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Health & Exercise Forum

Living with Lower Back Pain: Prevention

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May 16, 2009

Dr. Paul MackareyLiving with Lower Back Pain: Part III: Prevention of Lower Back Pain
This is the 3rd in a series of 3 articles related to lower back pain.

It is widely accepted in the medical community that the best treatment for lower back pain (LBP) is prevention. Keeping fit, (flexible and strong), practicing posture, and using good body mechanics are essential in the prevention of LBP. At our office, great time and effort is spent emphasizing the importance of these concepts.

Kane Trucking is a perfect example of the merit and value of LBP safety and prevention. For the past 6 years, I have served as a rehab consultant for Kane Trucking. During this time, Kane has noticed a significant reduction in LBP injuries through an onsite safety program which promotes education, wellness, body mechanics, lifting techniques, postural and stretching exercises and ergonmics.

Prevention of Lower Back Pain

Maintain Fitness Level

As little as 10 extra pounds puts great stress on your lower back. It also makes it more difficult to maintain good posture. Eat well, exercise regularly and don’t smoke. Smokers have a much higher incidence of LBP and failure from lower back surgery.

Practice Good Posture & Body Mechanics

Good posture is critical for a healthy back. When sitting, standing or walking maintain a slight arch in your lower back, keep shoulders back, and head over your shoulders. In sitting, use a towel roll or small pillow in the small of the back.

Perform postural exercises throughout the day. Most of the day you are sitting, standing and reaching forwards flexing your spine. These exercises are designed to stretch your back in the opposite direction of flexion. Please perform slowly, hold for 3-5 seconds and repeat 6 times each 6 times per day.

  • Chin Tuck: Tuck your chin back to bring your head over shoulders.
  • Shoulder Blade Pinch: Pinch your shoulder blades together.
  • Standing Extension: While standing, put your hands behind back and  extend lower back 10-20 degrees.
  • Lying Extension: Lying on belly, prop up on your forearms while keeping your belly on the floor to extend you back.

Good Body Mechanics and ergonomics are also important in the prevention of LBP. When lifting, think twice. Think about the weight, shape and size of the object. Think about where the object is going and the traction of floor. Does it require two people to lift? Can I safely lift that high or bend that low?

Lifting: When bending to lift an object think about safety:

  • Spread Legs Apart Shoulder Width
  • Bend at the Knees and Limit Forward Bending the Spine
  • Arch Lower Back Slightly
  • Get and Maintain a Firm Grip
  • Contract and Hold Abdominal (stomach) Muscles
  • Lift With Legs (not back)
  • Do Not Pivot or Rotate Spine With Load (use feet and step turn)
  • Lift Slowly and Carefully (don’t hurry)
  • Take Time to Perform Back Extension Stretches After the Lift
  • Remember, Pushing is Better Than Pulling a Heavy Load

Sitting: When sitting, use an ergonomic chair and work station with a lumbar support and adjustable heights. Get close to your keyboard and monitor. Stand up and perform  postural exercises every 45-60 minutes.

Walking: If you walk or stand most of the day, wear good shoes. Avoid high heels and shoes without adequate support like sandals.

Driving: If you drive long distances, use a lumbar support to keep an arch, sit close to your steering wheel to prevent bending forward and stop to stretch using the above postural exercises every 45-60 minutes.

Maintain Fitness

Aerobic exercise will help prevent weight gain and stiffness for a healthier lower back. Perform mild aerobic exercise such as walking 3-5 times per week for 30-45 minutes.

Core stabilization exercises designed to strengthen the abdominal and lower back muscles will help prevent injury. Some examples of core exercises are: (Perform slowly, hold the pelvic tilt 5 seconds, repeat 10 times)

  • Pelvic Tilt: Lying on your back and performing a pelvic tilt as you flatten you lower back into the floor
  • Pelvic Tilt/Heel Slide: Lying on your back, hold a pelvic tilt as you slide your one heel up and down and repeat with the other heel
  • Pelvic Tilt/Arm Exercise: Perform arm exercises such as biceps and triceps with light weight; while trying to hold an isometric contraction of your abdominal and lower back muscles. First perform lying on your back, then advance to sitting.
  • Avoid sit-ups – especially full sit-ups! Limit repeated flexion and torque on the lower back by using core stabilization techniques to strengthen abdominal muscles.

Weight Training

  • Performed 2-3 times per week, 20-30 repetitions with light weights through full range of motion.
  • Avoid spinal loading from overhead lifting such as military or overhead press.

Aerobic Exercises

  • 3-4 times per week for 30-45 minutes at moderate intensity
  • Treadmill, bike, recumbent bike, elliptical, walk, cross-country ski

Balance Exercises

  • Stand on discs or pillows to create unstable surface
  • First stand on two legs, then on one leg
  • Walk/Run forward, backward, figure eight, and crossover
  • Dance

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of  Scranton, PT Dept.