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“Why Does My Back Hurt?” – Top Causes of Back Pain, Part One

Virtually every patient, when confronted with back pain, will ask me the big question: “Why?”

Unless the patient has experienced a trauma or demonstrates a disease on imaging (e.g., spinal stenosis, disc degeneration or degenerative disc disease, arthritis or degenerative joint disease, etc) the answer to the question “Why?” is challenging to definitively answer.  Usually, the origin of a patient’s low back pain can be attributed to many cumulative mini-traumas, most of them sustained without any problem until the proverbial straw that breaks the camel’s back.

Some of these mini-traumas that almost always lead to back pain include:

1. Long Periods of Sitting cause Back Pain, and Worse…

There is no doubt that a great deal of low back pain and even diseases such as degenerative disc disease and spinal arthritis can be directly attributed to sedentary lifestyles.  Sitting increases the pressure in your low back nearly 40% compared to standing or laying down. Paradoxically, recliner chairs can make the problem even worse!

When I tell patients this I sometimes hear: “But doc, even though I work in an office and sit at my desk all day, I go to the gym every other night for an hour and I run five miles every morning!”

I still blame the sitting.

The world was shocked when researchers announced in 2013 that “sitting is the new smoking” with evidence that those who sit for a greater percentage of their life (like office workers and truck drivers) are much more likely to be in worse health and die earlier when compared to those who do not sit as much (like construction workers and surgeons). The really surprising aspect of this research was that these greater morbidity and mortality numbers in the sitting group’s data held up regardless of the fitness level of the individual! In other words, a marathoner accountant was more likely to die sooner than her less physically fit peers with more active jobs!

Bottom Line: Avoid Sitting like the Plague! Literally! If you are having back pain, try going several days without sitting; stand at work and lay down when possible. You may be surpassed at how well this works! If you are forced to sit, make sure you stand and walk around to stretch at least every 30 minutes.

2. Sedentary Lifestyles Cause Back Pain

But not so fast! If after reading the above section on sitting you think you need not exercise if you have an active job you’d be wrong! The reality is that movement, in general, helps keep back pain away. Researchers have shown that habitual participants in low-impact exercises such as walking, yoga and stretching all experience less episodic back pain.

Unless you are having some neurological problems with your back pain such as numbness/tingling, bowel/bladder dysfunction, shooting pains down your arms/legs or muscle weakness, just walking and light stretching might be enough to get you back on track! (No pun intended!)

Bottom Line: If your back hurts, MOVE!

3. Heavy Purses, Briefcases, and Backpacks Cause Back Pain

If you have back pain, put your regularly carried tote on the scale. If it weighs more than 10% of your body weight you have likely just discovered a significant contributor to your back pain. For example, a 150-pound adult should carry no more than 15 pounds routinely.

This is a HUGE issue with kids today carrying gargantuan backpacks. I frequently see children with back pain who magically improve when we lighten their load.

Women who frequently carry heavier than allowed purses are getting double the trauma because the weight of their bag is usually managed on just one shoulder causing a significant imbalance that will inevitably lead to back pain.

Bottom Line: Respect the 10% rule and evenly distribute your loads — left to right and front to back.

In the next article in this series, I will discuss the next three back pain creators.

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