C6 Tuesday, April 8, 2014
FITNESS & WELL-BEING
DISCORD As new research reveals the devastating toll of disability inflicted by lower back pain, Jeanette Wang looks at a widespread problem
oes your lower back hurt? Well, if you’re not experiencing any pain now, there’s a high chance you will sooner or later. “Most people will suffer from lower back pain at least once in their life,” says Dr Michael Tse, assistant director of University of Hong Kong’s Institute of Human Performance. “Most” refers to about 80 per cent of adults, according to the Hospital Authority’s Smart Patient website. In fact, an international study published a couple of weeks ago in the Annals of the Rheumatic Diseases shows that lower back pain causes more disability around the world than any other condition. Researchers looked at data from the World Health Organisation’s Global Burden of Disease 2010 study, which assesses ill health and disability arising from various conditions in 187 countries. These countries were grouped into 21 regions, and the data covers 1990, 2005 and 2010. Of all 291 conditions in the study, lower back pain ranked number one in terms of years lived with disability – 83 million years in total in 2010, to be exact. The study found almost one in 10 people (9.4 per cent) had lower back pain, and that men were affected more than women (10.1 per cent compared with 8.7 per cent). The condition’s prevalence and overall impact increased with age.
Western Europe had the highest prevalence (15 per cent) and the Caribbean the lowest (6.5 per cent). In East Asia, the region which includes China, prevalence was 6.7 per cent. “With ageing populations throughout the world, but especially in low and middleincome countries, the number of people living with lower back pain will increase substantially over coming decades,” the authors conclude. Lower back pain could be caused by a number of factors, including weak abdominal and back muscles, obesity, inactivity, poor posture, sitting for extended periods at work stations, the wrong random movement, or muscle strain resulting from strenuous physical activity. These tend to be the common causes of lower back pain in middle-aged and young people. “Because the body is like a kinetic chain, lower back pain could arise from a dysfunction elsewhere in the body, such as a stiff upper spine, weak glutes, tight hip flexors and hamstrings, or sometimes even having one leg which is longer than the other,” says Tse, who is also director of the institute’s Active Health Clinic.
Conservative treatment is usually better …The body tends to heal itself DR MICHAEL TSE OF HKU
Backache in the elderly, however, is typically caused by age-related degeneration of the intervertebral discs in the spine. But generally, most people will experience an occasional bout of non-specific lower back pain, whereby careful observation along with over-thecounter pain medication and targeted physical activity may be all that’s needed to resolve the issue, says Dr Scott Forseen, neuroradiologist at Georgia Health Sciences University. Forseen was the co-author of a 2012 study in the Journal of the American College of Radiology that put together a set of diagnosis and treatment guidelines based on the overwhelming evidence that hitech imaging exams and back surgeries don’t improve outcomes for most patients. “Conservative treatment is usually better,” says Tse. “The body tends to heal itself, so if you do nothing, pain usually subsides in a couple of weeks. If pain doesn’t go away in two weeks, you should get it checked. “On the other hand, treatment to address the root of the problem will help prevent lower back pain from happening again.” There are many options for conservative treatment, such as physiotherapy, massage, acupuncture and chiropractic, Tse says, while yoga, Pilates, strengthening and stretching may help with future prevention. These various modalities share the common goals of improving mobility, strength and posture. Dr Michal Katz-Leurer, of Tel Aviv University’s Sackler Faculty of Medicine, suggests a simple programme of aerobic walking
two or three times a week for 20 to 40 minutes each time. In her study published last year in the journal Clinical Rehabilitation, after six weeks of doing the programme, participants saw significant improvements in their condition that was comparable to a group who did a typical clinic-based muscle strengthening programme. The human body is structured in such a way that mobility at each joint helps share the load of daily physical exertions, Tse says. With age, we tend to move less on a daily basis, leading to stiffer and more immobile joints, which puts strain on other areas along the kinetic chain. As the hips and upper back tend to stiffen from inactivity or improper activity, people tend to rely on increased flexion, extension and rotation of the lower back. “This can be a recipe for disaster, as the lower back is meant to be stiff and stable,” says Tse. He recommends not only strengthening around the hips and core, but also maintaining joints which are supple and sufficiently mobile for a painfree body. Here, he suggests a series of simple exercises that you can do at home to prevent or alleviate lower back pain. The entire circuit will take about 10 to 15 minutes. If your muscles are very weak, start out holding each pose for 15 seconds and gradually work your way up to a minute. Repeat each pose for two to three times per side. You can do the circuit three to four times a week, any time of the day, says Tse. email@example.com
Lower back pain: exercise circuit Do these exercises in the order shown. The first four exercises warm up the body; in particular, the lower back, hip flexors, hamstrings and glutes, which can get tight if you have been sitting all day. The exercises that follow then work on strengthening the lower back and core muscles.
1. Cat-camel Get on your hands and knees. Palms should be flat on the floor and shoulder-width apart, while knees are hip-width apart and bent 90 degrees. Engage your core and abs and keep your spine in a neutral position. Cat phase: round your back up toward the ceiling. Hold pose. Camel phase: lift your buttocks towards the ceiling while pressing your stomach towards the floor. Hold pose. Repeat phases alternately in a slow, controlled manner. 2. Side bend Stand tall with feet shoulder-width apart. Slide left arm down left leg towards the knee, reaching as far as you can without twisting the body. Hold pose. Return to start position and repeat on other side.
3. Seated spinal rotation Sit tall on a chair, keeping feet flat on the floor. Extend arms straight in front of you at chest level. Twist torso to the right, keeping head and neck in line so that you’re always facing your hands. Keep hips facing straight. Hold pose. Return to start position and repeat on other side.
4. Lunge Stand tall with feet shoulder-width apart. Step right leg forward, keeping right knee over right ankle. Tuck pelvis under to feel the stretch in front of the right hip. Hold pose. Return to start position and repeat on other side. A simpler variation: drop your rear knee to the ground for support, keeping a 90-degree bend.
5. Bird-dog Get on your hands and knees, similar to the starting position for the cat-camel exercise. In a slow, controlled movement, extend your left leg behind you while reaching your right arm forward. Keep hips and shoulders square and lower back straight. Hold pose. Return to start position and repeat on other side. A simpler variation: raise only one limb at a time.
6. Bridge variations 6a. Front: Lie on your stomach with arms bent, palms and forearms on the floor. Using your core, lift torso off the floor. Keep palms, forearms and toes on the ground, and back straight. Hold pose. Return to start position and repeat. A simpler variation: keep knees on the floor.
6b. Side: Lie on your side with legs extended. Place right elbow directly under your shoulder to prop up your torso, while keeping your head aligned with the spine. Lift your hips and knees off the floor. Hold pose. Return to start position and repeat on other side. A simpler variation: keep knees on the floor. 6c. Supine: Lie on your back with knees bent and feet flat on the floor, arms by the side and heels hip-width apart. Using your glutes and core, push your pelvis upwards until your body forms a straight line from the knees to the shoulders. Hold pose. Return to start position and repeat.