What can help my lower back pain?

Today I attended the Employee Benefits Connect event to find out about the latest trends in employee benefits.  Quite a few speakers identified the growth of onsite well-being services like the Vitality Breaks services I provide, as the number one healthcare issue in companies right now and for the next few years. The key conditions that are driving the growth of well-being services are:

1. Diabetes
2. Heart Disease
3. High Blood Pressure
4. Back Pain

We all know that back pains is common, episodic, often recurrent and generally self limiting.  Long term absence form work is greatest amongst the minority of employees whose conditions is chronic (if the pains lasts for more than 12 weeks) or is recurrent (if there are several episodes of pain in one year lasting less than 6 months).  Most people who are effected by back pain either remain in work or return to work promptly.  About 85% of people with back pain take less than seven days off work. In a survey reported by the London Work Foundation it identified that 9.6 million workers are regularly affected by back pain.  In addition the London Work Foundation has identified that musculoskeletal conditions comprise about 55 %of all work-related illness throughout the UK compared to stress being responsible for 30 per cent of work-related illness, that figure drops to 31% when you focus only non-manual workers.    This makes musculoskeletal conditions the top reason for long term absence from work in the UK for non-manual workers. So why am I quoting all these statistics, because despite speakers talking about trends in healthcare being driven by amongst other things back pain and clear evidence that musculoskeletal conditions are the number one reason for absence there was no mention of solutions.  Go figure!!!!

One of the most common questions I get asked, by my clients is "is my back pain sciatica?".  So I would like take some time to explain what sciatica or piriformis syndrome is. Sciatica is the irritation of inflammation of the sciatic nerve, which runs from L3 down through your legs and feet to your toes, so its the longest (and widest) nerve in the human body.  The reason sciatica is called piriformis syndrome is that the piriformis muscle (which is in your bum) can compress the sciatic nerve.  Because in most people approximately  87% the sciatic nerve passes below the piriformis muscle, in approximately 13% people the sciatic nerve passes in part or entirely though the piriformis muscle.  So tightness in the piriformis muscle is a major cause of sciatica and this tightness can be exasperated by prolonged sitting.  Other notable causes are trauma to your lower back or your pelvis, a history of herniated disc in your lower back and some systemic diseases e.g. diabetes. So how can you tell if you have sciatica or lower back pain?  Sciatic is characterised by the presence of one or more of the following symptoms:

• Constant pain in one side of the buttock or back of one leg.
• Sharp or burning pain or tingling radiating down the back of your thigh.
• Pain is worse when sitting for long periods of time.
• Pain may be aggravated by sneezing, stooping or straining.
• You feel that you want to slouch away from the effected side.
• Possible pins and needles or parasthesia (numbness) down leg.

Sciatic pain can begin abruptly or can come on gradually and may vary from infrequent and irritating to constant and incapacitating.  While symptoms can be very painful, it is rare that permanent sciatic nerve damage (tissue damage) will result. The vast majority of people who experience sciatica get better within a few weeks or months and find pain relief with non-surgical sciatica treatment including massage. For others, however, sciatica pain from a pinched nerve can be severe and debilitating. There are a few symptoms that may require immediate medical, and possibly surgical, intervention, such as progressive neurological symptoms (e.g. leg weakness) and/or bowel or bladder dysfunction.

While sometimes it may not feel like it, your shoulders are the most flexible joint in your body.  The joint is formed by the union of the humerus, scapula (or shoulder blade) and the clavicle (or collarbone).  While we normally think of it as a single joint, it is actually three joints

1. glenohumeral joint
2. sternoclavicular joint
3. acromioclavicular joint.

These three joints work together to allow the arm both to circumduct in a large circle and to rotate around its axis at the shoulder.  As with most joints it is stabilised by ligaments.  However the shoulder joint is unique in that it is strengthened posteriorly and superiorly by the rotator cuff muscles, which act as "active and relaxable ligaments".  Unlike most joints which have a high degree of passive stability the shoulder joint depends largely on the active stability of the rotator cuff muscles. As soon as you move your arm joint stability is provided by the rotator cuff muscles alone.  The muscular action of the joint is more complex to move the joint in numerous directions. This design of the shoulder joint makes it the most flexible joint giving us a high degree of mobility & power.  This great range of movement comes at the cost of reduced stability.  A key benefit of the design is it does reduce the risk of arthritis in the shoulder when compared to other joints. Given the additional importance of muscles in shoulder's design when in the gym, it is important to:

• Work all joint articulations - if it moves that way, strengthen it.
• If you do a pushing exercise, counter it with a pulling exercise.
• Always use proper exercise form - control the resistance.

And don't neglect the smaller stabilizing shoulder muscles that make up the rotator cuff. Spend time fortifying them via internal and external rotation exercises with the upper arm at various positions.