Back Pain in Senior Men: Causes and Solutions

About 14%-30% of senior men have chronic back pain. Are you one of them? Has is reduced your quality of life?

If so, maybe you got some relief from a physical therapist who helped you with spinal stabilization exercises, performing joint mobilization, manual traction, stretching, and instructions for proper spine mechanics with lifting or working.

But what if the back trouble came back? It means you are continuing to do something that's irritating your back, whether you realize it or not.

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(The information on this page was extracted from an article by Michael Boyle, personal trainer. It's a long read but worth your time. If you don't understand a term, look it up!)

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The solution to low back pain is not the hour you spend in physical therapy each week, or even the hour or two you spend in the gym; it's every other hour you spend living your life. From standing, to sitting, to lifting, to sleeping, every position you take has an impact on the health of your spine.

Most people can attest that low back pain can occur after excessive compressive loading. However, what they don't realize is that most low back pain originates from long static positions, such as sitting on your chair or standing at your stand-up desk. Even though these static positions are so insulting for the back, people don't know how to modify them so they continue to be debilitating and painful.

What Are the Enemies of Your Spine?

If you don't understand the causes of a problem, you can't derive the solutions. listed below are the most common causes of chronic back pain, aside from injuries.

Don't have time to learn the causes? Jump to solutions here.

Sitting

We all sit at some point in the day, whether it is at the office, in front of the T.V. or in a car, but this position is one of the worst for spine health.

It's been clearly shown that sitting results in high compressive loads upon the lumbar discs. Studies have correlated a higher incidence in back pain and onset of symptoms to greater durations of sitting, while reducing sitting often alleviates pain. These observations are true for nearly all types of lumbar conditions.

The question is, why is such an innocuous, low exertion activity like sitting so damaging to the spine?

It seems that the position of the spine is key. Sitting is typified by a sustained flexion position. The discs are disproportionately loaded, as the posterior elements of the spine (the facet joints) are not in approximation during this flexion; thus, their load-bearing function is eliminated. The result is greater strain on the posterior aspect of the disc. Furthermore, ligaments are stretched, and if sustained, undergo a phenomenon known in biomechanics as creep -- or permanent elongation. Creep is seriously bad as lengthened ligaments lose their ability to provide passive stability to the spine, and may lose their proprioceptive function.

Static Standing

So if prolonged sitting is a problem, then we should stand all the time, right? Not necessarily. If standing is relatively static, meaning little sway or change of position, then it can be problematic as well. This is especially true for those with spinal instability (i.e., spondylolysis, -listhesis).

Standing, especially in a hyperlordotic posture, will divert stress disproportionately to the posterior spinal elements and compress the facet joints. The spine becomes positioned such that shear is more likely, which involves sliding of one vertebrae in relation to its adjacent vertebrae.

The exaggerated lordosis commonly seen in standing will also narrow the vertebral opening through which the spinal nerve roots pass through as they exit to the periphery.

Anything that exaggerates lordosis like high heels, or Nike Shock shoes, will cause more stress and more pain to attack the lower back. The look of a certain shoe is much less important than the feel of a pain-free back.

Frequent Forward Bending and Twisting

Both biomechanical and empirical research has established that frequent or sustained flexing of the spine, especially in combination with rotation, will result in excessive damage to the spinal discs.

Add loading to these conditions, and a scenario for lumbar disc damage is almost guaranteed. If in the gym, Russian twists, various forms of sit-ups, and poorly performed good-mornings and stiff-leg deadlifts are some irritating examples.

In spite of these damaging mechanics, many people can abuse their spine by repeatedly performing these motions with little immediate consequences. Why is this?

Perhaps it's due to the fact that damage to the discs occurs through a cumulative process as opposed to a one-time episode of flexion and rotation. Just like the formation of a cavity in a tooth, one exposure to a piece of candy won't cause the problem. Rather, repeated exposure to corrosive agents over months and years, combined with poor hygiene, will rot a tooth. A threshold is attained, and severe pain ensues. The analogy stops there however, as fixing a damaged disc is far more difficult, if not impossible, compared to filling a cavity.

Hyperextension

Frequent extension of the spine under loaded conditions is often the catalyst for damage to the posterior elements. Those with spinal instability will be particularly sensitive to lumbar extension, due to the shear and compressive forces upon the damaged lamina and facet joints.

Heavy Compressive Loading

This is perhaps the most obvious enemy of the spine, as it can cause damage to all elements. Of particular interest is that the main source of initial failure with excessive compressive load is the vertebral endplate, as opposed to the disc.

Researchers, including Bogduk, Twomey, Taylor, and McGill have brought this to light. They report that vertebral endplate damage initiates the changes that lead to lumbar disc changes, making the disc susceptible to pathology.

Both Bogduk and McGill propose that a healthy disc will not herniate, even if exposed to extreme loading, flexion and rotation. However, an unhealthy disc, damaged from the sequelae of events initiated by microtrauma to the vertebral endplates and outer elements of the disc, will eventually succumb to stress.

Thus, informed clinicians now refer to herniated discs as a consequence of lumbar disc degradation, as opposed to degeneration. The former implies a consequence of regional abnormal stress, while the latter is a consequence of normal age-related changes.

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What Are the Simple Solutions?

Sounds pretty daunting, eh? Just don't sit, stand, flex, rotate, extend or compress the spine, and your low back will never be in pain.

Thankfully, for those with a normal spine, you don't have to completely avoid the above stresses to be pain-free. However, for those with a back condition, these stresses will either have to be modified or reduced so that further harm to the spine doesn't occur.

As we said earlier, the key to eradicating low back pain, or preventing it in the first place, is to optimally manage and adapt to the little stresses that you face every day. If you have to sit for hours in your car, or stand in one place for a long time, the following solutions will make your low back pain-free.

Deloading

Given that the spine is generally intolerant to prolonged loading, especially injured spines or those placed in a less than ideal position (sitting), modifying or decreasing load will improve its health. This notion is the basis behind spinal traction, which is simply deloading of the spine.

There seems to be an aura of mystique behind traction of the spine, but the concept is really simple: if something is damaged, take pressure off of it. How do we treat fractured ankles, severely damaged knees, or post-operative hip replacements to enable them to walk while recuperating? We give them crutches -- which allow deloading of the limb. In most situations, the spine shouldn't be treated differently.

Unfortunately, most people don't take advantage, or are even aware, of the benefits of spinal deloading. You could use various apparatuses from several thousand-dollar traction tables to manually applied harnesses. In reality though, you don't need any special equipment. Instead, you can deload your spine easily while driving in your car or while standing at a counter.

Below are some examples that you can try several times through out the day. The more loading, sustained postures, or severe the back condition, the more frequent you should do them. Don't just do these only in response to pain, but rather before symptoms manifest.

Hold each for about 5-10 seconds, then take a brief rest, about 3 sec, and repeat for 10-20 reps.

Note: I [Mike Boyle] don't recommend sustained traction. Holding or sustaining a deloading position for longer than 10 seconds could result in ligamentous creep. This can permanently elongate the ligaments and further contributing to spinal instability. Intermittent deloading provides the same benefits, without the risk.

1) To deload while sitting, you're going to essentially hold your body above your seat with your arms. First, place your hands on your sitting surface and extend your elbows so they're locked, then slightly depress your scapula. The load will then be transferred to your arms, with some remaining on your feet.

This technique is excellent to do when you are forced to sit for long periods without any break, like driving. Do this on regular intervals, such as every 3 songs for example.

2) To deload while standing, you have multiple options. If you're at the office, hold yourself up off the edge of your desk, and let your feet remain in contact with the floor while supporting most of your weight with your arms.

Also if standing, find something tall and sturdy that you could hang from while still having your feet in contact with the ground. A pull-up bar, lat pull, strong bands, or sturdy door jam would do. Grab on, sink into a squat, and let your arms take the majority of your bodyweight. Your feet should still be touching the ground, accepting about 10% of the load.

3) Lie on the floor intermittently during prolonged standing or sitting. Find a comfy piece of floor. Lay on your back with your feet on an ottoman or your chair so your hips and knees are at a right angle. This position applies the least amount of loading to the discs while giving you significant relief. While lying there, you can also lightly contract your abs and reset your spine to a neutral position.

Changing Positions

Ever watch a gecko on the hot sand? Notice how they constantly raise their feet to alternate which foot is in the air? The gecko has learned to modify his behavior to prevent his feet from burning in the scorching heat. Changing positions of the spine is a similar concept.

If the spine is continually loaded, the accumulating stress causes aggravation via several mechanisms. The spinal joints, and most other tissues, respond best to movement and intermittent loading which optimizes joint nutrition, joint lubrication and avoids over-stimulation of mechanoreceptors.

Many parts of the intervertebral structures have little or no blood supply, so they must receive their nutrients via passive diffusion stimulated by intermittent loading.

Most adults get some stiffness in their joints after sitting or standing for a long time. This happens because the joints are starved from the protective effects of joint lubrication, which reduces friction and provides nutrition to joint surfaces.

Even if you adopt the perfect sitting posture (if one does exist), the spine is still deprived of its optimal stimulus for healthy function. To prevent this deprivation, avoid prolonged sitting by interrupting long bouts with deloading, standing and walking.

Prolonged static standing can also be problematic. If you have to stand for long periods, shift your weight as often as possible. Even subtle movements stimulate intermittent loading and activate the spinal stabilizers, thereby enhancing stability and eliminating excessive load.

Stay Neutral

Consider a martial artist, who's about to strike an object with his fist. Imagine the effect if he struck the object with a flexed wrist: it'd result in both one pathetic strike, and likely a damaged wrist. Then imagine doing the same with the wrist in extension: you'd probably see the same thing. Now, place the wrist in neutral. The result would be an impressive blow with little compromise to the joint.

Why? Because the wrist was in such a position that the joint was able to evenly distribute the impact. Thus, it tolerated the load optimally with minimal damage.

This consideration should be the same goal for the spine; learn to orientate the spine so it can optimally accept load. Doing so requires adjusting movement patterns to adopt and maintain neutral spine position.

This usually requires a considerable amount of practice to enhance position awareness, otherwise known by kinesiologists as proprioception. Although proprioception can be severely altered with injury, it is very trainable and can be recovered.

Once you enhance your position awareness, you'll know where your spine should be in most day-to-day activities. From sitting down, to standing up, to picking up your groceries, knowing what a neutral spine feels like will greatly minimize injury and pain.

Although the methods of improving spinal position awareness can be complex and require skilled instruction, a simple tool involves visualization.

While standing to achieve a profile view in a mirror, find neutral spine. If the protruding bones of your frontal pelvis, your ASIS (anterior superior iliac spine), are considerably lower (greater that about 2 inches) compared to the posterior pelvic bone protuberances, your PSIS (posterior superior iliac spine), then you'll need to slightly posteriorly rotate your pelvis with a subtle contraction of you abs and glutes. If the opposite is found, slightly extend your back.

A way to achieve this neutral position is to imagine you're holding 100 lbs. in each hand. With this type of load, most people will instinctively adopt a sufficiently neutral spine position. Now, imagine a piece of tape is placed from the back of your head to the bottom of your tailbone. Then, when you do any tasks, try not to stretch or slacken this imaginary piece of tape. It takes some practice, but you'll be able to do it eventually.

For more concrete feedback on neutral spine, try doing various tasks while holding a dowel against your spine as depicted below:

Create Stability

Let's go back to the analogy of the martial artist striking a target with his fist. Assuming he's bright enough to put his wrist in neutral, consider the outcome if he didn't contract his forearm muscles sufficiently to maintain that position upon impact. As you could imagine, his wrist would likely collapse into flexion or extension, and suffer the consequences of a fracture.

Similarly, once we can identify neutral spine position, and have ingrained new movement patterns, we must use the muscles that maintain dynamic stability and ensure the spine remains as close to this optimal position as possible.

Once you've mastered the ability to identify a neutral spine, you now need to  perform a contraction to keep this position. Forget about hollowing your spine or just turning on your transverses or multifidus -- turn them all on!

Brace your abdomen like someone's going to push you on your ass. As Dr. McGill says, lock your pelvis to your rib cage. The diameter of your abdomen should not expand (otherwise your transverses is not engaged), or hollow (or your global stabilizers aren't sufficiently engaged). Poke around your abdomen to ensure your trunk is solid. Once you've achieved this state of steel, you've perfected the brace.

Next, maintain this brace with a variety of movements, especially those performed in the gym. This requires mobility in the ankles, hips, thoracic spine, and shoulders, as well as coordination and strength endurance of the trunk musculature. See McGill's book, Ultimate Back Fitness And Performance, for an in-depth description of this process. 

For best results, make sure you maintain a neutral, stable spine throughout sitting, standing, bending or loading. Modifying these daily positions and tasks will prevent or reduce most lower back pain.

Putting It All Together

The secret behind any of the above methods is to be consistent and give each one enough time to work. You'll never see results if you cheat a little here and there, or if you stop following the plan because you don't see results in two weeks.

The same concepts apply to your spine. Although there are many different back conditions, and many different symptoms, an underlying theme lies beneath each one. In some cases, you might have to alter your training program or daily activities, and in others, you might have to seek frequent clinical guidance.

But, in all situations, a spine is attacked by 5 major enemies: sitting, prolonged standing, hyperextension, frequent bending and twisting, and heavy compressive loading.

It's almost a no-brainer that if you have any type of back condition, you should limit hyperextending, bending and twisting and heavy spinal loading. 

So, the next time you speak with a doctor about a back issue and he tells you to take it easy, suggest to him that you've been reducing or at least managing your pain by taking a load off and moving your joints frequently.

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