Dealing with low back pain can be both physically and emotionally taxing. A natural protective response kicks in when our bodies experience discomfort, such as low back pain. As a result, people with low back pain often exhibit a guarded state, wherein they move slower, lesser, and more cautiously. However, contrary to what our bodies might think, this limited movement isn't always the best solution in the long run.
Pain is our body's way of signaling that something might be wrong. When we experience low back pain, it's often accompanied by muscle tension and stiffness. As a protective response, our bodies tend to restrict movement in the affected area. This might seem like a logical step to prevent further injury or pain, but this limitation can have unintended consequences. Additionally, keeping our core contracted/tight or sitting upright, a bit of advice usually given by healthcare practitioners as a solution to back pain, adds to this guarded movement, likely making the pain worse or hindering any improvements.
From an evolutionary standpoint, humans are designed for movement. Think about our ancestors – those who could not move efficiently were at a disadvantage when it came to hunting, gathering, and escaping predators. In essence, a human without movement was likely facing dire consequences. Our bodies are finely tuned, meant to traverse and interact with the world around us. Embracing this inherent need for movement can significantly impact how we address low back pain.
While reducing movement might offer temporary relief, it can ultimately exacerbate the issue, increasing stress and decreasing our capacity to do activities. Consider clenching your fist tightly for an extended period – eventually, it starts to ache and becomes uncomfortable. The same principle applies to our backs. When we limit movement, we inadvertently increase our focus on the area of pain, heightening our awareness and sensitivity to it. This hyper-vigilance can lead to additional stress and tension in the muscles surrounding the low back, perpetuating the cycle of pain.
This systematic review and meta-analysis aimed to investigate the relationships between spinal amplitude of movement, disability, and pain intensity in patients with low back pain (LBP). The study included 106 studies with a total of 9001 participants, using cross-sectional and longitudinal data.
The authors concluded that interventions aimed at reducing protective spinal movements may help in managing LBP.
“This systematic review and meta-analysis demonstrated that larger spinal amplitude is weakly associated with lower pain intensity and disability in patients with LBP. It also showed that increasing the amplitude of movement is weakly associated with reductions in pain intensity and disability. Furthermore, the results supported the important role of reducing pain intensity to decrease disability, which may be achieved by increasing the amplitude of movement. Therefore, this work supports the consideration of movement measures in LBP research as well as multidimensional therapeutic interventions aiming at in- creasing the amplitude of movement.”
Simply said the two major findings from the paper indicate that:
If you have better spinal movement ranges, you’ll likely have lesser pain and disability than those who don’t.
If you don’t have good ranges, to begin with, any improvement is likely to help reduce pain and disability.
While it might seem counterintuitive, movement is an integral part of our lives, even when we're seemingly at rest. Take sleep, for instance – a time of repose for both the body and mind. Yet, our bodies remain in motion during slumber. On average, we change positions 17-20 times throughout the night.
Just as opening up a clenched fist can relieve discomfort, the key to addressing low back pain is to encourage gentle and consistent movement. Movement helps improve blood circulation, oxygenation, and nutrient delivery to the affected area. It also stimulates the release of endorphins, natural pain-relieving chemicals our bodies produce.
One of the most significant benefits of embracing movement is breaking the cycle of fear avoidance. Over time, avoiding movement can lead to a fear of pain, causing us to limit activities and become increasingly sedentary. This sedentary lifestyle can weaken muscles, decrease flexibility, and even lead to weight gain, which can further aggravate low back pain. By gradually reintroducing movement and understanding that discomfort does not necessarily equate to harm, we can regain confidence in our body's ability to heal and function, incorporating movement, something as simple as walking, into our daily routines then becomes an act of self-compassion.
The road to managing and overcoming low back pain involves a shift in perspective – from seeing movement as a threat to embracing it as a powerful tool and remembering our bodies including our backs, are resilient and supported by numerous structures like layers of muscles and ligaments. By working with healthcare professionals, gradually progressing through tailored exercises, and breaking free from the fear-avoidance cycle, we can empower ourselves to alleviate low back pain and embark on a journey towards a healthier, more active life.
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