Back pain is the most common ailment in the world. Over 70% of people will experience it at some time in their lives. In the United States, it has an economic impact of close to $100 billion dollars a year. Crazy.
Now, in the treatment of lower back pain, my personal opinion is that you (the patient) becomes a nail, and the provider you seek care with, is a specific type of hammer. If you see a chiropractor, you have a spinal dysfunction and need a chiropractic adjustment. If you see a medical doctor, you have pain so you need a pain killer. You get the idea.
The good news is that the most common cause of lower back pain is muscular strains and sprains. Muscle strains have a normal life cycle of a few days and sprains a few weeks if allowed to repair or assisted in repair. However, if you are like the rest of us and continue to spend long hours sitting at your desk or exercising when you know you should take a break, the pain continues. Sorry gym rats. The truth is sometimes painful.
A less obvious cause
Private practice is a special animal. We are exposed to things that many "scientific" communities are not. We are the class of providers that have their "boots on the ground" and see things that are ahead of any rigorous testing or studies.
Most people are unaware that indigestion, bloating, heartburn, reflux or any other type of digestive discomfort will lead to lower back pain.
The possible mechanism for this is simple and clinically significant. For you science geeks, keep reading.
The diaphragm is the primary muscle in breathing. As you inhale, the diaphragm goes down and on exhalation it goes up.
It is also connected to your lumbar spine (lower back), sacroiliac (tailbone) and it has fascial (sort of like plastic wrap for your muscles and tissues) connections all the way to the base of your head!
Underside view of your diaphragm
As shown above, your diaphragm has an opening that allows food to enter into your stomach via the "oesophageal hiatus." Acid reflux and heartburn are examples of digestive distress resulting from when that muscular opening gets weak or dysfunctional. You can also see some of the connections to your low back, "vertebral attachment."
How does it lead to back pain?
When you have digestive abnormalities, pressure builds up in your gut and pushes against your diaphragm. That pressure prevents the diaphragm from being able to properly move up and down and increases tension on the diaphragm and its attachments. Those attachments being your lower back, pelvis and tailbone areas, just like any other muscle.
How do I make it better?
There are some basic steps you can take to help identify what is causing the dysfunction and help make it better.
1. Find the offending food
First you have to determine what food is causing you indigestion or bloating. Otherwise, every time to eat that food, it will cause tension in your diaphragm and lead to lower back pain. Most common foods? - Foods that make you gassy: beans, broccoli, dairy, beef. So next time pay attention to when your back hurts and think about what you ate the day before. You may just notice a pattern. Once you have identified the offending food, take it out of your diet for a week. You should notice and improvement of your low back pain symptoms. Now the ultimate test is to re-introduce the food and see if it comes back.
2. When are you eating?
Second, investigate the timing of meals. If you eat a meal too late at night or right before a nap, that food is not being properly digested. That means your food is essentially rotting in your gut and "off-gassing." The process of off-gassing increases pressure on your gut once again and then increases tension on the diaphragm. Try to make your last meal no later than 8 p.m. If that is not possible, at least try to give yourself two hours after the meal before you go to sleep or take a nap. Also, start to notice how you feel upon waking. Are you bloated? Do you feel tension in your upper tummy or dullness in your lower back area? These may be indications that you did not properly digest your food from the night before.
3. Sitting posture
Last but not least, sitting time. This is a tricky one because we are technically combining two possible causes. However, you may be addressing one but not the other.
It is impossible to sit with good posture for prolonged periods of time. So when your posture degrades, you are increasing the pressure on the diaphragm by restricting its movement. As best you can, take a break every 30-40 minutes and stand up. Ideally, take a light stroll around the office.
Is there anything I can do to relax the diaphragm?
Rub your tummy in a clockwise direction. Gentle rubbing of the tummy stimulates movement of your gut. The gradual movement should help relieve some of the pressure on the diaphragm and hence, tension on the lower back.