Many of us experience the unbearable ache of lower back pain. In fact, approximately one in six people in England deal with it, across all ages and causes.
While some causes of back pain can be explained by a specific condition (for example ankylosing spondylitis or a herniated disk), the vast majority of cases (90 per cent) are non-specific. This means that it’s not possible to identify a structural reason to explain the pain, and can leave sufferers with more questions than answers.
There are some well-known risk factors for non-specific back pain that health experts will often point to – low physical activity levels, particularly a sedentary lifestyle, lifestyle diseases like obesity, and high levels of physical stress are particular triggers.
However there are also less well documented contributors to back pain. We spoke to expert Emily Alexander, Registered Osteopath at Backworking Osteopathic Practice to get to grips with the unexpected habits and decisions that could be contributing to your back pain and, crucially, how to fix it. While none of these factors guarantee back pain, she says they are worth checking into if you do experience it to see if you can alleviate the problem.
Whether you wear a fitted high waist, a cinched-in belt, or even wear trousers that are low slung but tight, your trousers can limit your movements. “This can change the way that you stand, or put a bit more pressure onto your low back and your abdomen. You need to allow yourself the ability to move freely in all directions,” says Emily.
That means clothes that allow for movement not just when standing, but when sitting too. If you can’t lean forward properly in your jeans, that can mean you’re stopping a section of muscle from working properly and freely, which puts strain on that whole area and above and below it. And if those trousers are low but tight, they can also restrict your pelvis, stressing the lower back.
The solution? It might seem obvious, but dress with comfort in mind. “It hasn’t got to be loose-fitted, but, but something that’s not ridiculously tight. And this goes for low waisted trousers as well.”
“Some people have perfectly functional flat feet,” Nell explains, “but if your feet are flat and weak or stiff, this can sometimes alter your entire body’s alignment from the ground up.” When your arches drop, it may cause your ankles to roll inward and your knees to rotate, creating a chain reaction that affects your hips and spine, straining your back muscles and overloading your joints. This can lead to pain as your body tries to compensate for the misalignments.
To counteract this, you can get orthotics (devices you can wear in your shoes to alleviate symptoms – either over-the-counter or custom ones), but Emily also recommends doing feet strengthening exercises.
“It’s always really good to strengthen your feet. Practice picking up tea towels by scrunching your feet, walk around barefoot on uneven surfaces, and walk on tiptoes.”
After major abdominal surgery like a caesarean you will need to build up your core muscles again and develop mobility in your scar tissue (once you’ve been given the all clear). “Without a certain level of strength in your core muscles and your lower abdominal muscles, everything tends to sink and slouch”, Emily says. “You get lots of pressure on your low back and your back muscles, which have to overwork to help support you.”
“Start building up slowly with some gentle yoga stretches and work and the strengthening pelvic tilts. Pilates from reputable instructors on YouTube can be particularly good, as long as you go as slowly and gently as you need.”
Smoking may not seem obviously linked to back pain, but Nell says that “smoking has a direct impact on your spine’s health in two ways: nicotine causing blood vessel constriction, and carbon monoxide reducing the ability of your red blood cells to take on oxygen.” This reduces your healing speed, meaning any damage to your spine will take far longer to recover.
Smoking also means that your tissues age more quickly, and your spinal disks will degenerate faster, Emily adds. “Your spinal disc keeps your vertebrae a certain distance apart, so if your discs start to degenerate, as they do with age anyway, your bones get closer together, and you have less mobility, which can put pressure on your muscles.”
So, to slow the risk of back pain, you’re better off stopping smoking.
If you have a bulky wallet or big phone that you keep in your back pocket including when you sit, that can have a knock-on effect on your back.
“When you sit down with a wallet still in your back pocket, you could push into your piriformis muscle, which is one of your buttock muscles that lies closely to the sciatic nerve,” Emily says. “If you did that consistently, you could get pressure on your sciatic nerve, which could potentially give you pain down your leg.”
This incidentally also happens if you always cross one leg over the other. “When you habitually cross your legs, you create an asymmetrical posture that puts uneven pressure through your hips, pelvis and spine”, Nell says. “This can lead to muscle imbalances and altered movement patterns that strain your back, and over time this can contribute to back pain.”
To combat this you have to recognise that you are human and will not have “perfect posture” – but perhaps you can swap sides of which pocket you keep your wallet in, or which leg you cross over the other. You should also try to get up and move regularly, as sitting in any position for long periods is not good.
You may find it comfortable to sleep on your front, but Emily warns that this can have a significant knock-on effect – particularly if you sleep with one leg angled up (similar to the recovery position).
“This is particularly bad for women because we have wider pelvises, and so you end up with quite a strong twist in the lower back if a woman sleeps in that position. But if a man does it, there’s less of a twist.”
In either case, Nell explains that “sleeping face down forces your neck to rotate to one side for prolonged periods and typically causes your lower back to arch excessively.”
Luckily, there’s a simple fix: sleeping with a pillow between your knees. Lie on your side and position a pillow in front of you. Then bend your top knee and roll halfway onto the pillow.
This position keeps the spine in good alignment and prevents too much pressure on the internal organs. This is also great for pregnancy, as the pillow helps to support the bump.
Vacuuming is one of those activities that we don’t tend to analyse our form on, but this kind of movement can be quite harsh on the pelvis and the spine.
Our bodies are not designed to be in a mid-stance posture for any length of time and it’s easy to injure a disc, muscle or other soft tissue while hanging over stooped like this for an extended period. As Nell explains, “This movement often involves poor biomechanics – especially if you’re reaching far forward or twisting from your waist instead of moving your feet.”
Try sweeping wooden floors, or look for the lightest vacuum cleaner possible and keep the movements you make close to the body, to minimise any stooping and stretching. You could also try to lead with the opposite leg to the one you usually lead with.
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