Lower Back Pain – A chronic problem

 Warm Greetings!

Previously I wrote a blog on understanding various intricacies involved in lower back pain and the ways in which we can mobilize our lumbar spine through various exercises. It was quite a simple step by step guide to tackle any nerve impingement by solely correcting the pelvic posture. But little did I know, the body is not as simple as it appears to be!

I figured more about the lower back pain in the fall of 2018, whereby I was suffering from a frozen lumbar region and the pain could not be put into words. The severity of the situation was so extreme, I could not even twist my torso, let alone perform any of the postural exercises that I described in my previous post on lower back pain. I started applying all sorts of natural methods like sitting up straight (which does not correct anything since the body tends to fall back into its original position eventually), supporting my lumbar curve with a pillow, subjecting the region to a Hot-water pack and countless other things. But each and every method targeted the lumbar region only which happened to be my biggest mistake!

Until this moment, like I was being told for years, I was trying to fix the symptom (Lower Back Pain) and wasn’t paying heed to the root cause of the problem which might’ve been causing the referred pain in the lumbar region. The concept of lumbar pain being referred or originating from a different region seems really absurd but stay with me on this one, I’m about to open up your mind and your vertebrae.

The most important aspect of maintaining a good posture is to have a clear understanding of the basic human anatomy with respect to the bones as well as the muscles. In my previous blog on lower back pain, I focussed chiefly on maintaining the ‘S’ curve of the spine by incorporating pillows/towels in the Cervical and Lumbar curve. On the other hand, exercises help in strengthening the muscles surrounding the spinal cord which clearly implies that the muscle & bone strength are equally important for a pain-free back.

Following is a pictorial representation of the Human Body (Male and Female) from the sides, portraying the posture in an upright position with the palm of the hands facing outward,

If you focus at the above diagram, you’ll find out that the head is in proper alignment with the Shoulders and the Ears are completely straight. This perfect balance between the organs, bones and muscles allows the body to stand straight without any forceful interventions.

So when I looked at my photos from 2018, I was extremely shocked at the position of my Head with respect to my Shoulders.  

In addition to my head being way too ahead from my shoulders, take a closer look at how my shoulders   are rotated internally (Pronation). The ears are tilted instead of being straight. The reason for this is very straight forward –A bad posture would make you look down towards the floor. In order to look up and ahead, the face overcompensates and what occurs is a Nerd Neck, whereby there is a hump on the neck and the entire face depicts the alphabet ‘L’ to a certain degree.

Rounding of the shoulders is not clear from the picture, but trace the internal rotation of the palm right towards the shoulders. Now this might not seem big of a deal, but let me inform you that such bad posture is extremely serious in the long run. The body does not show up symptoms in a day, and it definitely won’t heal in a day. 

Now, how did I get this posture? Of course I did not ask for it. It takes years to develop such a bad alignment of the head with respect to the upper body. While I was researching on this topic, I came across Dr. Alan Mandel on YouTube and found out some significant insights on Forward Head Posture.

Forward Head Posture can occur either due to physical or emotional factors. Constantly looking down on our cell-phones in this age of electronic devices, Reading something below the normal eye level, looking downwards more often as people put you down, excessive gaming on mobile phones etc. make up for some general examples that can set you up for a forward head posture. On top of all this, the current pandemic has forced everyone to sit with their laptops for a majority of hours and has aggravated the Lower Back Pain of our population.

In my case, it was all of the above mentioned reasons along with the intentional weight loss results that I achieved with the help of Healthy Ketosis and Intermittent Fasting. After losing approximately 44 pounds of overall body weight, I noticed a forward hunch in my posture which is termed as Kyphosis/Hunchback/Nerd Neck. This was taking a toll on my lower back and it had to be tackled immediately. Of course I did not go to the Doctor right away as I always like to research the topic deeply and experiment with some natural yet efficient methodologies involved to correct the hunch.

Before we dive into all the muscles that contribute to Kyphosis, it is imperative to understand how a forward head posture can add additional weight on the entire back thus putting a lot of pressure on the lumbar spine.

The weight of a human head on the spine is approximately 12 pounds when it rests in proper alignment with the shoulders. For every inch ahead of the normal posture, the pressure exerted on the entire back increases and the weight of the head on the spine spikes by an additional 10 pounds. This additional weight can be directly linked to any heavy object that you might be lifting without actually lifting it.

So I request you to look into a mirror sideways (or ask your dear ones to check for you) and carefully assess the position of the head and ears with respect to the shoulders medially. You can also stand against a wall with the sole of your feet and entire back touching the wall, and check if your head is touching the wall without any efforts. If you’re even an inch ahead, trouble is lurking my friend.

Let us now focus on the various muscles that get affected by this forward head posture.

POSTERIOR MUSCLES OF THE UPPER & LOWER BACK:

  1. Trapezius (Traps): Trapezius muscle is a flat and superficial paired muscle that extends from the Occipital Bone on the head and ends horizontally on the lower thoracic vertebrae. Trapezius muscles basically look like an extended scarf on our upper back. 

Traps are classified into three main functional regions – The upper (Descending) region supports the weight of the arm, the middle (Transverse) region which helps in retracting back the scapula to its natural position and the lower (Ascending) region which medially rotates and depresses the scapula to its normal position close to the ribcage.

A forward head posture would primarily affect the traps by pulling them upward and ahead, thus putting a lot of pressure on the neck, shoulders as well as the upper back.

    2. Rhomboids: Another important set of muscles are the Rhomboideus or Rhomboids. Rhomboids are located exactly below the Traps in between the two scapula. They primarily attach the scapula to the vertebrae of the spinal column. 

There are two sets of Rhomboids on each side of the vertebral column – Rhomboideus Minor (Upper) and Rhomboideus Major (Lower). Rhomboideus muscles play a vital role in keeping the scapula tied to the thoracic wall (Ribcage).

As we lean ahead, our arms tend to rotate internally in the forward direction thus pulling the scapula towards them. This action, in turn, stretches the Rhomboid muscles for better arm movement.
Forward Head Posture, over the years, tends to affect the Rhomboideus muscles in such a way that it over-stretches and becomes a bad muscle memory. Gradually, the body becomes tilted (as you can see from my initial photo) if the rhomboids do not relax thus marking the first step in destruction of the entire muscular framework.

3. Latissimus Dorsi (Lats): Latissimus Dorsi is the broadest muscle of the back. It is a pair of muscles located in the Lower back covered partially by the Traps and its point of attachment is really interesting. It extends its primary attachment from the Spine right towards the back of the arm (Armpits). Lats are involved in extension, adduction (Moving hands/limbs towards the Midline), abduction (Moving Hands/Limbs away from the Midline) as well as internal rotation of the hand.

This is extremely vital in linking a poor upper body posture with a severe lower back pain. An internal rotation of the arm would put a tremendous pressure on the Lats and thus causing additional lumbar/back pain. 

     4. Rotator Cuff Muscles: Four different types of muscles are part of the Rotator Cuff muscles;
Supraspinatus, Infraspinatus, Teres Minor & Subscapularis (SITS). These muscles originate from the scapula and extend towards the head of the humerus bone of the arm. Rotator Cuff muscles are chiefly involved in maintaining stability and strength of the shoulder joint by providing smooth movement of the head of the humerus within the cavity (Glenoid fossa) of the scapula. 

      

     

Supraspinatus, Infraspinatus & Teres Minor extend from the scapula to the head of the humerus bone on the posterior (back) side. On the contrary, Subscapularis extends from the entire scapula towards the anterior side (front) of the humeral bone. 

Supraspinatus muscles help in abduction of the arm away from the body, Infraspinatus and Teres Minor help in exo-rotation/external rotation of the arm whereas Subscapularis helps in endo-rotation/internal rotation of the arm. 

The moment we fall prey to a forward posture, the rotator cuff muscles start internally rotating the shoulder, thus hindering the fine movement of the arm which could lead to a forward hunch of the upper back.

5. Pectoralis Muscles (Pecs): Pectoralis muscles are a pair of muscles located on the anterior (front) side of the body, mainly on top of the ribcage. There are two types of Pectoralis muscles – Pectoralis Major (Superficial) and Pectoralis Minor (Deep). 

  

Pectoralis Major is a huge muscle that originates from the Clavicle (Collar Bone) as well as the sternum (Breastbone) and extends into the anterior part of the Humerus (Arm bone). It helps in adduction and internal movement of the arm. Pectoralis major can also be activated if we forcefully inhale, whereas it has no role in exhalation. 

Pectoralis Minor is a small triangular muscle located under the Pectoralis Major. It originates between the 3-5 ribs anteriorly and inserts into the clavicle.  

An excessive extension of the back muscles would truncate the pectoralis muscles overtime and this leads to an excessive internal rotation of the shoulders, leading to a pull of the scapula along with all the back muscles mentioned above. 

Apart from these muscles which indirectly support our posture, certain muscles in the neck are extremely important in placing the head on top of the shoulders. Weaker neck muscles in the front would tilt the neck forward and stretch every muscle that is involved at the back. 

Platysma, Sternocleidomastoid (SCM), Sternohyoid, Omohyoid, Levator Scapulae, Scalene are some vital muscles in the neck region which keep getting weaker in forward head posture. 

I know it was quite a long list but this is just a glimpse of the chief muscles involved in helping us stand erect as well as provide a huge range of motion. 

Over the past 2 years, I’ve learned some amazing stretches for the upper back which can be performed anywhere, anytime, anyplace without any equipments. All you require is an L-shaped Wall, Doorway frame and a Bed! Don’t worry, you don’t need to dismantle anything!

• The Chin Tuck: Chin tuck has to be one of the best stretches one can possibly do for strengthening the neck muscles as well as correct that hunched neck gradually. Apart from a normal chin tuck, there is another type known as the ‘Eagle Chin Tuck’ which is personally my favourite. 

In the case of a regular Chin Tuck, just stand against a wall with your entire back resting on it and feet around 6 inches away from the wall. Start lifting the head in an upward direction like you are sliding a piece of paper on the wall with your head. Hold it for a couple of seconds until you feel a burn in the neck and back muscles, and let it go. Repeat for as many times as you possibly can. The only downside to this stretch is that you would see a double chin. Own it entirely and do it anyways.

• Eagle Chin Tuck: This is an extension of the regular chin tuck in which we do not rest on a wall but rather stand straight in an open space. First step would be to do the regular chin tuck and as we hold that, we pull our shoulders apart with our hands. This opens up the Pectoralis muscles as well as work on the Rhomboids and the neck muscles. All we are trying to do is straighten up our body by strengthening our anterior and posterior muscles.

• The Pec Stretch: Just as the back muscles become overstretched, the front muscles compensate and start contracting overtime. In order to stretch these muscles, there are certain exercises that can really open up the Chest muscles (Pectoralis muscles) and relax the back muscles as well. 

Get a hold of any wall in your house, face towards the right/left side and put your hand up at 11 o’clock or 1 o’clock. If you carefully look at my other hand, the palm faces outward which externally rotates the shoulder and corrects the forward posture. 

Now hold this posture and look away in the opposite direction. You would feel a tremendous burn on your Pectoralis muscles as well as your Rhomboids.

Note here how my ears are completely aligned with my shoulders. You can even perform a chin tuck in order to engage the neck muscles as well. 

• Titanic Stretch: Well, I do not specifically know the exact name of this stretch but I like to call it the Titanic Stretch. No you need not fear the Iceberg! 

Just find an L-shaped wall in your house and face it with your arms wide open at an 180 degree angle. Please do a chin tuck as this is going to align your head with the shoulders. 

This exercise stretches out the Pecs, Lats as well as contracts the Rhomboids significantly. 

• Neck Stretch: It should be very clear till now that if the back muscles are overstretched, the front muscles of the chest and the neck are quite tensed. This tension makes the anterior musculature quite weak. In order to strengthen it, one can perform following exercises to work on Hyoid, Scalene as well as SCM muscles. 

There are two ways in which one can perform these stretches – either standing straight or on a bed. Regarding the first one, stand straight with the palm of your hands facing outward and glutes sticking inward. Look up at the ceiling and you’ll feel an amazing burn in your neck muscles. Hold it for a couple of seconds and do it whenever you can. 

Coming to the second one, just lay on your bed on your back. Please do not go to sleep! Now tilt your head out of the bed and allow gravity to take over, in such a way that your ears align with your shoulders. This helps in severe cases of forward head posture whereby chin tucks are quite difficult. 

These are the chief exercises/stretches you can do on a regular basis to improve Forward head posture, Nerd Neck and indirectly heal your lower back pain by working on the muscles in the upper back and front.

In addition to performing these exercises as part of the solution, one should simultaneously avoid the causative factors of the same problem. We should either spend limited time with our mobile devices or at least try to work with things at our eye level. 

We discussed all the physical approaches that can be taken to tackle Lower back pain. Let us now focus on a few dietary guidelines that support the muscle and bone health intrinsically.

• Vitamin D – It is one of the most important Vitamins when it comes to bone health as well as muscle vitality. Vitamin D not only reduces inflammation within the body but also helps in absorption of Calcium from the food into the Blood. Vitamin D along with Vitamin K2 would help in bone remodelling and thus support the lumbar spine. Consider reading my blog on Vitamin D in order to understand it’s mode of action and functions on a deeper level. Best source of Vitamin D synthesis would be the UV-B rays from the Sun. Get under the sun for about 30 minutes daily and it should take care of your Vitamin D levels.

• Sleep – We have been underestimating sleep always but it is really essential in recovery of tissue damage and tissue repair. I would recommend everyone to get a ‘Cervical Pillow’ that provides a support for the cervical region in the neck. This supports the entire spine and releases any pressure that is exerted on the lumbar spine.

Another important aspect while sleeping is the position of your hands. The moment you raise your hands to cover your eyes, no matter how comfortable it might be, the scapula is lifted in the similar direction and all the posterior muscles are stretched. Hence sleeping posture is as important as standing or sitting posture. Try to sleep with the palm of your hands facing outward. 

• Importance of Alternating Hot-Cold Water showers: After you fix the forward head posture gradually, any muscle inflammation can also be tackled by alternating hot-cold water exposure to that particular region. Cold water generally reduces the blood supply from a particular region and on Hot water exposure, the blood supply increases. Thus proper circulation can be maintained by adopting this method.

So this is it, I’ve laid down the most common yet extremely effective techniques to tackle lower back pain which does not originate in the lumbar region always. I would suggest you to do the above stretches according to your strength and give it time if it aggravates your condition further. Keep going slowly yet consistently! 

References:

1. Bio Digital Website – Quite an amazing website to understand different layers and regions of human anatomy.

2. Atlas of Human Anatomy by Thomas O. McCraken.

3. Some amazing Health Educators namely Dr. Alan Mandel, Dr. Eric Berg, Jeff Cavaliere and many more.