Chronic Low Back Pain caused by Poor Posture
Sometimes you don’t have to look at an MRI study to learn what is wrong with your spine. Sometimes all you have to do is look in a mirror. “Mirror, mirror on the wall” why do I have back pain after all".
A mirror is not going to show a disc herniation, spinal stenosis, arthritis or misalignment. A mirror will show slumping shoulders and curves in all the wrong places. These images are typical of non-specific low back pain that does not seem to be caused by any one particular thing. Overall, the mirror on the wall is telling a problematic story about a spine that is resting at the "end of its rope", at its end range. You may not be aware of the problem nor have the ability to find a neutral, comfortable range. Without good posture awareness, you will have limited tolerance of things you enjoy doing like gardening, walking, and playing with her children. This image on the wall is not so pretty after all.
Two typical patterns of non-specific low back pain due to poor posture are seen in the real world. One set of folks have a "flexion pattern" of pain. The pain is felt when the spine flexes forward and eased when the spine extends. In the mirror, those with flexion-biased pain will commonly see a loss of lumbar lordosis, also called a flat back. Another set of folks with have just the opposite problem. Their pain primarily occurs with extension and eased with flexion. In the mirror, their low back has a high degree of arching or hyperlordosis. Both of these patterns of spine pain, flexion and extension, are rooted in poor posture and a spine at the "end of its rope".
Fortunately, solving these problems with posture does not require a scalpel. Posture rehabilitation is accomplished by seeing a good physical therapist that understands spine mechanics. The physical therapist will help you find a comfortable, neutral posture by gently correcting the posture. Once positioned in a better position, the therapist will then teach you how to return to this neutral posture using mirrors and feedback. This is done while you are standing and while you are sitting because the images look different in the mirror and the postures feel different too.
After some practice, you will be able to keep the spine from hitting the end of its rope with improved posture control. Staying within your spine’s comfort zone will give you greater ability to do the things you love like gardening, walking and playing. So remember, even if the MRI does not show a definite problem, there is always room to improve your posture.
Reference: "Classification-Guided Versus Generalized Postural Intervention in Subgroups of Nonspecific Chronic Low Back Pain", Spine (Phila Pa 1976). 2013 Jun 11
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.