Posture and Lower Back Pain

As noted in my last post, posture can be linked to pain in a number of areas of the body.  One of the more common areas where we tend to see posture as a potential cause of pain is in the lower back.

The lower back or lumbar spine develops a mild inward curve as we progress through early childhood.  In utero, we are basically in a very flexed, "C" shaped position.  After we are born and are exposed to the outside world we start to develop "secondary curves".  One forms in the neck from raising our head to see when crawling or lying on our stomachs.  Another forms in our lower back as a result of standing.

As mentioned above, these curves were meant to be mild, gradual curves.  These gradual curves or "lordosis" helps support the body weight and helps to minimize wear and tear on the discs that reside between the vertebrae.  The picture on the left below demonstrates the lumbar curve.  The grey structures between the manila colored bones are the discs.  The yellow structures are the nerves that exit the spine between the vertebrae through something we call the intervertebral foramina.  In English -- holes between vertebrae.

 When in ideal posture, we maintain this curve as depicted above which minimizes stress on the discs and allows sufficient space in the foramina for the nerves to exit.  Deviation from this curve causes stress on the spine and associated structures and over a long enough period of time -- pain.

When the spine becomes too curved inward or "hyperlordotic" the space where the nerves are exiting becomes narrowed.  The back portion of the disc also becomes compressed.  We tend to call this position "swayback".  Below is a picture of what this posture would look like.

Referring back to the first picture in this post, imagine what the posture on the right above is doing to the space between the vertebrae where the nerves exit.  You are correct!!  Significantly narrowing it!!  This can not only cause pain in the lower back, but pain in the lower extremities as well due to compression of those nerves.

So if I look like the picture on the right, what do I do???  There are 3 simple things that you can do to help improve this posture and reduce pain.

1.  It is typically beneficial to do some exercises that help stretch out the shortened lower back muscles and "flatten" the curve.  Refer to Yoga for Back Pain or Alternative to Yoga for Back Pain for examples of exercises that help stretch out these muscles and flatten the lumbar curve

2.  The next thing to address would be stretching out the hip flexor muscles that are often tight in these cases which causes the pelvis to tip downward in the front, increasing the lumbar curve.  The picture below is a great way to stretch the hip flexors and quadriceps without further increasing strain on the lower back.

By holding the thigh tight to the chest you flatten the lower back and prevent further hyperextension.  If you have a "swayback" posture, holding this position and letting the other leg hang off of the bed, bench, sofa, you will get plenty of stretch in the hip flexor muscles in the leg you are not holding.  Maintain this position for 60 seconds on each leg times 2 repetitions.

3.  Strengthen your abdominal muscles.  By having this accentuated inward curve or "hyperlordosis" the abdominal muscles which basically run from your rib cage to your pelvis become stretched out and weak and are no longer supporting the spine as well as they should.  Below you will find 2 different exercises that I find particularly helpful.  These are the "basics".  After a few weeks of these 2 exercises you can advance to something more difficult.  It is imperative, however, that you start here as more demanding abdominal exercises without the proper foundation can cause you to hyperextend the lower back and cause more pain.  Here are the 2 "starter" exercises.

Draw-Ins.  Lying on your back or when seated, "pull" or "draw" your belly button in toward your spine.  Hold for several seconds and release.  Repeat 30 times.

Posterior Pelvic Tilt.  Lying on your back, press your back into the floor by tightening the abdominal muscles.  Hold for several seconds and release.  Repeat 30 times.

Obviously, this is only one of many different lower back postures that can cause pain, but probably the one I most commonly see.  In my next post we will address how this posture in the lower back affects the mid-back and then we will explore how altered posture in the mid-back will affect the neck.