Bending Forward Is For The Birds. Know How To Protect Your Back From Disc Injury
I’m going to share a bit of information with you that you may not believe in the beginning. What I want to share with you is the fact that bending forward is for the birds. Not for humans. The research strongly suggests that bending at the waist is not the best thing for you. Sit-ups, straight-legged deadlifts, and something as simple as bending over to pick up a pencil in the morning is likely doing you more harm than they are doing you good.
Preliminary Information About Back Pain and Low Back Disc Injury
To help you understand why myself, as well as back pain experts around the world, say this, let me try to set the stage first.
First, did you know that the most common reason for a person under the age of 50 years old to have back pain is due to a disc injury? Up to 40% of the low back pain cases that come through our doors are low back disc pain patients right off the top.
Through the research literature, we know that 40% of back pain cases are disc injuries. Knowing that, it makes sense that it would be beneficial to also know the most common ways of injuring discs. The most common way to injure a disc is by applying load when the back is not properly braced or prepared. Many times, people just do things without thinking about them or preparing themselves for the movement or activity. We can use core bracing techniques and movement biomechanics to help us prevent putting our lower back in a disadvantageous position.
We’re building your knowledge a little bit at a time here.
Next, when a disc actually does get injured, the most likely way it injures is to bulge toward your back. They don’t typically bulge or herniate toward the sides or toward your stomach. They almost always bulge or herniate toward the back because that is where the disc is the thinnest. That is simply how we were created, that is the weak point of the disc, so that is how it usually happens.
Now consider that the disc is really like a very strong bag of water. If I have a bag of water in front of me and I push on the right side of the bag, the left will rise and bulk up. If I push on the front of the back, the back with fill with pressure, rise, and bulk up.
Now, if discs almost always push through the backside of the discs, and the disc is like a bag of water, then you can start to understand why bending forward is for the birds. When we bend forward, we push down on the front of the disc and we push all of the force and contents toward the back of the discs; i.e. the weak part of the disc. It is only a matter of time before the disc begins to have signs of failure. It can begin weakening by developing small cracks that allow the contents to push further and further toward the outer edge. Eventually, something as simple as bending over to grab a pencil off of the floor can be the straw that broke the camel’s back if it’s not done correctly.
Protecting Your Back
When we talk about protecting your back from a disc injury, the first thing we want to say is that you desperately need to limit trunk flexion activities. Activities that bring your knees to your chest are inherently risky if you are not properly trained.
Next, life is about movement and movement often includes trunk flexion. It is something that cannot be completely avoided. For this reason, it is important to learn to brace for load and activity. Imagine someone is about to punch you in the stomach and you brace your abdomen to absorb the blow. That kind of bracing is what I am talking about. You do not want to brace for a boxing match like you would brace to pick up a pencil though. The amount of bracing should match the activity. Proper bracing in preparation for load or activity is vital.
Your lumbar spine, in particular, wants and desires a strong, neutral, straight, and solid posture. If you twist at the low back, you are at a disadvantage. If you bend forward at the waist and apply flexion to the spine, your spine is at a disadvantage. You must move through life and activity as if you have a fluorescent light bulb taped to your back and your job is to keep the light bulb from breaking. When you pick something up from the ground, use the shortstop stance keeping the low back nice and straight and using your hips and knees to accomplish the lion’s share of the work. When you open a heavy door, do not twist at the waist and pull the door back that way. Use your shoulders and your arms to accomplish the task. Keeping the low back in a nice, neutral, and strong position goes a long way in protecting it.
Here’s another tip for you to protect your back. When we sleep at night, our discs take on water. They re-hydrate to an extent. When we get up in the morning, the discs in our spine are fatter and more full. As we apply weight-bearing, gravity does its work and over the course of the next hour to an hour and a half, the discs reduce back to the size they will remain for the rest of the day. Knowing this, it makes sense that many disc injuries happen in the morning. They can also happen after having sat in one place for an extended amount of time. People allow their discs to fatten back up from inactivity and then start being active immediately without having given them time to reduce back down to normal.
Did you know that sitting is the most pressure you can put on your low back discs? Actually, that is not completely true. Bending forward, picking up something of substance with weight, and sitting up with it…THAT’S about as bad as you can get. Not only are you sitting and bending forward, which puts your back at a disadvantage and pushes all of the disc content toward the back where the disc is the weakest, but you have also applied weight/load to the whole situation. I bring this up because you can visit any gym in the world and see this scenario play out repeatedly all day every day.
How Do You Treat Low Back Pain From Lumbar Disc Herniations?
At this point, you know that low back discs are the most common for those under 50 years old, you know how they are most commonly injured, you know the mechanism of the injury, and you know how to give yourself a better chance of avoiding the disc injury. But, what about if the injury has already occurred, what can be done about it?
There are several different paths one can take in treating a lumbar disc herniation. In fact, the most common thing that comes to mind for patients when they hear about having a lumbar disc herniation is that disc bulges and disc herniations require surgery. While that may be true for a select few cases, in the large majority of cases it is not true. About 56 million people suffer from low back pain at any one time and only about 5% of those sufferers actually require any sort of back surgery.
If your reflexes, sensation, and motor functions are even from side to side, it is likely that your case does not require any surgical intervention at all. If you have no alteration in bowel or bladder function and no numbness or tingling in any area underneath or between your legs (anything that would touch a saddle), then surgery is typically not warranted. These are the most common reasons for surgery.
The American College of Physicians(Qaseem A 2017) came out a few years ago with updated recommendations for treating acute and chronic low back pain. Assuming the complaint isn’t an emergency and immediately surgical, their recommendations are as follows:
- First-line therapies that are backed by evidence and should be used first are spinal manipulation (chiropractic), exercise, massage, acupuncture, low-level laser (cold laser), yoga, Thai chi, cognitive behavioral therapy, and heat.
- Second-line therapies include NSAIDs such as Tylenol, aspirin, ibuprofen.
- Third-line therapies include prescription medication with consultation.
When everything else has failed, it makes sense at that point to explore more invasive options such as epidural steroid injections and/or surgery. AFTER all else have failed. Too often the last and final and permanent option is flip-flopped to the top of the list when it is not typically the best first answer.
When a patient goes to an evidence-based, patient-centered chiropractic office, and they undergo spinal decompression, low-level laser, McKenzie exercises, and other targeted activities, they are many times literally blown away by how effective the treatments can be when combined into a strategic protocol. Discs can respond to just laying on your stomach or taking a walk. Disc herniations can be treated effectively and successfully.
Disc herniations and disc bulges are not stuck that way. Patients aren’t stuck in pain forever typically. Disc herniations have a history of being somewhat short-lived and a well-trained chiropractor or physical therapist can speed up that healing many times and get you better faster. Because let’s face it, nobody has time for pain. We have too many things to do.
Like go bird watching for example.
Qaseem A (2017). "Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians." Ann Intern Med 4(166): 514-530.
Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast. Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected]
Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109
Jeff S Williams, DC, FIANM, DABFP