“I don’t get it. I’m really not doing much of anything – not lifting anything, not twisting or bending. I’m just standing there washing a few dishes and my back feels awful within a few minutes,” was his statement to me in an exasperated tone.
These types of activities – the ones that seem so simple and innocuous -are sometimes a source of chronic low back pain.
First, it’s human nature to want something that causes us trouble to also be something complex, difficult to solve, or unusual in nature. It makes us feel better about the problem, oddly, by knowing that it’s a complex problem.
Have you ever had a plumbing problem – maybe a drain that won’t unclog or a leak you can’t fix and when the plumber shows up, he solves it in five minutes with a simple twist of this or that? And then hands you a bill for $75 at which you, of course, gasp?
We feel better about our problems and solutions if both are complex.
So, in this case, when I suggest that one of the causes of ongoing lower back pain is washing dishes (and the solution isn’t always to stop washing dishes – I’ll get to that in a minute), it creates an internal conflict in the person with the problem which is only resolved by accepting my observation.
This is very hard for most people to do and the result of course is continued low back trouble because they just cannot accept that something simple, like washing dishes, is really that big of a deal.
The second reason is physical.
One of the causes of lower back pain is excessive internal pressure in the spine that, in a sense, distorts or stretches the soft tissues (intervertebral disc, fascia, ligaments, bone). Nearly all soft tissue has pain sensors that respond to pressure or stretch or torsion (which is stretch and pressure combined).
Try this and you’ll see what I mean.
This is basically what is happening in the spine (but without the bending) when you wash dishes. The internal pressure goes up substantially and combined with weak spinal tissues, you hurt.
In a study published in SPINE, researchers measured pressure inside the intervertebral disc during a variety of everyday tasks (no doubt, a special volunteer in this study to allow a needle to be inserted into his spine). And what they found was surprising.
Standing bent forward, as in washing dishes, had over ten times the pressure of lying on your back, three times the pressure created by slow running, and the same pressure as holding 44lbs close to the body.
Can you see the problem here?
It’s a lot easier to accept that slow running could cause back pain or holding a big bag of dog food than washing dishes.
But washing dishes is a lot of work for your spine.
If you visit your family doctor about this problem, you’ll most like get a prescription for drugs and be told to stop washing dishes.
Neither of which is a good long term solution but both may work in the short term.
Let’s assume you have nothing malicious going on in your spine – no tumor, massive herniation, gnarly arthritis, or systemic disease.
What you have is just garden variety, hard to diagnose but easy to provoke lower back pain.
When you hurt, what goes through your head is pretty simple: I don’t want to hurt. So you might reach for a Non-Steroidal Anti-Inflammatory (Advil, Aleve, etc) or a pain reliever (Aspirin, Tylenol).
These drugs sometimes do help but there’s a price to pay – delayed healing if you continue to use the drugs and a number of other side effects (gastrointestinal disorders, liver or kidney damage).
There are a number of good, natural “first aid” options, in fact so many, I wrote a book on the subject (to get the book for free, see the end of the post). So, for this post, I’ll cover a couple of things to do.
What I’ve found very helpful in the recovery phase is a simple, easy to execute movement that can dramatically reduce lower back pain.
It’s not a long term solution but a great natural pain reliever.
We call it Rock n’ Roll.
Here’s how you do it:
Another option is a “pain patch“. I’ve used them and have found them to be quite helpful. How they work, from a western medicine perspective, is by altering brain activity and promoting anti-pain mechanisms.
Once you’ve moved out of the recovery phase, pain levels are low to none, movement is easier, it’s time to start restoring and rebuilding your strength, endurance, and mobility.
The underlying problem with most lower back pain is tissue weakness – fasica, muscle, tendon, disc, bone – and because the tissue is weak, your lower back “fails” when exposed to forces above its capacity.
Yes, things like tight hip flexors or inadequate hip rotation come into play as well but without strength, the mobility will not save you.
The challenge is to manage the forces of everyday life, make wise choices, challenge your body physically, and control the worry monster in your head.
A lot of stuff.
From a physical perspective, this may be the most difficult thing to do because it requires you to understand how certain activities affect your spine.
There are five activities to be aware of: sitting, stooping, repeated bending/twisting, standing, and of course, lifting.
These activities are challenging because of the internal spinal pressures. In a descending order of the amount of pressure:
The forces of everyday life can undo your restoration and rebuilding efforts. So, in other words, what you do day to day matters as much, and maybe more, than the your specific training.
Here’s an example.
You have lower back pain that is not disabling but is very annoying. It shows up at inopportune times, disrupts your social life, and generally is, well, a pain in the butt.
However, you have days where you feel pretty good too. And on one these days, you decide to do some “light work” in your garage. Just some general clean up, some re-organizing, moving light boxes (10lbs or so), etc. that lasted three hours.
Two days later, your back seizes up like a an engine without oil.
Because the back attack showed up two days from the garage work, you don’t make that connection. Most of us only look back in time 24 hours at most. And, because you perceive the garage work to be “light”, you dismiss that immediately as a cause for the attack.
Now, you’re stumped. Perplexed. Worried. Pissed-off. You blame it on your exercise or the walk you took with your dogs that morning or whatever you can point to in the prior 24 hours or so.
All that garage work, fatigued your spinal tissues. Then, just about anything could trigger the attack. Like sitting in front of your computer for a couple of hours.
I’m not saying to never work in your garage again. What I am saying is to be strategic about it. Instead of three hours in the garage, spend 30 minutes then take a break and get into the rock n’ roll position for a few minutes. Allow your spinal tissues some time to recover. Then you might try another 30 minutes later in the day.
To rebuild your spinal strength, you have to use everyday activities as part of the rebuilding process and not look at those activities as separate from the rebuilding.
What’s a “wise” choice? I’ll give you an example from my life of one that wasn’t so wise.
Last Thanksgiving, I made the mistake of washing dishes, thinking I was being helpful, but it went on for a long time.
Two days later, I couldn’t stand up straight.
I knew better but I did it anyway. That is the definition of an unwise choice.
You’re faced with situations almost daily where you’re up against going along with the crowd – you don’t want to look weak, injured, unable – versus doing what’s best for you.
Pause, breathe, and listen to the inner voice – the one that is whispering to you, “Doug, that is not a good idea right now” and heed the voice. If your friends are truly your friends, they’ll understand.
I’ve covered how the forces of everyday life have to part of the rebuilding process. You also have to train.
Sometimes you need help from a pro. Someone who can guide you – physical therapist, coach, personal trainer.
But the work is always inside-out. You have to rebuild the capacity of your spinal tissues – the muscle strength and strength of the connective tissue (fasica).
People with chronic lower back pain have altered connective tissue in the lower back region which reduces the force capacity
Physical training can improve the tissue tolerance but you have to ease into it by rebuilding your “core” muscles/tissues and general endurance.
My book, Build a Rock Solid Core: Stop the Sit Ups and Save Your Spine, is organized around this concept of rebuilding your tissue capacity from the inside-out. It offers a logical, progressive approach to increasing your strength and endurance.
Whatever you choose, be sure to examine the exercises for too much spinal pressure. One exercise that is often suggested by trainers and others is the “superman” – lying face down on the floor and lifting the arms and legs up. Bad idea. Super high spinal pressure.
Worrying is borrowing trouble from the future.
There is very little to be gained from it but I understand its power.
The key to managing worry is to realize that it is an active process and sometimes it’s moment to moment. Worry is always lurking just waiting for an opportunity to take control of your mind, derail your plans, and make your life miserable.
I know. I’ve been there and still worry about things more often than I would like.
Here’s the thing. While you’re worrying about whether your back pain will ever go away or if you will live like this the rest of your life, you’re not working on those things you can change which, paradoxically, directly impact your future.
As long as you’re worrying, you’re not changing. Without change, there is no improvement.
Yes, you may never get to your desired goal but you’ll never get there by worrying.
While you’re working on building up your capacity, life goes on which may include washing dishes, pots & pans, etc. So, how do you do that and not completely undo all of your hard work?
Almost every kitchen sink has a cabinet below it. When you stand in front of the sink, make sure you open the cabinet door and place one foot on the edge of cabinet floor. Then, brace the mid-section (you can find more info on bracing and core development in “Build a Rock Solid Core: Stop the Sit Ups and Save Your Spine“).
Placing your foot on the cabinet floor establishes “load sharing” – it creates a wider base of support for you to manage the load of your trunk and it will help reduce the internal forces on the low back.
Work only to the point of mild fatigue and then take a break.
If you struggle with lower back pain, pay attention to the forces of everyday life, like washing dishes, make wise choices, challenge your body physically, and manage the worry monster to reduce the impact lower back pain has on your life.