If you’ve ever had low back pain, you are not alone. Low back pain (LBP) is one of the most common conditions I treat at the clinic and it affects people of all ages. Even school age kids have it, so it does not discriminate by age. It can be described as dull and aching or sharp and shooting. Sometimes LBP is accompanied by radiating pain into the back of the leg(s), buttocks, or anterior thigh. It can extend clear down to the foot in some cases. It’s no wonder that LBP is one of the most common reasons people see a doctor or miss work.
There are many different causes of LBP. Congenital reasons such as scoliosis (curvature of the spine) and an increased or decreased lumbar lordosis (swayback or flat back). Injuries such as strains, slips, and falls, or car accidents. Degenerative changes in the spine are another common cause and include stenosis (narrowing of the spinal canals), degenerative disc disease (thinning of the intervertebral discs with age), and other types of arthritic conditions (ie, spondylosis and ankylosing spondylitis). Some conditions affect the nerve and cause entrapment either at the spinal cord or exiting spinal nerves, such as disc herniation/protrusion, spondylolisthesis, and sciatica.
I actually prefer when a patient comes to me and hasn’t had any diagnostic testing. While knowledge is power, oftentimes in the case of LBP, ignorance is bliss. Studies have shown that we can pull 100 people off the street who have no back pain and ~70% of them will have degenerative discs/arthritis, ~50% will have a disc bulge or two, and ~30% will have a disc herniation…with no pain!!! People are shocked to learn this and wonder how can this be? So many different factors affect whether we have pain in the body. When it comes to low back pain and especially radiating pain such as sciatica or lumbar radiculopathy, this is especially true. And if you’ve been treated by me or have taken my Stretch class, you know I love the analogy of birds on a wire.
I’ve always been fascinated by how birds sit on telephone wires. It makes me laugh to watch them shuffle from side to side, making room as new birds arrive and spacing out as others leave. Several years ago I began explaining neural tension to my patients and students as having “birds on a wire”. The more birds that sit on a wire, the lower it sags and the more tension. Tension on a wire (nerve) is a large reason for pain and discomfort. This is true not only for back and leg pain, but also for neck and arm pain. I consider anything a person has on an MRI as just another bird on the wire. Now some birds are bigger than others and may cause more tension (large herniation or bone spurs). Other birds aren’t going anywhere (stenosis, scoliosis, arthritic/degenerative changes). But just like those studies show, people can have birds of all sizes on their wires and not have any symptoms whatsoever. My job as a physical therapist is to get as many birds off the wire as I can and let the body do the rest of the work. It is an amazing self healer if given the opportunity.
So what are some birds we can get off our wires? Tight hips and glutes. Your sciatic nerve runs right under your buttock muscles, so if those muscles are tight, they’re just birds pushing on that wire. Limited hip mobility. If you can’t move from your hips, where are you going to move? From your back. Poor body mechanics due to limited hip mobility…bird on the wire. Weak hips and core…bird on the wire. Hypermobility of the lumbar spine…bird. Hypomobility of the thoracic spine…peep peep! Prolonged sitting…cheep cheep! Poor posture…caw caw! Honestly the list goes on and I’m running out bird sounds. 🙂 Think about ways you may be putting too much tension on your wires. What are birds you can get rid off to free up the body to heal itself? LYTⓇ yoga is a great place to start because it’s smart yoga. Listen to the cues we give you and apply them to your daily life. Mobilize, strengthen, stabilize. On that note, I’ll see you on the mat!