper money on a good quality mattress.”
Aylott highly recommends regular, brisk walks for lower back health. “Walking is one of the best exercises for lower back pain, because the spine is allowed to move in a very natural way,” agrees osteopath Dan Kay. “It bends to the side, rotates, bends to the side, rotates repetitively. The more walking you do, and the less sitting you do, the better your lower back pain will be.”
The key? “You want to walk at a pace that causes your arms to swing, because that encourages rotation through the upper body,” says Kay. “If you’re ambling, your spine doesn’t get the same sort of movement.”
“The roles of stress and sleep on lower back pain can’t be underestimated,” says Amberin Fur, osteopath and clinical director at The Vital Practice. “If you’re not getting enough sleep then the back can’t rest and repair. So sleep hygiene is important.” Fur suggests blackout blinds, and banning phones from the bedroom.
Also: “Choose a nice oil, put it by your bed and massage it gently in clockwise motions over the abdomen to aid natural drainage and blood circulation,” she says. “It’s a great way to relax your body and enter a deeper sleep cycle.”
“Sleeping on your front is probably the worst position for back pain,” says Kay. Instead, he suggests, “try sleeping on your side, with a pillow between your thighs or knees so that you’re less likely to cross your legs and create rotation in the spine. Supporting your neck is just as important for lower back pain. So use a pillow to keep your back and head at a right angle to your shoulder and your spine neutral.”
Sleep on your back? “Place something under your knees to reduce the tension in the lower back and prevent a curve in the back,” says Kay.
“When we see people with acute lower back pain, it generally involves them having bent forward to lift something with their legs straight,” says Kay. “Getting something out of the car or the dishwasher, lifting a child from a cot or buggy… All you have to do is make sure you bring the load close to you and bend your knees, or go down on one knee.”
Amazon lists over 4,000 products promising relief from back pain… Are any of them a guaranteed fix? “There are some great products out there,” says Fur. “But sadly there’s no ‘one size fits all’ solution. If there was, it would be the only thing on the market. Massage guns can be great, but put them in the wrong position and they can be detrimental. The same applies to foam rollers.”
Use carefully, or seek professional advice as to which suits your personal situation and what techniques will help your specific pain.
“Acute episodes of lower back pain are agonising,” says Kay. “But the situation is probably not as bad as you think it is. The brain interprets the pain in an exaggerated way because it’s trying to protect the spinal cord. So try to resist this catastrophisation of your pain. Breathing exercises can be really useful.” Kay recommends box breathing, a technique used by Navy Seals to relieve stress. Inhale for a count of four, hold your breath for four, exhale for four, hold your breath for four, and repeat.
Pain in the sacroiliac joint that links the pelvis and lower spine, or into the vertebrae just above it, is common, says Fur: “If you picture the pelvis, it’s holding the bowel, sex organs and bladder. If the bowel is congested and this area’s blocked, this potentially creates pressure and sluggish venous return [that’s the rate of blood flow back to the heart from the lower limbs]. Restoration and healing require good blood supply. Having your elimination pathways working properly also decreases unnecessary inflammation and stagnation in the body. So opening your bowels every day is actually pretty important for low back pain.” Probiotics, fibre and fermented foods can all help.
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