Has your social calendar and weekly routine fallen victim to your low back? You’re not alone. Many of our patients surrender their daily chores and social calendar based on the positions required. For some, sitting is the nemesis, but for others, standing and walking can create a firestorm of radiating low back pain. So, what’s the deal? How can such a seemingly easy activity like static standing cause hours of agony?
Both ‘aged’ and young spines can both suffer from low back pain with standing and walking; however, it’s usually associated with a degenerative spine. Conditions like degenerative disc disease (DDD), degenerative joint disease (DJD), and spinal stenosis are a few conditions who notoriously hate standing and walking. These conditions are generally lumped into the “arthritis” category by the general public. As we age, degenerative spine changes occur. For those who sit, lift, and repetitively bend for a living the process can be accelerated. Symptoms can range from mild achiness to debilitating back pain that limits walking greater than a few minutes, making even the easiest daily task a chore. The crazy thing is the amount of relief that can be achieved with sitting. Patients often describe their relief as instantaneous once their rear end meets the chair.
Disc degeneration results in a breakdown and dehydration of the spacers (discs) between vertebrae, which is actually the reason we shrink as we age. Fluid loss thins our discs, essentially shrinking the spacers and narrowing the space between the vertebral bones. This space, called foraminal canal, provides an exit point for nerves leaving the spinal cord and traveling into the legs. With the narrowing of space comes the approximation of bones, possibly compressing the nerves as they exit the spine. Nerve compression in your low back can lead to pain, tingling/burning, numbness, and/or weakness in your back, hip, thigh, lower leg, and/or
So, why are your symptoms typically worse when standing and walking? The answer lies in the position of your spine. Placing your spine in any extended position narrows the space on either side of the spine. Normally, you would have some breathing room and remain symptom free; however, pre-existing narrowing will cause crowding of the nerve root and often pain. The opposite is true of sitting. Sitting will flex your spine and widen your foraminal canal, providing much needed breathing room for those suffering from symptoms associated with a degenerative spine.
As Physical Therapists, we hear it quite frequently from our patients, “I can sit all day, but I can’t stand for 5 minutes nor can I walk to get the mail because of my back pain.” Anatomically your symptoms check out. Standing and walking (extension) can minimize the available space along your spine and crowd exiting nerve roots. Sitting (flexion) on the other hand maximizes the available space along your spine and provides much needed relief.
Now before you think that all hope is lost you should be aware of your options. Like most conditions there’s rarely a quick fix; however, selective stretching that promote opening of the low back paired with select core and hip strengthening exercises can work wonders.