Niall is a Master of Osteopathy working from The West-Gate Clinic. He provides strength & conditioning and anatomy learning online.
How Being Homebound Affects Posture and Pain
The 2020 Coronavirus Pandemic has grounded the world almost to a halt. With new laws being introduced that restrict travel and outdoor activities, people are having to spend a lot more time at home.
As an Osteopath, one of the most common presenting symptoms at my clinic is low back pain (LBP). There can be hundreds of different causes, however, an increase in time spent sitting and a decrease in time spent exercising are up there with the most common. This will be discussed and broken down to highlight some of the main causes of LBP to allow the reader to understand why they are feeling the symptoms of LBP worse than before the pandemic.
Increased prevalence of musculoskeletal injury is common with sedentary lifestyles. Thankfully, there are things you can do to combat this including; exercises, posture corrections and simple changes to your lifestyle in quarantine. This article will explore and give examples of these beneficial techniques.
If you would seek health, look first to the spine
Why the Low Back Curve Is So Important
When you stand, lay down, run, swim, or perform any functional movement, your low back normally presents itself in an inward-curving (lordotic) position. This is to maximise shock absorption, flexibility, and to positively contrast the thoracic spine’s kyphotic curve, strengthening the tensegrity of the spinal structure.
When we sit, however, the low back begins to arch in the opposing direction—that is, it becomes kyphotic—so the thoracic spine also alters its curvature to provide balance and not be fully slumped forward.
What does this mean in terms of pain? It has everything to do with the intervertebral discs of the low back. These are the cylindrical, gelatinous structures between each individual vertebra (see the photo above). They get slightly bigger and wider as you go down the spine. That is because as the further you go down the spine, the more weight is loaded onto the spine. When we stand or as we move, the intervertebral discs provide cushioning, absorbing the weight and shocks applied through the spine to prevent damage to the vertebra. The loads on the intervertebral discs are normally evenly distributed when we stand or perform basic movements.
However, when we are seated, the kyphotic curve of the low back shifts more of the load to the front of the discs. This pushes the gelatinous structures inside the discs toward the back. Just imagine squeezing one side of a water balloon. Over time, it can also gradually lose its strong structure and small fissures can appear, leading to a weakening of the disc wall and sometimes a small bulging of the disc posteriorly. Due to the location of the nerves, usually either the femoral or sciatic, these bulges can directly irritate the nerves, leading to pain in the low back and/or other pain conditions, such as sciatica.
How the Quadratus Lumborum Can Contribute to Pain
Quadratus lumborum, or QL, is a muscle that spans the space between the iliac crest of the pelvis, the transverse processes of the low back and the last ribs. It gets its name from its shape and location: Quad (quadrangle shape) and lumbor (lumbar region). Humans have two of these muscles, one on each side of the body (the one on the right side shown in the picture above). Its main functions are to stabilise the trunk, and to rotate and side-bend the trunk.
If you are active, these muscles are in constant use, so they maintain proper function and flexibility. But imagine what happens to these muscles when you’re sitting or lying down, say, binge-watching your favorite show. Spending long periods of time in one position, these muscles (along with others) will stiffen, making your low back feel tight and sore.
What’s worse is if you’re like most people and slouch to one side. The left side would be stretched, while the right side is scrunched up, or vice versa. When you sit up or stand up, one side feels tighter than the other, and overall, your spine and body are not balanced. This will continue to affect your posture and movement until you stretch and move around.
Being homebound, you’re more likely to sit or lie down for extended periods of time. Over time, this can lead to weakening and tightness of these muscles, which can lead to chronic pain—not just the temporary discomfort upon standing.
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What Can You Do?
Exercises to Relieve Low Back Pain
There are plenty of great exercise to do that will keep you moving and negate the effects of sitting for longer than you usually would.
Below is a list of my recommended exercises and a video of me performing the exercises with good form! I also recommend doing these exercise first thing in the morning, before you sleep at night, and even throughout the day, particularly if you’ve just spent a long stint on the sofa.
Cat pose/Cow pose
2 sets of 10 alternating
2 sets of 8, 1 sec pause at top
Knee to chest
Hold for 30-45 secs x3
Sphinx or cobra pose
Hold for 30-45 seconds
Lumbar spine rotations
2 sets of 10 alternating
2 sets of 10 alternating
Demonstration of Low Back Exercises
Alternate Between Different Positions
Sitting is sort of the default for most modern daily activities, from watching TV to reading to having coffee. However, throughout human history, we’ve engaged in more dynamic positions:
- The squat
- Sitting on the floor with legs outstretched
- Sitting on the floor with legs crossed
- Laying in A sphinx position
Alternating between regular sitting and these four positions throughout the day can maintain your body’s flexibility and prevent your muscles from tightening up. A good way of challenging yourself is to alternate positions every time there’s a commercial break in the programme you’re watching.
Establish a Routine
Making a daily routine like the one below will keep you from sitting or laying in one position for too long. It will also help you be more productive as you plan things to do each day to fill your time. This can help you feel better both physically and mentally.
Sample Daily Schedule for Low Back Pain Recovery
Low back exercises
Read a book in a new postural position
Go for a run
Free unplanned time
Learn a new skill in a new postural position
TV, Hobby or craft
Prepare and eat dinner
Watch a movie sitting. Stand and move every 20 minutes
Low back exercises
Yoga and Meditation
Meditation, mindful breathing, and other mental exercises can also help you relieve pain. Stress has been shows to directly correlate with pain, and the frustration of being stuck at home all day certainly doesn’t help. I would suggest listening to an audiobook or soothing sounds as you do gentle exercises like jogging, cycling, yoga, or pilates. The goal is to keep your mind and your body occupied with something other than your homebound status. You’ll find your low back feels better for it.
Ice and NSAIDs to Relieve Pain
Along with the aforementioned methods of reducing low back pain, there other ways to help relieve pain, such as using ice packs or taking pain relievers (NSAIDs, non-steroidal anti-inflammatory drugs)
Ice is useful as it reduces local inflammation. This can be useful if your back has become inflamed from sitting for long periods. You can use an ice pack or even a pack of frozen veggies. Make sure you wrap the pack in a tea towel to prevent direct contact between the ice and skin. If this leaves you feeling good but a little stiff, try alternating between hot and cold. Apply cold for 5 minutes then heat for 2 minutes. Alternate this as many times as you feel necessary, finishing with heat so that the muscles are ready to use again. This will hopefully help quicken the inflammatory process, reducing the amount of pain you feel.
Hopefully this has been a useful resource to you. Feel free to leave feedback or message requests for further articles similar to this one.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Audrey Hunt from Pahrump NV on April 15, 2020:
Gee, this is so informative and helpful. How kind of you to share your expertise. Thanks!
Lucy from Leeds, UK on April 14, 2020:
Thanks for this article, it's great. My back is certainly hurting more now that I'm glued to my computer for the majority of the day.