A Practical Plan for Preventing Low Back Pain

Zack McCormick, MD

Clinicians and researchers have scratched their heads for decades in search of reliably effective treatments for low back pain. Unlike antibiotics for strep throat, inhalers for asthma, or statin drugs for high cholesterol, we still haven’t come up with a consistently successful solution for low back pain.

But what about preventing this problem in the first place? If we can stop it before it starts, all the better. The prevention of low back pain is not as complicated and enigmatic as treating it. The majority of low back pain stems from problems with posture, weak core strength, and excess weight. I’d like to share some practical advice to help you address these issues and to prevent low back pain before it becomes a problem in the first place.

Your mother was right – posture is extremely important. The ideal posture, whether sitting, standing, or walking involves keeping your head level, such that your line of vision is parallel with the floor and ceiling. Your shoulder blades should be held down and back just slightly so that they lay flat. Think about holding your shoulders behind your ears, but shrugging them down towards the floor. A good way to practice this is to make a motion as if you are going to put your elbows in your back pockets, then keep your shoulder and shoulder blades in that position, but allow your hands to relax to your sides.

Finally, keeping an inward curve in your low back is necessary. This tends to come naturally if your shoulders and shoulder blades are in the correct position. It may be helpful to tie this all together by picturing that an imaginary string attached to the top of your head is pulling you directly up towards the sky – thinking about sitting, standing, or walking “tall” will help maintain these three elements of good posture. Are you sitting up straight yet?

Once you have a sense of what good posture “feels” like,. the next step is being able to maintain it as much as possible. This can be a challenge depending on your daily activities or work requirements. If you sit for much of the day, use a lumbar support. These can be purchased for $10-15 or you can use a rolled up towel that you place behind the small of your back, such that your low back is positioned with a slight inward curve. If you use a computer, make sure that the center of the monitor is in line with the height of your eyes so that your head is level. Most monitor screens need to be elevated 6-8 inches higher than desk level. Additionally, if possible, use a keyboard set-up that allows your elbows to be at right angles. Using a keyboard that is too high will force you to round your shoulders and elevate your shoulder blades.

If you stand most of the day, change your standing position every 20-30 minutes. It may be helpful to use a solid object 6-12 inches tall so that one foot is resting higher than the other. Then switch. Whether you sit or stand during the day, taking breaks to walk – even if it is only 30 seconds – every hour will help keep the bones, joints, muscles, and ligaments of your back limber and aligned.

The last two pieces to preventing low back pain are core strength and maintaining a healthy body weight. The less weight you carry in your upper body, the less weight your bones, ligaments, and joint will have to bear. Having strong core musculature – abdominal, low back, and hip/pelvic girdle muscles – will help offload the bones, ligaments, joints, and discs as well. A trim figure and a strong core will also help you maintain good posture more easily and for longer durations throughout the day, which will in turn keep the musculoskeletal structure of your low back in proper alignment and pain-free.

Weight loss is a broad topic that is reviewed extensively, but my top pearl of wisdom, if nothing else, is that you cannot “overdo” raw vegetables. Raw vegetables are full of micronutrients, high in fiber, and will fill your stomach, yet contain very few calories relative to most other food. Try to eat raw vegetables with every meal and snack on them instead of the standard high-caloric options.

When it comes to core strengthening, you will find droves of exercises plans, gadgets sold on “infomercials,” or structured classes at workout studios and gyms. What’s most important is finding a routine that works for you and maintaining consistency. If that’s a home exercise routine, great – just make sure you do exercises to strengthen all of the core muscles and not just crunches or sit ups.… The hip/pelvic and low back muscles are just as important as the abdominals in creating a strong core that will support your spine. If you prefer a group setting to motivate you, yoga and Pilates are both excellent for strengthening the core. Many professional athletes use these techniques to help with their own core strength.

If you can focus on these four areas – good posture, ergonomics, maintaining a healthy body weight, and core strength –- you will significantly reduce your chance of developing low back pain or prevent recurrence if you’ve struggled with this in the past.

Dr. Zack McCormick is a physician specializing in sports, spine, and pain medicine. He earned his medical degree at the University of Pennsylvania and is a currently a Physical Medicine and Rehabilitation resident in the Northwestern University medical system in Chicago, IL. His current research focuses on interdisciplinary pain management, interventional spine procedures, and the cost of low back pain. He publishes and speaks to a national audience regarding these topics frequently.