If you are reading this blog, you have probably experienced a low back-pain ATTACK and never want to experience another one.  Or you may have be lucky to have never experienced your first Attack but want to remain pain free.  No matter your goal, it is critical to recognize the warnings.  Many low back pain Attacks can be minimized or even completed avoided when  we recognize the warning signs, know what they mean and learn how to deal with them. here are the 5 signs of a low back pain attack:

5 Signs of a Low Back  Pain Attack

  1. Back pain when you cough or sneeze
  2. Back pain or stiffness when you get out of a chair
  3. Back pain or stiffness when you sit for less than 30 minutes
  4. Back stiffness in the morning when you haven’t worked out the day before
  5. A desperate need to sit down when you have been standing for less than 30 minute

1. Why does my back hurt when I cough or sneeze

This symptom is highly correlated with a bulging disc or extreme muscle tension in your hips or back.  No matter which one you have – heed the warning.  It is not normal for the back to hurt when you cough or sneeze.

What do I do about it? 

  • Sit less.  Too much sitting puts a strain on your disc and can cause excess back and hip muscle tension.
  • Walk more.  If you haven’t walked much recently then begin with shorter durations several times each day  to allow your body to adjust to the increased activity
    • John Gray’s,  (Reg. Kinesiologist), articles can help you find a balance on increasing activity safely.
  • Limit bending forward and don’t lift heavy loads.  These activities put more strain on the already strained structures. Wait until you feel better to start these movements again. 

2. Why does my back hurt when I get out of a chair?

Back pain getting out of a chair can be one of the earliest warnings of an impending low back pain attack.  This pain can be caused by a strain on your disc, tight hip flexors (psoas) or insufficient use of your buttock muscles (gluteus maximus).

What do I do about it? 

  • Walk more.  This is often the simplest and most effective strategy.
  • Stretch  your hip flexors.  The typical kneeling stretch with one foot forward in a lunge position is good. If you can’t get down to the floor or if you have had a total hip replacement you can put your front foot up on a chair and hold the chair’s arms as you stretch forward.
  • Put less tension in these muscles.  Most people don’t realize how tight their hips get with crossing their legs or sitting with their feet “en pointe” like a ballerina.   Make an effort to sit with both feet entirely flat on the floor.
  • Avoid perching.  Those low back bar stools may look good in your new kitchen design but too much perching can be disastrous for tight hip flexors.  A wider foot support is best, as is a higher back support.  If you really love a minimalist design, then admire them like a piece of art from the comfort of your more supportive dining room chair.
  • Use your buttock muscles.  Many people rely too much on their hip and thigh muscles to get out of a chair.  This means these muscles are working harder than they need to.  Using your buttock muscles reduces pain and minimizes how hard these muscles need to work.

3. Why do I get back pain when I sit too long?

The easy answer is that sitting is the new cancer, however it’s not that simple.  Sitting affects our circulation and metabolism.   There is no doubt that these effects have profound impact on our health however there is nothing wrong with sitting, we just sit too much.

When our back is healthy, we should be able to sit comfortably  for 1.5 – 2 hours.  A short break (10-15 minutes) and our back should be ready to repeat this all over again.  If you decide to sit through 2 movies or pull an all-nighter, studying without breaks, then expect your back to hurt as this is just too long to go without a good break.

When you can sit for less than 30 minutes, in a good chair, the pain is most often caused by:

  • strain on the disc
  • poor core support
  • tight hip and back muscles

What do I do about it? 

  • Walk.  Increasing  your walking can go a long way to correcting this problem.
  • Stretch:  Focus on your  hip flexors and quads
  • Strengthen your core.  Dead bugs, bridges and planks can all be useful.

4. Why is my back stiff in the morning?

20-year-olds tell me that they hurt in the morning because they are getting old while many 80-year olds have no morning stiffness. Unless you have radically increased your workout or suddenly decided to accomplish everything on your “Honey Do” list, don’t mistake a sudden onset of morning stiffness as age.

The two most common causes of morning stiffness are:

  1. Increased disc fluid – Discs drink at night.  When we lie down a negative pressure is created in the disc.  This attracts fluid and results in you being slightly taller in the morning.  It is also one of the reason astronauts have back pain while in space.  Astronauts counteract this problem by walking on treadmills using weights to simulate the effects of gravity.

      2. Inflammation in the back joints (facets) – When you irritate the back joints it’s almost  the same as spraining your ankle.  Both injuries cause swelling which results in the joints becoming stiff.  It’s harder to get going in the morning when you haven’t moved for several hours.  You may also feel worse at the end of the day as poor posture and insufficient muscle support puts more stress on the facet joints.

What do I do about it? 

  • Walk more.  When the problem is the excess fluid in the disc, like the astronauts, you need to walk.  Fortunately you don’t need to carry the extra weights they do.
  • Don’t lie down for long periods.  The more you lie down the more fluid there is in your disc.  When this is your problem, a walk before bed can help you to sleep longer, more comfortably.
  • Correct your posture.  Joint inflammation typically can’t be walked out.  Instead you need to focus on correcting your posture, lengthening tight leg muscles and restoring core support.

    5.  Why does my back hurt when I stand?

    Many people are not even aware they are limited in standing because they seldom challenge it.  Chairs are everywhere.  Take a moment to time yourself as you should be able to stand for at least 30 minutes.

    Some of the signs that you may be limited in standing are when you avoid or limit these activities:

    • cocktail parties
    • shopping
    • museums

    The most likely causes of standing back pain are poor posture (sway-back), tight muscles or poor core support.

    What do I do about it? 

    • Correct your posture. Reduce the sway in your back.
    • Stretch tight muscles.  Stretch your quads and hip flexors.
    • Activate your hip muscles.  The hip abductor muscles (gluteus medius and minimus) are your most important muscles for standing and balance.

    When should I see my spine therapist?

    Your spine therapist can be a resource to guide you through these symptoms and your recovery however it is more important to seek advice if:

    • Walking does not relieve the pain
    • You are ready to get back to fitness and feel at risk
    • You don’t know how to activate your core support muscles
    • Your low back pain increases when you try to get more active.

    If you need more advice call us to book an appointment at 416-925-4687 or email us at physio@orthophysio.com.  If you are still in the attack stage this article will help you to get to the next stage of Recovery – which is the subject of my next blog.