Low back pain and the importance of putting first things first

According to the Canadian Chiropractic Association, 85% of working people can expect to experience low back pain (LBP) at some point in their lives, and in a six-month period, half of all Canadians suffered LBP1. The statistics are similar across the industrialized world: for example, LBP is the second most common cause of disability in American adults, resulting in an estimated loss of 149 million days of work per year in the U.S.2 These are pre-pandemic, pre- “I can’t breathe” figures, so I’d be willing to wager that LBP is at record levels right now. (Reports from physiotherapists with recently reopened practices suggest that this is true.) But what do coping with a pandemic and a deeply intensified confrontation with systemic racism have to do with low back pain?

The pain of working from home

First, the more obvious: many of us are now working from home, sometimes in setups that are less than ideal ergonomically. In addition to dealing with awkward workspaces, we may be neglecting to take frequent breaks from our computers. During the workday, we should be getting up and moving around every 30 minutes or so, and we should also be engaging in a variety of activities, including restorative movement. But between work, news consumption, social media, and digital entertainment, many of us are staying glued to our seats and screens for most of our waking hours. Not even the most flawless ergonomics can compensate for the harm this does to our bodies.

The LBP that results from poor ergonomics and too much sitting has a “mechanical” cause, which simply means that it’s the result of faulty mechanics involving the ligaments, tendons, muscles, intervertebral discs, vertebral bodies, and facet joints of the spinal column. Other mechanical causes of LBP include heavy lifting, accidents, disc herniation, and spinal osteoarthritis (spondylosis) or other spinal disorders (which, incidentally, can be caused by poor ergonomics and too much sitting). LBP can also be caused by faulty mechanics in other parts of the body, often the hips or feet.

What does inflammation have to do with low back pain?

Some LBP, however, is caused by inflammation rather than mechanics. Inflammation is your immune system’s response to irritants, infection, or injury. To fight off one or more of these unwanted invaders, white blood cells release chemicals called pro-inflammatory cytokines into the bloodstream and affected tissues. This process stimulates nerves and often causes pain. Where auto-immune disease is present, the immune system attacks healthy tissue rather than sites of injury or infection, but the process is the same, as is the result: inflammation.

Pro-inflammatory cytokines are meant to do their job and then disappear, but they tend to be upregulated and stick around when we are chronically stressed. There are multiple, complex mechanisms by which stress triggers the immune system, but the upregulation of cytokines is a major culprit because it habituates the body’s inflammatory response. If you want to know more, this article outlines the link between stress and inflammation. What’s key to remember is that stress reduction is critical for preventing or addressing LBP. Improving ergonomics, sitting less, and engaging in restorative movement will help tremendously, but won’t completely do the trick in the absence of measures to reduce the inflammatory impact of stress.

Since low back pain can have either mechanical or inflammatory causes, an increased risk of faulty mechanics plus an incredible amount of chronic stress may be creating an epidemic of LBP at this moment in time.

Feelings of helplessness during crises can contribute to pain

Intriguingly, the feeling of helplessness elicited by our current circumstances may be a contributing factor to LBP as well. Researchers have long identified a persistent link between self-efficacy and pain perception. When people feel a sense of helplessness, their perception of pain increases. We don’t know exactly why, but there appears to be a strong link between feelings of helplessness and LBP in particular3.

In our current moment, it’s infuriating and incredibly disheartening to witness the continued depth and pervasiveness of systemic racism. As police brutality against racialized people continues despite the eyes of the world watching and evaluating the actions of “law enforcement,” it’s hard not to feel overwhelmed by a sense of impotent rage. If you’re a white person, you may also feel (as I do) immobilized by not knowing exactly what to do, and deeply uncertain about where, how, and when it’s appropriate to use your voice.

As far as the pandemic is concerned, while a crisis typically puts pressure on us to act, Covid-19 requires a passive response from most of us. We must sit back (literally) and wait to see what happens, and we have no idea what the timeline for this crisis might be. If ever there were a recipe for feeling helpless, this is it.

Self-care is a critical first step

It’s difficult to see self-care as a priority with so much suffering and uncertainty front and centre, but I know this for sure: taking care of our bodies and minds is the first thing we need to do if we want to have the greatest positive impact on the world around us.

These are not just words to inspire you, and they’re not “permission” to create space in your life for self-care. They’re a call to action, because chronic pain is more than just a personal issue: it’s also a social problem. Chronic pain is in and of itself a stressor that makes us irritable, drains our energy, and inhibits rational thinking and decision-making. It has a negative effect on our ability to do the things we need and want to do to create a better world. As Stephen Covey et al. put it in First Things First, “When we aren’t feeling well, it’s much harder to think clearly, to relate in positive ways to others, to focus on contribution rather than survival” (47)4.

To keep ourselves feeling well, we must prioritize self-care. There’s no getting around this, no shortcut to wellness. We need to put in the time required to keep our bodies and minds functioning at their best—especially in the midst of crisis, when demands on our bodies and minds multiply and intensify.

You may have come across Stephen Covey’s “Time Management Matrix” at some point. It looks like this:

Covey asserts that our time is best spent in quadrant II. This is where we invest in ourselves and our relationships, laying the foundation for the kind of life we want to have and the type of person we want to be. In quadrant II, we spend quality time with our families, make sure our WFH setup is as ergonomic as possible, take frequent breaks from our computers throughout the day, get plenty of exercise, and broaden our minds through education and training—perhaps by reading a book like Ibram X. Kendi’s How To Be An Antiracist, for example. According to Covey, while time spent in quadrant I is inevitable and not always problematic, many urgent deadlines and pressing problems are mitigated by spending adequate time in quadrant II. The way that low back pain can become a pressing problem when we don’t manage stress and make time for restorative movement in our daily lives is a perfect example of this.

Covey recommends that we strictly limit the time we spend in quadrants III and IV, since these add nothing of real value to our lives. Unfortunately, these days it sometimes feels like quadrant III and IV activities (which include things like excessive news consumption, social media, and Netflix) are taking over our lives. Using “breaks” from work to check the news (which feels urgent, but is not a “break” and is not important to do more than once or twice a day) is an example of falling into quadrant III instead of actively choosing quadrant II.

Restorative movement alleviates low back pain in several ways

Restorative movement simultaneously addresses mechanical and inflammatory causes of LBP by improving the structure and function of our bodies while also helping us to manage stress. An emphasis on the exhale portion of the breath cycle (an important element of restorative movement) physiologically alleviates stress; psychologically, the heightened sense of self-efficacy we experience when we consciously choose and commit to self-care plays an important role in stress and pain management.

Covey writes about what he calls a “Personal Integrity Account” into which we make deposits every time we follow through on our commitments to ourselves and to the things that truly matter to us. This “account” is a “metaphor that describes the amount of trust we have in ourselves, in our ability to walk our talk” (Covey et al., 68). The more that’s required from us in the world, the more we need to take care of our bodies and minds so that we have the confidence and the stamina needed to face challenges and solve problems. Indeed, as Covey puts it, good mental and physical health is “a resource to accomplish worthwhile purposes” (48).

How to make eliminating low back pain a priority

Here’s what to do if LBP is distracting you from worthwhile purposes:
– Reduce stress. Try deep breathing exercises, meditation, spending time in nature, taking long walks, and setting reasonable limits on news and social media consumption.
– Take the time to set up an ergonomic workspace. (Your employer may be willing to cover some of the costs associated with this, but expensive fixes aren’t always necessary. See below for some very affordable ergonomic tips and tricks.)
– Try the exercises in our free Work from Home Relief Pilates Video Series, all of which can be performed while seated at your desk.
– Even if you do these exercises, you still need to get up from your desk and move around at least once every 30 minutes throughout the day. It’s also very important to limit additional sitting and screen time after work.
– Add several sessions of restorative movement to your weekly schedule. Make these sessions an absolute priority and follow through on your commitment to them.

Almost any type of exercise is beneficial for helping to prevent LBP; what your body hates most is inactivity. But if you’re already experiencing LBP, you’ll want to be more careful when choosing exercises. Here are some good basics to start with:

• Pelvic tilts
• Tabletop single leg lifts
• Neutral hip bridge
• Cat/cow
• Quadruped arm-leg reach
• Swan (thoracic extension—bending your upper back backwards)
• Wall sit/slide (neutral spine—slight arch in your low back with ears, shoulder, ribs and hips aligned; no pelvic tilt)

There’s no shortage of online videos and tutorials (many of them free) to guide you through a restorative movement session at home; explore what’s available and find what works best for you. All of the videos in our BH on Demand library and all of our Live Online Classes fall into the category of restorative movement because of the attention they pay to breathing, alignment and positioning, and mobilization of the spine and joints.

While some movements such as pelvic tilting and cat-cow are often particularly helpful for people with LBP, the truth is that since all parts of the body are connected, the best way to address LBP is with full body exercise sessions. If you’d like to really focus on the lower back, you’ll find several videos in our on-demand library that fit this description. If your pain is acute, consult a healthcare provider for advice before proceeding, and stick with the “Beginner” or “Restorative” levels in our library or live online classes. We’re also here for you if you prefer a more personalized approach through virtual one-on-one sessions.

Tips for making your home office more ergonomic

As promised, here are a few cheap and cheerful ergonomic tweaks to improve your WFH setup.
Before you start digging around the house looking for the props you’ll need, have a clear picture in mind of what you’re trying to achieve:

• a neutral spine
• chin parallel to the floor and eyes slightly lowered to look at your screen
• wrists level with naturally dropped elbows (let your arms hang by your sides and relax your shoulders, then bend your elbows until forearms are parallel to the floor. This is where you want your wrists to be while keyboarding)
• wrists in a neutral position (i.e., slightly “cocked,” as if you were about to knock)
• feet flat on the floor, with knees in line with hips

Sit in your usual workspace, and evaluate your setup with the above guidelines in mind so that you know what needs to be improved. Then start scavenging—you already have most of what you need to improve your workspace lying around the house.

A small cushion or rolled-up towel at the small of your back can help you to maintain the spine’s natural lumbar curve (“neutral spine,” neither tucked nor arched). You can place beanbags or rolled-up socks under your wrists to help keep them in a neutral position. If your knees are higher than your hips when seated, prop yourself up on cushions or books topped with a folded towel (for padding!) until your thighs are parallel to the floor; if, on the other hand, your feet are not flat when seated, make a footrest out of books, a yoga block, or a box.

If you’re working on a laptop, it’s worthwhile to make the small investment in a separate keyboard. This will allow you to get the top of your screen at or just slightly below eye level and your elbows and wrists down in a healthy working position. Prop your laptop up on a stack of books or an appropriately sized box until the middle of the screen is at eye level. Place the keyboard and your mouse at elbow level as determined above (make sure your shoulders are relaxed when you find this sweet spot!). I’ve found that if I elevate myself slightly by sitting on a cushion, my elbows land at just the right height when my keyboard is on my kitchen table. We’re all different, of course, so depending on your proportions, you may need to get especially creative when coming up with a solution for your keyboard and mouse.

Don’t let low pain keep you from purpose

Not regardless of but precisely because of the chaos in the world, we need to take the best care possible of our bodies and minds. LBP can be an important message from our bodies reminding us that we’ve neglected our own needs, often in an effort to do more for others. Sidelined by pain, we realize the necessity of putting first things first in order to accomplish worthwhile purposes.

1 “Canada’s Low Back Pain Epidemic”
2 “The Rising Prevalence of Chronic Low Back Pain”
3 See LaTouche, Roy et al., “How does self-efficacy influence pain perception, postural stability and range of motion in individuals with chronic low back pain?” Web of Science vol. 22, no. 1, January – February 2019, pp. E1-E13; Kolek, M. et al., “Psycho-social factors and coping strategies as predictors of chronic evolution and quality of life in patients with low back pain: A prospective study.” European Journal of Pain vol. 10, no. 1, January 2006, pp. 1-11.
4 First Things First: To Live, to Love, to Learn, to Leave a Legacy. Covey, Stephen R., A. Roger Merrill, and Rebecca R. Merrill. New York: Simon and Shuster, 1994. Print.