We’ve got your back! Let us help you lighten the load a bit. Back pain is something that most of us have experienced and it can really put a damper on your quality of life. From an evolutionary standpoint, where we had no choice but to be actively on our feet (otherwise we would die) until the recent technology age and age of the iHunch, we humans are finding ourselves being ourselves more and more curled and hunched over. It is causing some serious and tragic problems on a micro and macro scale. Here we answer common questons, like what are some common causes of back pain for professional workers, do’s and dont’s to manage and prevent pain, and whether to see an ortho, PT, or chiropractor!

I would like to thank my co-editor, Neda Khalili, who is a certified NASM trainer, for sharing her wisdom in this article. Please be advised that no part of this article contains medical advice, and that we recommend you consult a doctor for any medical opinions. Please listen to your own body, use best practices, and if your pain is disruptive or significant, see your primary care physician ASAP. 

Back pain unites the world just as much as COVID

The World Health Organization published a study, stating that, “[back pain] occurs in similar ​​proportions in all cultures, hindering quality of life…Chronic Back pain has strong psychological overlay: work dissatisfaction, boredom, and generous compensation system all contribute to it.” The sad note here is that a lot of these studies were carried out in 2018, well before the pandemic, so the scale of those experiencing such pain is likely to be much greater. Low back pain is a very complicated issue in its mere diagnoses. Most of the time, the very root cause of the pain is unknown except for impact accidents and trauma injury. I must also give the disclaimer that one can also be very fit and still suffer tremendously for reasons ranging from dominant side sleeping positions, ergonomics of your individual chair, what type of heels you typically wear, and/or if you may be genetically predisposed to osteoporosis.

Common causes of back pain 

Your sedentary job 

I stated earlier, the real root of back pain often is truly unknown – but its pain IS known, and it’s so disruptive to both our fitness routines and work.  However, we do have biomechanics of the body to support claims a lot of pain is in part due to the fact that we are hunched and curled over our devices. Our curled over spines cause kyphosis (literal hunchback) this causes compensations to happen all the way from the neck and shoulders all the way down the back, and especially hitting the hamstrings. Our hamstrings then put undue pressure and force on our pelvis, then causing the compensation cycle of the body to keep circling! 

You may think it’s ok that you are sitting most of the day if you start or end it with a 5 mile run…think again. According to this article in Running Magazine, sitting all day is actually riskier for the back than running, and the lack of movement from sitting all day makes it more likely you will get injured when you actually start being active.

It Might Be Your Head that’s the problem

For many, chronic stress manifests itself as chronic physical pain, and it has been studies and argued over that it may be two sides of the same coin! What happens here is that as human beings, like all living creatures,  we are unable to find homeostasis because of how pain and stress share so much of the same conceptual and physiological overlaps. It is as if the mind is experiencing so much distress, that the body can’t process it and literally displaces the stress within the body. So here, pay attention to the distress that you might be feeling and it may be that you need the help from a therapist, psychologist, or counselor to help mitigate what is going on. You don’t have to carry all of these burdens all by yourself and ‘power through’ because sometimes that will cause more harm than good. 

Your Peloton addiction

So cycling IS low-impact, but so many things about indoor cycling can contribute to back pain, incluidng improper seat or handlebar height, which can lead to hunching over the handlebars. You also may be tempted to turn down the resistance when you cannot keep up with the instructor – but that can create complications because there is not enough resistance to support your body weight. Finally, the convenience of remote work means you can just jump off the bike and head over to your desk for that call – but failing to stretch key muscles worked like your quads, hip flexors, hamstrings, and obliques can make you feel super stiff and prone to inury. This article by the Virginia Spine Institute does an amazing job of listing out the stretches you can do – most of which are possible at a standing desk WHILE on camera. And it also has other tips for positioning your bike and maintaining proper form.

Not warming down or cooling down properly before a workout

Look, we are ALL in a hurry and we only have so much time to work out. But skipping the warmup or doing the wrong warmup is a recipe for disaster, especially when the temps are so cold outside. Read this post we did on how to maximize your workout, with the proper way to warm up and cool down. Most people have it backwards – pre-warm up is NOT the time to be doing static stretches, as we discuss later in this article, the wrong type of static stretches can actually WORSEN back pain. Cooling down is the time when you do want to explore some gentle stretches, which is also discussed in the linked post. 

So how do we help build our backs better? 

If you have had this unfortunate pain, you are not alone. And it’s tempting to try to just throw money a the problem. Back pain and especially, low back pain is the leading cause of non cancer prescribed opioid use in the US (to make matters worse, it is only until recently that it has been found that non opioid treatments might be far superior to traditional opioid treatments.)

But in the long run, medication, whether it’s over the counter or prescription, only masks the symptoms, and does not resolve the real issue. The real issue is often a weakness in our hamstrings, glutes, and core. Our hamstrings, glutes, and our core muscles are part of the keys to creating ‘an insurance’ system to keep our spines strong! Here are some methods Neda has used in training her clients to get stronger backs and back support.

Focus on core and posture 

We have already focused a lot on this blog on both core and posture, which are essential to keeping your back strong and healthy. If you missed these posts from last year (here and here) going into depth about strengthening your core and improving your posture, I strongly encourage you to visit those, because those are two key building blocks for a stronger and happier spine. These posts contain exercises there that you can easily add on to a workout or do in 10 minutes a day. Also, the post on posture contains ways you can prevent sabotaging your cycling and running workouts with bad posture.

One of the best forms of cross-training you can do for your core and your back is Pilates. It may not seem like you are doing much but lying on the floor, but minutes into the class you will be aching in your core. The thing that’s great about Pilates is that it’s not just doing superficial exercises like crunches – it’s working both your back muscles and your transverse abdominal muscles, which is your deepest layer of core musculature. The transverse abdominus connects directly to the spinal column. The vulnerability of the transverse abdominus is that it goes completely underactive while we sit and hunch over; however this should only give us more ammo in the fight against the detrimental effects of sitting. When we hunch over, we are displacing force along the backside of the body and putting too much force on the pelvis. Pilates can be key in the reversal of that strain and essentially mobilizes us to use our muscles as we should (versus unnatural compensatory movement). You can find some great Pilates app suggestions in this post on the best apps for yoga and pilates.  My fave is the free app Blogilates, with Cassey Ho. She has a bunch of really short workouts organized around playlists you could do over several days, like this one. She also has all-standing workouts, if you don’t want to get grimy by being on the floor or just quickly do them while waiting for your laundry to dry! You can find the workouts and other great videos in the post on the DAOFitLife Youtube Channel, which you can find on the DAOFitLife home page.

The hamstrings have it 

We haven’t focused on hamstrings until now, and we NEED to in order to fully get to the heart of this back pain issue. 

So, why the focus on hamstrings? The deception, that is why! Because of the nature of sitting, our quads are flexed and our hamstrings go completely underactive, thus causing an intense tightness (glutes and hips went to sleep a while ago, more on that in a bit). Our hamstrings are part of our kinetic posterior chain (backside of the body) and are supposed to be a key player in holding ourselves upright. Due to the fact that the glutes are completely underactive and our hamstrings start where the glute muscles end, the spine has no lower support and instead puts undue pressure onto our actual bones. 

So we naturally think,  “Oh geez, my back is tight and so are my hamstrings, so let me stretch them out!” This is where disaster happens and personally, I feel that it is almost a grade school issue. In grade school, we are all taught to “be flexible” , curving our bodies way forward in any way that we can to touch our toes- seated or standing! Toe touches were embedded into our minds as the pinnacle of flexibility! 

WE DO need to release the muscles of our glutes and hamstrings, however by no means by static stretching. Static stretching traditional seated or standing positions is putting more and more compression onto our spinal column, further causing more spinal injury. There are some static stretches that may provide relief, however they are in a lying down position and I would highly suggest seeing a physical therapist before performing to make sure you have your literal ducks in a row on it!. In this case, a physical therapist can show you how to release the muscles (via self myofascial release and trigger point therapy). The muscles that can be statically released are the quadriceps, doing a simple standing foot hold stretch. (as seen in the video below).

Stand for better back health

You can burn almost twice as many calories per hour at a standing desk than sitting. Head over to this calculator to see how many more calories you can burn by standing 4-5 hours a day. It also gives you stats on how many calories extra you can burn a week – and mind came out to about 3,700!

But even more so than just the calorie burn, standing instead of sitting at work is a game-changer for your back. I know personally, because I got a standing desk when recovering from a stress fracture in my lower back. I had never been in so much pain when this happened, and I was so depressed because I could barely go on the elliptical for 10 minutes after two months. And then, my physical therapist suggested I look into a standing desk. Once I got one and started using it, my back started feeling better and I felt more energized and focused. You mau think, what’s the difference, standing is just as sedentary as sitting – but not true. When you stand for even more than a minute, you naturally shift your weight from side to side and make a lot of micromovements. Plus, I am much more likely to go grab a drink of water or do some other quick errand when I am already standing, because I am more energetic. Since 2012, I have been using a standing desk, and have had a happy back ever since.

A couple of tips for making sure your standing desk has the right height can be found here.

Give it break and get shakin’ a little bit! 

In other promising news, there is sustainable relief available to you. A new study suggests that every half hour, to get up and move a little bit and that can help in the strain and undue stress that placed upon our spines from sitting all day. Although the study suggests really any movement, from jumping jacks to burpees (!!!) to light walking, I would err on the side of low impact territory, like a brisk walk.

Another sustainable lifestyle choice in helping you feel better is making sure that you have the right ergonomic chair . An ergonomic chair helps you maintain comfort without the sacrifice of posture. One reason why we lean forward in our chairs is because our backs aren’t supported enough with the chair not having enough “height.” An ergonomic chair would eliminate this excessive lean whilst reducing the pressure in your hips because your seat is at the correct depth.

Have “foam rolling” calls

Another pain relieving pointer is the use of lacrosse balls or even a foam roller near! Perhaps you have a few meetings and you have the option of turning the camera off, there is no reason why you can’t smooth out some of the knots in your neck, lats, glutes, and hamstrings. Especially if you are taking meetings and calls from home on large group calls/webinars, pull out the foam roller! Here, you can really get into muscles and tendons of your lower body really benefiting from the wider surface area of the foam roll. I really like this series with the lacrosse ball and this series with the foam roll!  

Should I go see Chiropractor, Orthepedic Physician, or a Physical Therapist?

Good question. This article covers the content concerning chiropractors versus physical therapists. Neda has some clients that are medical malpractice attorneys, and they have made a boatload of money from their clients suing chiropractors for permanent disfigurement/paralysis. Enought said as far as I am concerned on this question! Also, see point number 4 in the article.

If you are experiencing pain and soreness that does not go away within a few days, schedule an appointment with your primary care physician (or directly with an orthopedist and/or physical therapist if directly available) to see first rule out whether something neurological is happening or not and to get yourself the care that you need to feel and move better throughout your day. Your back is too sensitive an area to ‘self-doctor’ (aka googling or seeing what is going on on WebMd) and I would definitely avoid explosive exercises or really heavy lifting (even during a move) until you get some concrete answer. Most non-surgical paths will lead you to a physical therapist and there, the physical therapist might physically be able to manipulate over/underactive muscles and also teach the correct movement pattern moving forward. They might also “prescribe” exercises performed in house and/or ‘homework’ using therabands, trigger point balls, a theracane, an adjustable canvas strap, ice, and your own body weight.

As far as orthopedic or PT first, this video from Rehab Renegade explains that insurance companies usuallly want to see you have attempted PT before getting an MRI, which is usually what an orthopedic physician would recommend. In most cases, the orthopedic will recommend PT, so all roads basically lead to that. Surgery or any dramatic medical procedure is sometimes necessary, but usually a last resort.

If you are in DC, I highly recommend Release Physical Therapy. They have excellent therapists that are masters in trigger point therapy. For me personally, any back or neck pain issues are usually resolved in 3-4 visits. And they have an in-house masseuse that charges a very reasonable rate (with no tip required) that can be covered by an FSA.

So what CAN I do and cannot do when I have hurt my lower back? 

First, listen to the professionals, whether it be a PT or your doctor, especially about exercises to avoid until you get the green light. Your body will give you a tremendous, “THANK YOU!” I actually had to avoid yoga for at least six months and it nearly killed me, but it was entirely necessary to be able to recover and do the things I love.

Some great low-impact ways to keep your fitness high that is ok after a period of time include fast walking, the elliptical, recumbent stationary cycling, swimming, and water aerobics. Low impact does not mean low intensity; the key here is to avoid the pounding that your joints usually get from inclines, running, and the HIIT class that you feel suspended in the air ½ the time. 

Like anything else, feeling injured or not, you always want to pay attention to form before function. So while you may be on the treadmill or elliptical, speeding away- make sure that you are using your whole body to propel you forward versus holding onto the machine with momentum just taking over. 

It would be a best practice to avoid cycle classes and the traditional spin bike due to their lack of spinal support and essentially continuing the kyphotic movement pattern that you already experience at your desk. I do realize that it may feel so good to get your heart rate pumping high and get into the zone but there lies part of the problem. You are so into it and feeling the beat and energy of a class that you completely disregard the integrity of your spine and your already overactive (from sitting all day) quads continue to fire. By choosing a recumbent bike, with your back pressed to the back pad, you are able to more equally distribute the work of your lower body and strengthen your underactive hamstrings.  

Resistance training tips

With regards to your resistance training, you want to keep yourself in a supported position, so here is a great time to get comfortable using a weighted pin machine for isolation exercises. Some great choices would be the seated upright hamstring curl, hip abduction, seated rear delt flys (with your chest upright and against the chair), and lat pulldowns. In addition, you can do some mat work consisting of diaphragmatic breathing, lying down pelvic tilts, bridges, planks, fire hydrants, rear glute kickbacks, and baby cobras (singularly lifting your head, neck, and the very top part of your shoulders). Part of the reason why there is such a focus on your glutes and hips is because they have been constantly flexed forward, thus deactivating them! Your hamstrings connect to the insertion (top) point of the glutes. The hamstrings are the ones responsible for keeping your glutes supported, and your glutes (being the single most powerful muscle in the human body) are supposed to be able to take the pressure off the spine. So, as you can start to see, much like solving a complicated math problem, if you get something out of bodily alignment in the beginning, it all ends up out of whack! Believe it or not, knee injuries can cause shoulder pain and can even predict subsequent shoulder weakness! 

The number of sets and repetitions can vary anywhere from 3-5 sets of 12-18 repetitions, things should feel somewhat easy at first but by the end your set, you should feel the burn *comfortably* uncomfortable. I would suggest working close to a mirror if possible so that you can keep an eye on your form and when your form starts to really break (versus just twitch because of fatigue), then stop, and rest. Your HIIT classes, high incline walks, runs, stairmasters, urg machine, boxing sessions, along with your chest presses, quad curls, and crunches will be pause because of the exacerbating impact and forward flexing, but I guarantee you that have a whole different perspective on them in due time. So, in the meantime, go and get it!  

More resources:

• Back Pain Consortium (Come Back University of California San Francisco) 
• Opioid Prescribing for Low Back Pain (Jama Network)
• Low Back Pain (World Health Organization) 
• Why Stretching Your Hamstrings Won’t Help Back Pain (Austin Physical Therapy)  
• Association Between Sitting and Occupational Low Back Pain (NIH)
• Practical Model For Injury Prevention (Salt Wrap) 
• The DAO of ABS (Dao Fit Life) 
• Posture is the New Prada (Dao Fit Life) 
• Are Tight Hip Flexors Contributing to your Back Pain? (Cooper Institute)
• Move for 3 Minutes Every Half-hour to counter Ill Effects of Sitting (Seattle Times)
• 10 Reasons Why Ergonomic Chairs at the Office are So Important (OfficeInteriors CA)
• Can Knees Cause Shoulder Pain? (Ability Rehabilitation)
• Knee Pain Predicts Subsequent Shoulder Pain (NIH)
• Stress Alterations in the Pain Matrix (NIH)