We assume poor postures for greater amounts of time than we used to, predominantly due to hi-tech gadgets. Sitting a lot in bad positions puts an unnatural load on the lumbar discs, the building blocks of our spine in our lower back. Issues with lumbar discs are debilitating but are surprisingly simple to avoid. If you don’t sit much and your work involves manual labour don’t skip this chapter! Repeated lifting can have the same effect on the lumbar discs as sitting in poor positions.
Lumbar Disc Anatomy
The spine is made up of a stack of blocks of bone called vertebrae. These vertebrae are categorised into three groups: cervical (neck), thoracic (mid-back) and lumbar (lower back).
Looking at the spine from side, it easy to see it is built with natural mild curves: in at the neck, out over our shoulder blades and back in again at our lower back. From the front or back our spine should be nice and straight.
We have discs sandwiched in between each of the vertebrae in our spine, which are fused to the vertebra above and below. The discs act like a cushion or shock absorber. The presence of these discs combined with the natural curves of our spine work like a spring to absorb the impact and shocks that are imposed on our body from natural movement. The ultimate role of all of this shock absorption is to protect our most precious structure––the brain.
The discs in the spine are made up of concentric rings of fibrous tissue surrounding a pocket of jelly in the centre. Picture a jam donut––a sugary dough casing a heart full of jam in the middle. This is similar to our disc structure (though I’d imagine they don’t taste nearly as good). The discs are springy, and the jam in the middle allows the disc to compress slightly if the spine is loaded.
When our spine is in the upright or straight position, the lumbar spine (lower back) has a natural inward curve. When the lumbar spine is positioned with its natural inward curve, the discs are loaded evenly, and the jam is centred in the middle. Our spine and the discs within it can withstand considerable loads In this upright or neutral position. This includes holding bags full of shopping or carrying a heavy backpack. This neutral position is generally the position we get into when we stand and think tall.
If you have been to an Asian or African country, you may have seen locals gracefully carrying heavy produce and containers on their heads. They are always standing very straight; if they let their head or body bend forwards even slightly, they would either drop their load or create injuries that could threaten their livelihoods. This vision is true testament to the enormous strength of our spines if they are loaded in an upright or neutral position.
What goes wrong
Unfortunately, most of what we do in modern times is not in an upright or neutral spinal position, but rather a position in which we are bent in the middle. We sit at a desk, we sit in a car, we pick up a child’s toys, we lift groceries out of trolleys and we slump on the couch. When we bend, our lumbar spine loses its natural inward curve. The front part of the disc compresses. This causes the jelly in the centre of the disc to move.
Picture this––you raise the enticing jam donut to your mouth. It is full of sweet, warm jam, you take a big bite squashing the front half of the donut and compressing the space available for the jam. Where does the jam go? It squeezes out the back wall of the donut and runs down your hand . . .
This mouth-watering analogy is reminiscent of what happens to our discs when we bend a lot.
In reality, the jelly doesn’t burst out of the back of the disc straight away. Over time, the jelly pushes on the back wall of the disc so much that it creates little fissures or tears on the inside of the back wall of the disc. Then, each time you bend or sit, the jelly keeps pushing back into those fissures making them a bit bigger.
This process can be happening to your discs right now without you even being aware of it. The nerves (and therefore, your pain warning system) only supply sensation to the very outer layer of the disc wall, so internal damage can go undetected until . . .
You bend over to pick up a pen and BANG––sudden pain and spasm in your back. The cumulative disc load has finally caused the outside layer of the disc to become swollen and distended. You register a pain response via the nerves. For some people, the onset of pain is less dramatic (a small niggle that builds), but it can also escalate to a debilitating level.
Disc issues can become recurrent and ongoing. Once you have suffered once, you are ever vulnerable. Some people can correct these issues with rehab, others end up under the surgeon’s knife with a range of outcomes.
The management of these issues after they have occurred is not the focus of this book. We wish to address prevention. This prevention advice can still be relevant to you if you have already suffered a lumbar disc issue; however, this should be in consultation with your health professional.
Take action before you break
There are three main things you need to remember in order to protect your lumbar discs. The first is that discs are by far happiest when the spine is in a neutral position and the lumbar area has its natural inward curve. This means maintaining that small inward curve in your lower back while you sit, lift, garden and pave that path at home. It can help to use a lumbar support in your chair by making sure you always sit right at the back of the seat with your back supported. When doing more physical activities, think of sticking your butt out and keeping your shoulders back.
No one is perfect and we live in a real world, so it is impossible to avoid bending our back all day everyday. In fact, it is healthy for us to move constantly including into bent positions, but our default spinal position should be neutral. These days, the volume of bending we are in the habit of doing is far too much for our lumbar discs to bear.
The message here is that bending is inevitable, but it should be done in small doses.
Changing bent spine habits into neutral spine habits takes time and effort, but the time and effort required is insignificant when compared with the time and effort associated with a disc injury if you don’t make changes. If you can decrease the time you spend slumped in your chair (or curling your lumbar spine over the garden) by just five percent each day, you will eventually find that the healthier positions form new habits and become automatic and require less effort.
The second thing to remember is to find any excuse possible to frequently move from a prolonged position. For example, make a cup of tea, walk to the post office, hand deliver a message and stand for morning tea during your day of desk-based work.
Clearly, the less sitting and computer work you do the better, but this is difficult if your work relies on it. As an ideal rule, a maximum of half a day at a time should be spent locked into computer use.
The third thing to remember is that you can compensate your lumbar discs for all of the bending forwards by arching back the other way! This can be done in both a standing and a lying position. Since compressing the front of the disc by bending forwards or sitting forwards causes the jelly to push to the back of the disc, arching backwards helps to coax the jelly back into the centre of the disc. By moving the jelly away from the back wall of the disc, the pressure is relieved, allowing the back wall of the disc to recover and heal. Put your hands on your hips while standing and arch your back (keep your head straight though, if you throw your head back you could fall over!). Lie on your tummy on the floor and use your arms to push your upper body up, leaving your hips on the floor. The yogis call it the cobra. These simple exercises are explained clearly in the following Injury Proof Toolkit.
Injury Proof Toolkit:
1) Change your environment
Make it easy to maintain the natural inner curve of your lower back:
- Support your gadget so that you are looking ahead not down.
- Adjust your back rest to support your lower back and keep you upright and sit with your bottom right at the back of the chair.
- Add a rolled up towel across your lower back if you need extra back support.
2) Change your habits
Follow these guidelines:
- Get up from your chair for a minimum of 10 minutes every hour for the first three hours then five minutes every half hour afterwards.
- If at all possible, keep computer use to a maximum of four hours a day, five days a week.
- Take every opportunity to lie on your tummy instead, e.g. reading, watching TV.
- Take every opportunity to do non-sitting activities: walk at lunchtime, post mail, chat at the water cooler!
- Get rid of your coffee table! A carpeted area in front of the TV is a great environment to replace some sitting activities with lying.
- Perform any physical activities like lifting, gardening or vacuuming with your bottom sticking out and your shoulders back. This encourages you to keep the natural inner curve of your lower back and the jelly away from the back wall of the disc.
3) Add these exercises
Extension in Lying
- Lie flat on the tummy with palms flat on floor underneath the shoulders.
- Slowly push up the upper body, leaving hips on the floor.
- Do not push into pain.
- Perform 5–10 repetitions 3–4 times a day.
Extension in Standing
- Stand and place hands on hips.
- Slowly arch backwards, trying to keep knees straight.
- Do not push into pain .
- Perform 5–10 repetitions 3–4 times a day.
- This may be done with forearms resting on a wall, gently taking the hips into the wall.