Lower back pain and walking
April 10, 2017 10:24 AM
For most of my life, my lower back has gotten very tight very quickly when I walk or stand. It usually tightens up when I walk after about 5 minutes or after 10 minutes when I stand in one place (like at a concert, say). I've always ascribed this to my anatomy causing me to have a swayback, but now that I'm older I'd like to (1) identify the causes properly and (2) find out how to mitigate the pain.
I have a big hiney and am top heavy, so my assumption has always been that this combo just naturally makes my posture one in which I have a deeper curve in my lower spine and I compensate for the top heaviness by eaning back.
My second theory for this is age (early 40s) and also the fact that I have an extremely sedentary job where my posture isn't great for much of the day and the muscles around my lower back (psoas, abs, hamstrings) don't get used much.
Both of these ideas could very well be crackpot theories, though.
In the past few years, the lower back pain comes on faster and is more painful (not debilitating, but it definitely makes whatever I'm doing less enjoyable). I usually can stretch out my lower back temporarily by dropping down into a squat, but I'd like to start walking more without having to tolerate this pain.
Who should I be considering to get an expert opinion on what is causing the back pain? Primary doc, physical therapist, specialist? I'm not a huge fan of chiropractors, so I'd rather not start with them.
Secondly, if you've had this exact issue, what has worked for you?
I have a big hiney and am top heavy, so my assumption has always been that this combo just naturally makes my posture one in which I have a deeper curve in my lower spine and I compensate for the top heaviness by eaning back.
My second theory for this is age (early 40s) and also the fact that I have an extremely sedentary job where my posture isn't great for much of the day and the muscles around my lower back (psoas, abs, hamstrings) don't get used much.
Both of these ideas could very well be crackpot theories, though.
In the past few years, the lower back pain comes on faster and is more painful (not debilitating, but it definitely makes whatever I'm doing less enjoyable). I usually can stretch out my lower back temporarily by dropping down into a squat, but I'd like to start walking more without having to tolerate this pain.
Who should I be considering to get an expert opinion on what is causing the back pain? Primary doc, physical therapist, specialist? I'm not a huge fan of chiropractors, so I'd rather not start with them.
Secondly, if you've had this exact issue, what has worked for you?
Disclaimer: I am not a doctor or physical therapist so please keep that in mind.
I have a herniated disk and sit on my arse all day. About 15 years ago my back was in pretty bad shape. I had limited movement, pain and stiffness. It was bad.
Firstly, I began to practice Sivananda yoga (12 basic asanas) and that alone changed my life. The stretching and strengthening was so helpful. I also read somewhere that for every one pound of fat you have on your belly it equates to ten pounds of pressure on your back. Who knows if that is true but it makes sense. I've always been slender so keeping the weight off my stomach was not so difficult.
You need to move, stretch and strengthen. You're slowly killing yourself by being sedentary. And don't tell me you don't have time. If it's important to you the time is there.
Lastly, never get surgery. In my opinion this is addressing the symptom but not the cause.
posted by uncleGarage at 10:34 AM on April 10, 2017
I have a herniated disk and sit on my arse all day. About 15 years ago my back was in pretty bad shape. I had limited movement, pain and stiffness. It was bad.
Firstly, I began to practice Sivananda yoga (12 basic asanas) and that alone changed my life. The stretching and strengthening was so helpful. I also read somewhere that for every one pound of fat you have on your belly it equates to ten pounds of pressure on your back. Who knows if that is true but it makes sense. I've always been slender so keeping the weight off my stomach was not so difficult.
You need to move, stretch and strengthen. You're slowly killing yourself by being sedentary. And don't tell me you don't have time. If it's important to you the time is there.
Lastly, never get surgery. In my opinion this is addressing the symptom but not the cause.
posted by uncleGarage at 10:34 AM on April 10, 2017
Go to your primary care doctor, get a referral/prescription for a physical therapist (probably needed in order for it to be covered by insurance, but if your insurance doesn't require it, then you can skip that step).
Be a little wary of self-treatment: I have back problems (different from yours) and 3 different PTs in my life have told me, unprompted and unasked, that Yoga was a Really Bad Idea for me. Pilates helps in my case, but PT and doing (and continuing to do) the specific stretches and exercises recommended by them has helped the most. It's when I stop doing them that it slowly gets worse again and I have to go back for another round.
posted by brainmouse at 10:45 AM on April 10, 2017
Be a little wary of self-treatment: I have back problems (different from yours) and 3 different PTs in my life have told me, unprompted and unasked, that Yoga was a Really Bad Idea for me. Pilates helps in my case, but PT and doing (and continuing to do) the specific stretches and exercises recommended by them has helped the most. It's when I stop doing them that it slowly gets worse again and I have to go back for another round.
posted by brainmouse at 10:45 AM on April 10, 2017
I sit all day as well. That is the worst possible position for your back. I used to have terrible back problems. Now I do twenty minutes of yoga and stretching every morning. I absolutely have to find the time in order to function. Some of the exercises were given to me by a physical therapist, and I agree with starting there. A physical therapist can figure out exactly which muscles are giving you problems.
IANAD, but I don't see anything in your description that sounds like a herniated disc as opposed to the much more common problem of tight muscles.
posted by FencingGal at 11:16 AM on April 10, 2017
IANAD, but I don't see anything in your description that sounds like a herniated disc as opposed to the much more common problem of tight muscles.
posted by FencingGal at 11:16 AM on April 10, 2017
I had this issue, it was a combination of anterior pelvic tilt (which contributes to underdeveloped glutes, also exacerbated by desk jobs) and tight psoas and hips. This article does a good job of describing the basics, including what is happening to your body and some ideas for how to begin to correct it. A good way I was taught to think of it is to imagine your pelvis as a fish bowl full of water--you want to keep the bowl totally upright, not tipping forward or backward or side to side, so the water doesn't spill.
I do the exercises mentioned in the article I linked, in addition to foam rolling the heck out of my glutes and using a tennis ball on my psoas and hip flexors. If you haven't used a foam roller before, it will huuuurt---but it's not damaging you, it's just breaking up sticky fascia which contributes to stiffness and immobility in the body ( but don't use it on the low back!). There are a lot of good how-to's and guides online, plus most foam rollers come with a little book of exercises if you buy one--I do Figure 4 (slyt) every day. I also lift weights to strengthen my posterior chain. Pilates helps, but yoga is dicey for me--everyone is different with yoga and some people do better with it than others.
As for who to go to, my best recommendation would be to first spend time on your own reading about the body, movement, and kinesiology. In my case, I lucked out finding a certified personal trainer with an MS in Biomechanics who helped me understand the postural issues contributing to my pain, but first I wasted six months and a ton of money on a physical therapist who didn't help and in fact set me back, mobility-wise, and subsequent personal trainers have been useless. This is why it's so important to understand both the body and YOUR body, so you know if what someone is suggesting is likely to help or hurt you. If I had to do it again I would try to find someone with a background in Kinesiology, Sports Biomechanics, or Corrective Exercise, whether that's a physical therapist or personal trainer, or sports medicine doctor. Nothing will change unless you address the underlying postural issues and muscle imbalances/weaknesses, though, so be wary of professionals who don't start there (and of course please get imaging first if you think you have a herniated disc!).
Good for you for seeking help for this--it can feel insurmountable but it's so worth the work to get there. I have had debilitating back pain my whole life and now I'm stronger than I've ever been, and with almost no 'bad back' days anymore. Good luck!
*On preview--even if you do have a herniated disc, which you might, the above advice still applies. Of course every body is different, but I had back pain my whole life because of medical professionals' insistence that my two herniated discs be babied and not jostled/irritated; it wasn't until I changed my posture and started weightlifting (slowly and under supervision!) that the pain went away. YMMV but just to let you know that you can still regain mobility even if it turns out that you do have a herniated disc.
posted by stellaluna at 11:19 AM on April 10, 2017
I do the exercises mentioned in the article I linked, in addition to foam rolling the heck out of my glutes and using a tennis ball on my psoas and hip flexors. If you haven't used a foam roller before, it will huuuurt---but it's not damaging you, it's just breaking up sticky fascia which contributes to stiffness and immobility in the body ( but don't use it on the low back!). There are a lot of good how-to's and guides online, plus most foam rollers come with a little book of exercises if you buy one--I do Figure 4 (slyt) every day. I also lift weights to strengthen my posterior chain. Pilates helps, but yoga is dicey for me--everyone is different with yoga and some people do better with it than others.
As for who to go to, my best recommendation would be to first spend time on your own reading about the body, movement, and kinesiology. In my case, I lucked out finding a certified personal trainer with an MS in Biomechanics who helped me understand the postural issues contributing to my pain, but first I wasted six months and a ton of money on a physical therapist who didn't help and in fact set me back, mobility-wise, and subsequent personal trainers have been useless. This is why it's so important to understand both the body and YOUR body, so you know if what someone is suggesting is likely to help or hurt you. If I had to do it again I would try to find someone with a background in Kinesiology, Sports Biomechanics, or Corrective Exercise, whether that's a physical therapist or personal trainer, or sports medicine doctor. Nothing will change unless you address the underlying postural issues and muscle imbalances/weaknesses, though, so be wary of professionals who don't start there (and of course please get imaging first if you think you have a herniated disc!).
Good for you for seeking help for this--it can feel insurmountable but it's so worth the work to get there. I have had debilitating back pain my whole life and now I'm stronger than I've ever been, and with almost no 'bad back' days anymore. Good luck!
*On preview--even if you do have a herniated disc, which you might, the above advice still applies. Of course every body is different, but I had back pain my whole life because of medical professionals' insistence that my two herniated discs be babied and not jostled/irritated; it wasn't until I changed my posture and started weightlifting (slowly and under supervision!) that the pain went away. YMMV but just to let you know that you can still regain mobility even if it turns out that you do have a herniated disc.
posted by stellaluna at 11:19 AM on April 10, 2017
I've had shoes that make me feel the way you describe. They had low heels and they must have just moved my posture and spine to the exact point where it would hurt. Does this happen to you with any shoes? Or is there a pattern?
posted by mareli at 11:21 AM on April 10, 2017
posted by mareli at 11:21 AM on April 10, 2017
I have the same sensations (and physical attributes!), and what has helped me most is doing work to strengthen my core so that I can better support myself when I'm standing or sitting; I started with a number of exercises prescribed by a physical therapist, then did a year of weekly Pilates mat classes, and now I just do a mix of a bunch of the exercises I've felt have been most helpful. I also pay attention to engaging my core in my normal daily life, and I think Pilates was most helpful in teaching me how to do that.
I will also caution that most of the "yoga for low-back pain" articles and videos I tried made my pain worse, because the assumption seemed to be that the viewers' pain was caused by slumping their low backs, rather than overarching them, and so the exercises all exacerbated the problem for me.
posted by lazuli at 11:27 AM on April 10, 2017
I will also caution that most of the "yoga for low-back pain" articles and videos I tried made my pain worse, because the assumption seemed to be that the viewers' pain was caused by slumping their low backs, rather than overarching them, and so the exercises all exacerbated the problem for me.
posted by lazuli at 11:27 AM on April 10, 2017
High heels also tend to force the lower back to overarch, so if you wear heels, switching to flats (or lower heels) might be helpful.
posted by lazuli at 11:31 AM on April 10, 2017
posted by lazuli at 11:31 AM on April 10, 2017
It has always been my understanding that stronger abdominal muscles will help with posture and ease back pain, so I would think that exercises that strengthen the abdominals would help... but in my more personal experience with similar back pain since an injury, is that the movements of Tai Chi (specifically the 108 moves of the Taoist world membership kind) that specifically extend, compress, and twist, lower spinal muscles regularly, cyclicly, and with no impact: within the set of movements - is the best medicine ever.
posted by itsflyable at 11:42 AM on April 10, 2017
posted by itsflyable at 11:42 AM on April 10, 2017
I haven't had your exact issue, but I had a pretty severe herniated disc that was cured by surgery last August. From what you've said, it doesn't sound like that's your problem, but who knows.
Anyway, the first step with any back pain is likely to be physical therapy. You could try going to a physical therapist without seeing a doctor first, but if you go to a doctor that specializes in back pain, that doctor might be able to recommend a specific physical therapist with experience and a track record of success dealing with your issue. I eventually went to an orthopedic surgeon that specialized in spine surgery, and he recommended a fantastic physical therapist for me. She helped me quite a bit and got a large percentage of my worst pain to go away. (I eventually elected to have surgery to get rid of the remainder of the severe pain that did not respond to PT and other conservative treatments.)
I'll also note that I brought my back pain up with my primary care provider, and he was less helpful. He also referred me to PT, but he had no specific PT to recommend and just referred me to the hospital system he was associated with. That PT did not help me at all, and in fact I suspect it made my symptoms worse. So I'd vote for going straight to a specialist to get the PT referral.
Lastly, never get surgery. In my opinion this is addressing the symptom but not the cause.
I just want to chime in here to strongly disagree with this advice. If your pain is being caused by disc material compressing a nerve root, then having the material removed and the nerve decompressed will absolutely address the cause of your symptoms (well, 95% of the time it will, which is the success rate for the kind of surgery I had). Of course, to prevent a recurrence, you need to do the PT exercises after your surgery and likely for the rest of your life, but if the PT alone did not get your pain to an acceptable level, and a reputable surgeon thinks that surgery is a good option for you, then surgery is a very reasonable choice.
posted by crLLC at 11:47 AM on April 10, 2017
Anyway, the first step with any back pain is likely to be physical therapy. You could try going to a physical therapist without seeing a doctor first, but if you go to a doctor that specializes in back pain, that doctor might be able to recommend a specific physical therapist with experience and a track record of success dealing with your issue. I eventually went to an orthopedic surgeon that specialized in spine surgery, and he recommended a fantastic physical therapist for me. She helped me quite a bit and got a large percentage of my worst pain to go away. (I eventually elected to have surgery to get rid of the remainder of the severe pain that did not respond to PT and other conservative treatments.)
I'll also note that I brought my back pain up with my primary care provider, and he was less helpful. He also referred me to PT, but he had no specific PT to recommend and just referred me to the hospital system he was associated with. That PT did not help me at all, and in fact I suspect it made my symptoms worse. So I'd vote for going straight to a specialist to get the PT referral.
Lastly, never get surgery. In my opinion this is addressing the symptom but not the cause.
I just want to chime in here to strongly disagree with this advice. If your pain is being caused by disc material compressing a nerve root, then having the material removed and the nerve decompressed will absolutely address the cause of your symptoms (well, 95% of the time it will, which is the success rate for the kind of surgery I had). Of course, to prevent a recurrence, you need to do the PT exercises after your surgery and likely for the rest of your life, but if the PT alone did not get your pain to an acceptable level, and a reputable surgeon thinks that surgery is a good option for you, then surgery is a very reasonable choice.
posted by crLLC at 11:47 AM on April 10, 2017
Agreeing with a PT visit. A gait assessment might be a good idea.
posted by jgirl at 11:55 AM on April 10, 2017
posted by jgirl at 11:55 AM on April 10, 2017
>For most of my life, my lower back has gotten very tight very quickly when I walk or stand.
> ... I have an extremely sedentary job where my posture isn't great for much of the day and
> the muscles around my lower back (psoas, abs, hamstrings) don't get used much.
I think you have identified the most likely cause yourself. Your swayback is partly a result of your weak lower back support (like in horses) and could improve (lessen) as you strengthen the muscles in your trunk. Likewise, your poor posture is partly a result of your weakened trunk muscles. That "tightness" you feel could be the sensation of acutely fatigued and overworked muscles.
Walking is a mild and effective exercise for strengthening the muscles you need. Obtain a pedometer. I'm partial to the FitBit Zip for which the website or app will provide daily activity graphs, or the Oregon Scientific PE326CA for which you will have to keep your own records.
Try to steadily improve on your daily step count. Don't work too long past that tight feeling in your lower back: you don't want to overdo it. At first, take multiple short walks a day. Don't walk in high heels. Wear a hat if you are outside. If you develop other pain (knees, hips, neck, etc) pay attention to it.
I control my own lower back pain and moderate to severe sciatica by intentional walking every day, intentional posture, and by considering my lower back when doing physical labor (digging, dragging, hoisting, hauling).
posted by the Real Dan at 12:10 PM on April 10, 2017
> ... I have an extremely sedentary job where my posture isn't great for much of the day and
> the muscles around my lower back (psoas, abs, hamstrings) don't get used much.
I think you have identified the most likely cause yourself. Your swayback is partly a result of your weak lower back support (like in horses) and could improve (lessen) as you strengthen the muscles in your trunk. Likewise, your poor posture is partly a result of your weakened trunk muscles. That "tightness" you feel could be the sensation of acutely fatigued and overworked muscles.
Walking is a mild and effective exercise for strengthening the muscles you need. Obtain a pedometer. I'm partial to the FitBit Zip for which the website or app will provide daily activity graphs, or the Oregon Scientific PE326CA for which you will have to keep your own records.
Try to steadily improve on your daily step count. Don't work too long past that tight feeling in your lower back: you don't want to overdo it. At first, take multiple short walks a day. Don't walk in high heels. Wear a hat if you are outside. If you develop other pain (knees, hips, neck, etc) pay attention to it.
I control my own lower back pain and moderate to severe sciatica by intentional walking every day, intentional posture, and by considering my lower back when doing physical labor (digging, dragging, hoisting, hauling).
posted by the Real Dan at 12:10 PM on April 10, 2017
nthing PT. If you find a good one they are amazing. They will certainly know and understand this problem better than you, your physician or us internet strangers ever will. Whatever they tell you in terms of stretches and workouts, do it religiously. Don't expect huge progress in a week or a month. In three months, in six months, in one year, you'll know it made a difference.
posted by beagle at 12:44 PM on April 10, 2017
posted by beagle at 12:44 PM on April 10, 2017
First - Nthing PT (on preview - same as Beagle). I have very similar issues to what you describe, and finding a good physical therapist has been essential to resolving the issues I have. Like you, I knew that sitting was a problem, but my solution was to go running which was absolutely the wrong thing to do (for me). Might be the same for you in terms of choosing pilates or yoga - they can be great, but not-so-great for you. Get a referral and see what they say.
Second - it takes time to heal. It's really hard, but be patient. My PT says most patients don't follow up with the exercises. If you do, you'll notice a difference within weeks, if not sooner. I've been in PT for over 5 months but noticed a difference in strength within a couple of weeks. My issues continue to be strength and stability, so I'll be coming for a while. Everyone is different, though. I walked 6 miles - up hills! - with no pain! - this past weekend, and it was glorious. I owe it to my physical therapist, who kept encouraging me to be patient and keep up the good work.
Third - shop around for a good PT. I can't emphasize this enough. Personally, my best experience has been seeing a sports medicine doctor, and getting a referral to a sports medicine center. The PTs are top notch because they work with athletes. Where I go, the qualifying criteria isn't how "good" you are as an athlete or how fit you are - it's if you can't exercise because of X. They don't just see professional athletes, their only goal is to get you back to doing your chosen activity.
Good luck!
posted by onecircleaday at 1:08 PM on April 10, 2017
Second - it takes time to heal. It's really hard, but be patient. My PT says most patients don't follow up with the exercises. If you do, you'll notice a difference within weeks, if not sooner. I've been in PT for over 5 months but noticed a difference in strength within a couple of weeks. My issues continue to be strength and stability, so I'll be coming for a while. Everyone is different, though. I walked 6 miles - up hills! - with no pain! - this past weekend, and it was glorious. I owe it to my physical therapist, who kept encouraging me to be patient and keep up the good work.
Third - shop around for a good PT. I can't emphasize this enough. Personally, my best experience has been seeing a sports medicine doctor, and getting a referral to a sports medicine center. The PTs are top notch because they work with athletes. Where I go, the qualifying criteria isn't how "good" you are as an athlete or how fit you are - it's if you can't exercise because of X. They don't just see professional athletes, their only goal is to get you back to doing your chosen activity.
Good luck!
posted by onecircleaday at 1:08 PM on April 10, 2017
In the past few years, the lower back pain comes on faster and is more painful (not debilitating, but it definitely makes whatever I'm doing less enjoyable). I usually can stretch out my lower back temporarily by dropping down into a squat, but I'd like to start walking more without having to tolerate this pain.
I have had this exact issue. For me, it's worse when standing or walking very slowly (like visiting a museum) but brisk walking (which is my normal ambulatory speed) doesn't trigger it so much.
For me, it is significantly exacerbated by having very tight hip muscles. Yin yoga (very deep stretching, basically) was a godsend and has helped immensely. The article on anterior pelvic tilt that stellaluna linked to is also highly relevant to my situation.
posted by desuetude at 1:28 PM on April 10, 2017
I have had this exact issue. For me, it's worse when standing or walking very slowly (like visiting a museum) but brisk walking (which is my normal ambulatory speed) doesn't trigger it so much.
For me, it is significantly exacerbated by having very tight hip muscles. Yin yoga (very deep stretching, basically) was a godsend and has helped immensely. The article on anterior pelvic tilt that stellaluna linked to is also highly relevant to my situation.
posted by desuetude at 1:28 PM on April 10, 2017
It sounds like I'm built very similarly to you, and have had those issues. Being more mindful of my posture has helped--but even more effective was committing to a fitness class focused on "everyday mobility" (ie, doing lots of squats and light weights). In particular, I realized that strengthening my glutes and hamstrings have made a tremendous difference in easing back discomfort. Good luck!
posted by TwoStride at 4:08 PM on April 10, 2017
posted by TwoStride at 4:08 PM on April 10, 2017
Does it feel better when you bend over and touch your toes? You might not be able to tell at first, but hang in there for like 5 minutes.
How do you feel about triangle pose?
These might be worth it as a quick hack when things hurt.
posted by benadryl at 5:23 PM on April 10, 2017
How do you feel about triangle pose?
These might be worth it as a quick hack when things hurt.
posted by benadryl at 5:23 PM on April 10, 2017
I'm surprised no one has yet recommended the McKenzie exercises. I learned about them here on Ask Metafilter and my life has been ever so much better since. I had similar issues: my lower back would hurt after standing/walking for a bit and it was interfering with my life. From the very first time I fiddled around with the McKenzie stretches, I started feeling better. Several years later, I still do them every day. Here is the original source. Miracle stuff, and yet so simple!
posted by DrGail at 8:05 AM on April 11, 2017
posted by DrGail at 8:05 AM on April 11, 2017
I hope that other folks are right that this is posture/stretching/activity related. No one has mentioned the possibility of spinal stenosis, which would account for the discomfort with standing and walking, and the quick relief when you stop. That's what I've got, discovered after physiatrist recommended MRI. Obviously, explore all other possibilities before going down that road, but I've gotten very nice relief of both the back pain and leg symptoms with gabapentin at a pretty low dosage. Good luck.
posted by bullatony at 9:02 AM on April 11, 2017
posted by bullatony at 9:02 AM on April 11, 2017
Hubby has this issue. Daily stretching of glutes and hammies keeps his pain at bay. He does stretches for about 30 mins at night on the living room floor while watching tv. This routine was at the advice of our chiropractor. He hasn't had to go back for that issue for a few years now.
He also found some useful information by learning about Foundation Training. This link is for the book but hubby used the dvd, you might find it at your library. There are some free online videos too.
posted by vignettist at 9:13 AM on April 11, 2017
He also found some useful information by learning about Foundation Training. This link is for the book but hubby used the dvd, you might find it at your library. There are some free online videos too.
posted by vignettist at 9:13 AM on April 11, 2017
I have had periods of time in my life with this exact sort of pain and periods without. The difference? During the periods without that pain, I was exercising regularly. My theory is that my core muscles were all stronger so holding my long spine up was less work. And by core muscles, I mean like everything you'd use to hold yourself up while doing planks, which is a lot of different muscles.
posted by purple_bird at 9:25 AM on April 11, 2017
posted by purple_bird at 9:25 AM on April 11, 2017
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posted by GuyZero at 10:27 AM on April 10, 2017