We live a far more sedentary life than our ancestors. As health professionals we find a wide variety of sedentary based injuries becoming more prevalent. One such issue for sedentary workers is postural related lower back pain.
In this blog we explore posture related lower back pain; what it is, what causes it, how to rehabilitate it and a general prognosis for return to pain free function at work. As well as this, below are some helpful videos with corrective exercises for posture related lower back pain and ergonomic advice for your working environment.
If our body’s low back (lumbar spine) articulated with the pelvis in a completely straight line, we would hinge forwards in a sitting position. To allow for this, our lumbar spine is curved and this is called the lumbar lordosis. A normal lumbar lordosis is characterised by an average lumbosacral angle of 39° – 53°. A variety of different muscles that are found in the lumbar spine and pelvic region help maintain this lordotic curve and normal posture. Some of the common muscles we will discuss in detail below as they play an important in posture related lower back pain:
Hip flexor: There are main two muscles that make up the hip flexor; The Illiacus and the Psoas major. The Psoas muscle originates at the transverse processes of lumbar vertebrae 1-5. The illiacus muscle originates on the iliac crest and joins with the psoas major to form the iliopsoas or ‘hip flexor’. Together, they insert together into the lesser trochanter of the femur.
Function: To flex the hip.
Hamstring group: There are three muscles which make up the hamstring group; the biceps femoris, semitendinosus and semimembranosus. All three hamstring muscles originates at the ischial tuberosity. It becomes three muscles that go down the posterior thigh. Semitendinosis connects to the medial surface of the tibia, semimembranosus connects to the medial tibial condyle, and biceps femoris attaches to the lateral side of the head of the fibula.
Function: To flex the knee and extend the hip.
Erector spinae group: A group of three muscles. The three different muscles are illiocostalis, longissimus and spinalis. These basically run the length of your spine and have attachments to the ribs, neck and pelvis. For posture related lower back pain, we are concerned with the branch of erector spinae originating in the pelvis and has connections at rib level.
Function: To extend the trunk and maintain upright posture
Rectus Abdominis: A pair of parallel muscles separated by a midline band of connective tissue called the linea alba. They originate at the anterior lower sternum (breast bone) and insert into the the pubis. However, it is interrupted by 3-4 tendinous intersections. This is what makes it look like a six pack!!!
Function: To flex the trunk
Our normal posture and lumbar spine curve can be interfered with by a sedentary lifestyle where sitting predominates the day. This can result in the mal-aligned postures pictured below.
Over time, imbalances in musculature can occur (through the hip flexor, hamstring, erector spinae and rectus abdominis) and impact the posture created in the lower back pain.
Hypo lordosis (flat back): A decrease in the usual lordotic curve of the lumbar spine. Generally people with hypolordosis will place increased pressure through the intervertebral discs in day to day life and have an increased risk of disc related injuries.
Hyper lordosis (sway back): An increased lordotic curve of the lumbar spine. Generally people with hyperlordosis will put increased pressure through the facet joints of their vertebrae and have an increased risk of facet joint arthropathies and muscular spasms.
There are plenty of factors that contribute to hypo and hyper lordotic postures and associated lower back pain such as congenital causes, obesity, poor upper back posture and degenerative changes. However, a sedentary lifestyle will further impact these postures. Below, in the table you can see how different lower back postures are impacted on by imbalances of tight and weak muscles:
|Posture||Potential for Tight Muscle/s||Potential for Weak Muscle/s|
|Hypolordotic lumbar spine||Rectus abdominus, gluteals, hamstring||Erector spinae, hip flexor|
|Hyperlordotic lumbar spine||Hip flexor, erector spinae||Rectus abdominus, gluteals|
Opt for a workplace ergonomic assessment. It is generally better to get professional help for your seating arrangement at work, especially if this is where you are spending the majority of your day. Most employers in corporate environments are supportive but may need a written approval from your physiotherapist, osteopath or medical practitioner. Below is a video that demonstrates basic correct ergonomics for your seat at work:
Heat packs are a great way of improving pain levels when pain is significant. They will help relieve pain and relax muscles in spasm. Apply for a period of 20minutes and wrap towels around the heat pack if it is too intense.
Sitting for more that 5 hours of the day can greatly impact you low back and increase your chance of experiencing low back pain. Consider have a microbreak every 30-60 minutes where you get up from your desk, change your posture, move around, stretch, etc. This is a good habit to get in to; you may find it helpful to set an alarm or notification on your phone/computer/smart watch.
It is recommended that a healthy adult participate in 150 minutes of moderate aerobic exercise (~20 mins per day) or 75 minutes of vigorous aerobic activity a week. This should be combined with strength training of major muscles groups at least twice a week.
Bed rest is not recommended in low back pain. It is important to remain mobile and use the muscles and joints of your low back.
Regular exercise also comes with a plethora of other health benefits including increased energy levels, improved memory/concentration, weight maintenance/loss, mood improvements, improved muscle and bone strength, decreased risk of chronic disease and improved sleep quality.
Your physiotherapist or osteopath will assess your low back posture, range of motion and identify weaknesses/overactive muscles in your initial appointment. They will use this information to tailor your management plan. Rehabilitation will follow a format similar to below:
This is very much dependent on the individual, the severity of the issues and the rehabilitation that is completed. However, generally, a period of four to six weeks is an appropriate timeframe (while receiving professional help and completing all the correct rehabilitation) to return to normal pain free function. See your physiotherapist or osteopath for a more accurate assessment and prognosis of your low back pain.
By Sydney CBD Physiotherapist Ryan Dorahy