If you often experience a dull, achy feeling in your lower back, you’re in good company. Back pain is perhaps the most common cause for visits to the doctor. It’s also the single leading cause of disability worldwide. People with chronic back pain are also three fold more likely to report significant levels of psychological distress, depression and anger.
The costs of treating this problem are enormous and rising quickly. According to a recent study, $88bn was spent on medical treatments for back and neck pain in America, not far short of the $115bn spent on cancer. And a great deal of this money seems, sadly, to do little good.
The mechanics of back pain
Spinal discs are pillow-like sacs residing between your vertebrae that absorb shock during physical activity. At the core of these discs is a jelly-like fluid that cushions against impact, without which the spine would be highly vulnerable to injury. These discs fill up while you’re asleep and reach full capacity in the morning. This means you’re actually a little taller when you wake up as the discs are filled up tightly.
This fullness can also cause tightness, explaining why you might feel stiff as a board in the morning. In fact, those semi-bulging discs are pressure-loaded and far more prone to slipping when you rise from a long slumber. This explains why so many backs have been thrown out by such innocuous things as bending over to pull on socks or kneeling for a golf ball.
So make a note to self; before reaching for the sock drawer tomorrow morning, remember to a) refrain from abrupt movements and b) consciously tense your stomach muscles before bending, as the abdominals stabilize the spine and can prevent a world of pain and c) where possible, perform a Golfer’s Lift. The golfer’s lift entails placing one hand on a sturdy object while allowing one leg to serve as a counter balance as the lift is accomplished. This technique is an excellent way to avoid back injuries on and off the course.
Here’s another little known fact: Musculoskeletal conditions are often under-recognized and poorly treated by primary care physicians. This from the Stanford School of Medicine:
“Training hours devoted to non-operative orthopedics have been historically limited, even though musculoskeletal pain accounts for approximately ten percent of all visits to primary care. This limitation has an end effect on physician confidence and competence which reflects the deficits in our training for physicians both in medical school and in clinical practice.”
The good news is, by spending a few moments considering underlying biomechanics, you can help prevent musculoskeletal injuries in the first place. More on this later.
Back pain very common in construction
Construction work is physically demanding, but just how bad is it for your back?
According to the Harvard School of Public Health, studies show a “high prevalence of musculoskeletal pain”, with chronic back pain being experienced by “40% of construction workers over age 50”. The 2012 study also found that “workers over 50 whose longest-held job was in the construction industry were 32% more likely to experience persistent back pain or other back issues than those not in construction”. Likewise, the University of Iowa “found that 70% of construction workers experienced back pain over a one-year period.” The majority of respondents had pain in the lower back (50%) while only 2.1% complained of upper back pain.
Why do construction workers experience so much back pain?
Manual work is inherently risky, and it’s the repetitive bending and lifting required of construction workers that does the most damage. OSHA’s Advisory Committee on Construction Safety places the blame on “repeated lifting of materials, sudden movements, whole body vibration, lifting and twisting at the same time, and bending over for long periods of time”. According to OSHA, working as a laborer or scaffold erector can be particularly bad for workers’ backs. Other risk factors for musculoskeletal injuries identified by OSHA include “floor surfaces and obstacles in the work area, housekeeping practices, the height of the work, whether the work is within the worker’s capacity, techniques used for lifting, tool belts, and temperature”.
What to do about back pain
The bottom line is that musculoskeletal injuries are best treated with posture, core strength, and breaks at work. And remember that postural re-education and lifestyle changes can take time, so talk to your doctor or physiotherapist about making safe and incremental improvements.
Pay strict attention to posture and balance in all positions including standing, sitting, lifting or driving. The goal is to allow the skeleton to do its weight bearing job and allow the muscles to relax whenever possible.
Keep a wide base of support when lifting. In other words, your feet should be shoulder-width apart, with one foot slightly ahead of the other. Instead of bending at the waist, bend at the hips and knees only. See here for more tips
Working at a desk with a poor ergonomic setup can both increase the risk for injury and symptoms as well as intensify an existing imbalance. Tight chest muscles result from holding arms too far forward. Tight upper back muscles result from holding shoulders hunched and arms in elevated positions above the keyboard. The head too far forward can inflame neck muscles. Creating an economic workstation and paying attention to your posture during work hours will go far in preventing and treating musculoskeletal issues.
Key lessons from Stanford School of Medicine
In terms of treatment modalities for sprains and strains, the key approaches reinforce that:
- Pain does not necessarily equate to damage
- Staying “active as tolerated’ promotes recovery
- Movement and sensible activity will not cause harm
- Staying at work is beneficial. It:
- Reduces the risk of job loss
- Encourages self-confidence
- Promotes a gradual recovery
- Eases the adjustment to full-time work
- Results in less disruption to the employee, work group, and family