Can bending backward prevent low back pain?

Disease prevention is a major focus in the current paradigm of healthcare. Whether it’s the prevention of skin cancer, heart disease, or diabetes, doctors will emphasize what you can do now to lessen the likelihood of a problem later on.

The aforementioned diseases have well-known recommendations, including protecting your skin from sun exposure, eating a proper diet, getting adequate exercise, and quitting smoking. Research has shown the effectiveness of these recommendations, all of which are universally accepted.

When it comes to low back pain, preventative advice is less understood. You may hear one medical professional tell you to strengthen your core. Another will tell you to stretch your hamstrings. A third may tell you to stop lifting. If you sought the opinions of 10 different providers regarding the prevention of low back pain, you could easily get 10 different recommendations

We are in the era of evidence-based medicine, where healthcare decisions should be made based on the findings from well-conducted research. So what does the scientific literature tell us regarding the prevention of low back pain? While most research in this area tends to focus on diagnosis and treatment for those who are already afflicted, there is a hidden gem regarding prevention that should be mainstream information, especially for those who treat low back pain.

Published in the journal Spine in 2002, a groundbreaking study provides valuable insight into the prevention of low back pain.

• The study consisted of 249 army recruits in Denmark who were randomized into two groups, an intervention and control group, and their rate of back pain was recorded.

• The intervention group was instructed to adopt good sitting posture and to perform 15 prone press-ups twice per day. The prone press-up is similar to a cobra pose in yoga, where the low back bends backward.

• These subjects were compared with a control group, who were simply instructed to carry out their daily activities without intervention.

The findings were significant. Over the course of one year, low back pain was reported in just 33% of the press-up group compared with 51% of the control group. During this time, only 9% of the press-up group sought medical care for low back pain, compared with 25% of the control group. These findings indicate a substantial reduction in the rate of low back pain in the press-up group compared with the control group.

When you consider the impact of low back pain on society, findings such as these are profound. Low back pain is one of the leading causes of disability worldwide, affecting up to 80% of people at some point in their lifetime. It has been estimated that the total costs related to this condition have grown well into the tens of billions of dollars in the United States alone, with the highest annual estimates exceeding $100 billion. This is not surprising when you consider the fact that several hundred thousand surgeries are performed on the lumbar spine each year, with some outlets reporting that this number is more than one million.

Why would simple instructions such as bending backward a couple times per day and sitting upright have the effect they did? It almost seems too easy. The answer likely lies in the cumulative effect of how we position and move our spines on a daily basis.

As a society, we spend the bulk of our time in spinal flexion and very little time in extension. Spinal flexion occurs when we sit slouched and when we bend forward. Spinal extension occurs when we bend backward, whether while standing or when performing a prone press up.

A 2014 study gave us great insight into the mismatch between spinal flexion and extension. This study tracked more than 200 people and showed that on average, they spent only 24 minutes in some degree of spinal extension per day and the vast majority of their time in spinal flexion.

Performing spinal extension movements allow people to undo the effects of a great deal of time spent in flexion. There is debate as to the specific tissue or tissues that are affected, however this doesn’t really matter. What does matter is that if people create more balance between forward and backward bending (spinal flexion and extension), the overall incidence of low back pain should decrease, and along with it the associated costs of healthcare, disability, and impaired quality of life.

Low back pain is a symptom, not a diagnosis. Therefore, a single intervention won’t have the same effect for everyone. In fact, some people won’t tolerate spinal extension at all. If you want the most bang for your buck, however, research has shown us that performing prone press-ups twice per day and adopting better sitting posture can have a major impact on the prevention of low back pain. When you consider the massive problem that is low back pain, these simple and easy-to-implement strategies have the potential to save billions of dollars and thousands of spinal surgeries each year in the United States.

Dr. Jordan Duncan was born and raised in Kitsap County and graduated from the University of Western States in 2011 with a Doctor of Chiropractic Degree. He practices at Silverdale Sport and Spine.He is one of a small handful of chiropractors in Washington state to be credentialed in the McKenzie Method.

This article originally appeared on Kitsap Sun: Can bending backward prevent low back pain?