Lower back pain part 2: Herniation
In one of my previews blogs I already talked a little about herniation ( http://sports-diet-pain.blogspot.be/2013/10/abdominal-part-2-how-to-really-train.html), but this one is going to be entirely about it.
People are afraid of a herniation and whenever they hurt their back they automatically think they have a herniation. So, what they do when they hurt their back is go straight to the doctor. The doctor (hopefully) will do a couple of test on you to see that you don´t have any ¨red flags¨, meaning serious injuries, and he might do an X-ray or an MRI on you. Hopefully, if he is a good doctor and has seen that you don´t have any red flags, he will just reassure you that you don´t have anything serious, tell you to try to keep active, and maybe give you something for the pain. I say ¨keep active¨ because different studies have seen that bed rest worsens the condition. At most, and if the pain is really bad, you could do bed rest for 1 or 2 days but never more than 2 days (1). However, if he is not such a good doctor he will send you to have an X-ray or MRI. Patients with simple back pain and no red flags do not need any diagnostic investigations in the first month of symptoms (2). Now, you may ask yourself why this is bad. This is bad because, as I´ve mentioned before in other blogs, 70% of us possible have a disc herniation, disc degeneration, or some other structural abnormality and are asymptomatic, meaning we have no pain (3). So if we have back pain and the doctor sends us to have an MRI he will probably find something wrong with us, but this is probably not the cause of our pain. So, now we will be mislabeled and potentially be receiving unnecessary treatments, but even worse, now we will think ourself as being ¨sick or having something wrong with us¨. And this will probably lead us to having more pain, more absenteeism (sick leave, time off work), decreased productivity while at work, loss of earning, and having a poorer health status (4) . But anyway, this is beyond the scope of this blog. So let us get back to herniation and how we can prevent it.
In one of my previous blogs, I mentioned that it is almost impossible to herniate yourself without being in full flexion and having a compressive force act over the vertebrae (5). A compressive force can be produced by an external weight, like for example a backpack, or by our own muscle. Every time a muscle contracts it produces a compressive force somewhere in the body, so you don´t even have to be picking up something heavy to herniate yourself. Now this is where I´m going to surprise more than one, when you are sitting down you are basically in flexion, your lower back is bend, this causes the nucleus inside the disc (the disc is made of an annulus and a nucleus, the nucleus is gel-like substance and is surrounded by the annulus) to deform posteriorly. This is why sitting down for a long time is bad, because it stresses the tissues. Human beings were not made to perform repetitive work that emphasizes only a few tissues. Nor were humans designed not to be stressed. Research has established that tissues adapt and remodel in response to load (6-8). Too little activity can be as problematic as too much(9) .So let me give an example for you guys to understand what I have just said:
- In the 1960s, in a power plant in the USA, operators had to respond to a vigilance buzzer on their desk that went off every 10 minutes. At each buzzer interval they would stand and walk around the control panel making adjustments. There was no history of back trouble. As technology got better, they changed the plant so that workers did not have to get up anymore from their desk every 10 minutes. These workers worked 12 hour shifts but now most of the time they were seating down. Well guess what, back problems increased and they had to hire a consultant to help them with their problem.
So, what I basically want you guys to understand is that too much of anything is bad and sitting down for long periods of time is horrible. So all you have to do is get up once in a while. I always recommend my clients that at least once an hour they have to stand up. And if you have a boss that won´t let you get up, just tell him, first and foremost to read my blog and second that you are saving him money!!
This was only part 1 of herniation, in part 2 I will talk about things you can do to prevent a herniation.
- Deyo RA, Diehl Ak, Rosenthal M. How many days of bed rest for acute low back pain? New England Journal of Medicine 1986;315:1064
- Liebenson Craig. Rehabilitation of the Spine. A practicioner´s manual. Lippicott Williams & Wilkins 2007. pg 131.
- Kim S, Lee Hoo T, Lim Mee S. Prevalence of Disc Degeneration in Asymptomatic Korean Subjects. Part 1: Lumbar Spine. Journal of Korean Neutrosurgical Society 2013 January;53(1): 31-8.
- Kendrick D, Fielding K, Bentler E, Kerslake R, Miller P, Pringle M. Radiography of the lumbar spine in primary care patients with low back pain: Randomized controlled trial. BMJ 2001;322:400-05.
- McGil S. Low Back Disorders 2nd Edition. Human Kinetics 2007 pg 45.
- Carter DR. Biomechanics of bone. In: Nahum HM, Melvin J. Biomechanics of trauma. Norwalk, CT: Appleton Century Crofts.
- Porter RW. Is hard work good for the back? The relationship between hard work and low back pain-related disorders. International Journal of Industrial Egonomics 1992;9:157-60.
- Woo Y, Gomez MA, Akeson WH. Mechanical behaviors of soft tissues: Measurements, modifications, injuries, and treatment. In: Nahum HM, Melvin J. Biomechanics of trauma (pg 109-33). Norwalk, CT:Appleton Century Crofts.
- McGill S. Low Back Disorders 2nd Edition. Human Kinetics 2007 pg 153.
- Placebo (sports-diet-pain.com)
- Lower back pain part 3: Prevention (sports-diet-pain.com)
- Report: Cowboys Dez Bryant Received Epidural, Sign Of More Serious Back Issue? (bloggingtheboys.com)