Is Sitting the Cause of Your Back Pain Here is the Reason Why and the Solution for it!

Hi i’m Dr. DAVID Neurosurgeon specialize in pain management. Today ‘s topic is low back pain which almost everybody have experienced once in a life time including myself. Let me show you my case first. A 42-year-old man who mostly works at a desk job, recently feeling a decline in overall strength but not particularly exercising. He began to feel pain in the lower back and sacral region one month ago and has been observing the condition while wearing a supportive device. However, the pain did not decrease and he sought out a neurosurgery clinic. X-rays showed formation of osteophytes and degeneration of the intervertebral disc in the lumbar spine, but he was diagnosed with muscular lower back pain and given physical therapy. The pain was particularly strong during standing and bending motions, and was felt throughout the sacral and lumbar regions. A tenderness of the iliocostalis and longissimus muscles were confirmed by palpation. He received physical therapy using heat therapy and interference waves, and stretching exercises for the longissimus and iliocostalis muscles. As a result, the pain seen at rest was reduced but the pain in the lower back during bending movements remained. Upon re-evaluating the lower back, it was found that the strength of the multifidus muscle had decreased. Therefore, exercises to increase the strength of the multifidus muscle including guidance on posture were performed. The patient's pain that occurred during bending movements has disappeared. There may have been parts that were difficult to understand, but I will explain in detail in progress. Low back pain (LBP) is a broad term that encompasses any pain felt in the lumbar region of the back, regardless of whether it is present during rest or physical activity. Among LBP, specific types of pain caused by specific conditions such as herniated discs or compression fractures make up about 15% of cases, while non-specific LBP, in which there are no clear imaging findings and the cause cannot be identified, make up about 85% of cases. Within non-specific LBP, a subtype called degenerative lower back pain occurs when the muscles and tendons around the joint are chronically tense. The cause of this can be from overuse or over-stress of the lumbar muscles and tendons, and it is characterized by the absence of neurological symptoms such as nerve irritation or paralysis. The muscles of the lower back include the intrinsic muscles, such as the semispinalis muscles, rotator muscles and multifidus muscles, and the extrinsic muscles such as the erector spinae and longissimus muscles. Functionally, the intrinsic muscles provide stability to the spine while the extrinsic muscles provide mobility. Both the intrinsic and extrinsic muscles are covered by a common fibrous tissue called the thoracolumbar fascia. This stress can be caused by the compensating contraction of muscles such as the transverse abdominis, oblique muscles and quadratus lumborum and gluteus maximus that are attached to the thoracolumbar fascia. This type of stress is often seen in cases of repetitive motions such as work or sports. Also qqdue to poor posture, pain provocation and occur. Poor posture can cause tension in the thoracolumbar fascia which increases stability of the lower back. However, this contraction of the fascia can lead to a decrease in the strength of the lower back muscles, causing the thoracolumbar fascia to become more dependent and rely more on it. This excessive stress on the thoracolumbar fascia can lead to fatigue and inflammation, which can also cause excessive muscle tension in muscles such as the longissimus and erector spinae muscles. The lumbar muscles are covered by a common fascia, forming one Additionally, the increase in muscle pressure causes a decrease in blood flow and ischemic pain. It has been reported that during flexion of the back, muscle pressure within the back muscle compartment increases more than in physiological standing position. These multiple reasons is the cause of myofascial low back pain. compartment. Therefore, if the pressure inside the muscle of the extensor muscle increases, it presses the nerve branch which innervate the back muscle.