Telegraph feature: 4 steps to reduce back pain

Check out our feature in the Telegraph: “Exercising with back pain”

It is estimated that 80 per cent of us will suffer from some form of back pain throughout our lives. This may be due to specific reasons, such as a trauma from an accident of sports injury, or a congenital condition such as scoliosis for example, but for many of us, back pain is not the cause of serious injury or a specific condition, but rather by issues such as strains, sprains, and neural conditions, which are the result of daily activities and lifestyle habits.

Most of us will suffer from low back pain, centered around an area that is called the lumbar spine. This is an important area of the body, which serves a number of important functions, including key structural support and providing a platform for movement. A healthy lower back provides strength and stability and is involved in just about everything that we do. It is a part of the body of which we demand a lot of, meaning that it can be quite debilitating when it is not functioning correctly.

It’s worth noting though that the body is a complex system with lots of working parts and it can often be difficult to identify the exact cause of pain, particularly in the low back. So if you are experiencing pain it is important to seek the help of somebody suitably qualified, such as a physiotherapist or chiropractor. But for those of us who are looking for strategies to reduce or minimise the risk of back pain, here are four key things that we can do to keep our back strong and healthy.

1. Sit less 
Whilst this might be a fairly obvious one, and something that almost all of us will be familiar with, it is worth repeating. We are not designed to spend long periods of time seated, as it is not favourable for our structural health. The bones of the spine – or vertebrae to give them their correct name – are designed to be stacked on top of each other, or neutral, rather than rounded or compressed unevenly for prolonged periods, which is what happens in a seated position.

Structural adaptations will occur throughout the body through prolonged seating, which can lead to problems. In simplistic terms, the muscles at the front of the body tighten up, pulling us round and forward, whilst the opposing muscles at the back of the body become relatively stretched out and weakened. The most obvious example is at the hips, where the hip flexors adaptively shorten and the glutes becomes less active. But the same is true at the shoulder and in the neck also, where muscles adapt to the seated position.

As tedious as the message may sound, try and get up every 20 minutes or so to stretch and walk around. You will relieve the tension that a sustained static period can cause and it will likely make you more conscious of your position when you return. Even a break of two or three minutes is likely to make a significant difference.

2. Strengthen your core 
Core strength is still one of the biggest buzz terms in fitness, with people still basing entire programmes and approaches upon the premise that we need to ‘strengthen our core’. But whilst it is true that the muscles of the trunk need conditioning, in much the same way as our limbs, it is probably fair to say that it has been taken to extremes in some circles. We need some, but it need not be our entire focus.

That being said, the right amount of core training is a vital part of a balanced training programme. It helps to ensure that the limbs impact on and interact with the trunk in a way that is favourable, loading the joints correctly, enabling us to move in a way that is efficient and pain free. What this means in practical terms is that our trunk, or core, needs to be strong enough to promote, and resist, movement in multiple directions.

From a training perspective, we need to condition our trunk to be able to resist hyperextension of the back by conditioning the abdominals to work in the opposite direction, to resist excessive rotation by strengthening the obliques, and to keep us standing upright by conditioning the muscles of the lower back. And we need to develop adequate amounts and the right balance of strength and stability across all of these areas in order to move well and vastly reduce the risk of pain or injury.

3. Improve your posture 
Posture is the way that we hold ourselves both statically, when standing still, and dynamically, when we perform tasks that involve bending, lifting and so on. When posture is good, the vertebrae in the spine are correctly aligned and loaded and we move efficiently. In some circles the issue of posture is perhaps overplayed, especially for those with otherwise healthy structures, but if we can improve our posture, both statically and dynamically, we are likely to be taking a significant amount of load and stress off our bodies.

Some postural improvement can be brought about through corrective exercise, although my suggestion is that posture is as much, if not more, about neural adaption, than muscular. In other words, much of our postural behaviours are habits and are a product of patterns that we have learned, rather than muscles that are either tight and short or long and weak. I’m not suggesting musculoskeletal factors are not important, far from it, but I think we should look at it as a systemic issue.

Focus on corrective exercise will also help, but improving efficiency of movement, especially in the gym, will probably yield greater changes. If we take the time to do some movement re-education training and learn how to move and exercise in the right way, whilst perhaps also targeting some specific muscles, we will probably find that this this will go a long way towards alleviating any symptoms, as the right muscles start to become more active and our body becomes systemically stronger.

4. Develop structural balance 

Most of us have muscle and strength imbalances throughout our bodies. Some of this is developed through childhood, whilst some of it is adaptation to our daily activities where we perform some activities repeatedly, using certain movement patterns and muscles over and over, and therefore creating relative imbalances. Some degree of imbalance is normal, perhaps even beneficial in some instances, but where it becomes too pronounced, it can cause issues.

If we use our previous example of spending too much time in a seated position, where the muscles at the front to the hips tighten and the muscles of the backside become relatively weak, a good programme of hip flexor stretches or Yoga style warrior poses, coupled with some glute activation and strengthening for example, can go a long way to rebalancing the hips. The same is true with an imbalance at the shoulder, where we can focus on strengthening the muscles at the back of the shoulder to bring them in line with those at the front.

We need the correct balance of mobility and stability throughout the body in order to function correctly. Although perhaps not the perfect system, it is also helpful to view the body from a joint-by-joint perspective, where the joints are loaded alternately with either a predominance of mobility or stability. We need a degree of both at each of course, but at the ankle we need more mobility, stability at knee, mobility at the hip, stability in the lower back, mobility in the thoracic spine, and stability at the shoulder.

A deviation from the predominant requirement in any of these joints will lead to potential complications in the joint above and or below, so it is important that we get this balance right, according to our personal structure and requirements.