Why does my back hurt?
Is it my posture?
Low back pain is very common. I don’t know any adult who hasn’t had at least one episode of back pain. I’ve seen a lot of children who experience back pain too. It’s definitely not fun to go through, but the good thing is back pain is usually manageable without needing opiods or surgery. While most people want to understand what is causing their pain, the answer may not always be what is shown on imaging. One big comment I get from clients is that they know their “posture” is bad. They may even have been told that the cause of their pain is poor posture.
I was watching an exercise video on YouTube today in which the medical professional instructs us in “how to correct an anterior tilt”. This is where I think the message about posture falls short.
An anterior tilt of the pelvis is when the front of the pelvis tilts forward toward your toes. A posterior tilt the back of the pelvis moves toward your heels. These are normal motions that happen with each and every step we take. Lordosis is a normal curve in the lower back and neck. Postural changes — at rest — might be an increased anterior tilt with an excessive lordosis. This can sometimes lead to feelings of compression, especially when standing, in the low back because there is too much extension force. The opposite, a posterior tilt can be associated with decreased lordosis and likely too much flexion. Sometimes this will lead to pain with sitting.
The trouble I had with that video is that we automatically assume that a resting posture is bad, but really, it’s only troublesome if we can’t move out of that posture. Sometimes to move out, we need to go further in and get a stretch response to allow the opposite movement. And sometimes we need to do the opposite. When there is too much motion such as an increased anterior tilt, there is usually less motion somewhere else. It could be the mid back (Thoracic spine) or it could be the hips. It also could be that the lumbar spinal muscles are over working in relation to the abdominals and/or hip flexors.
Knowing which joints are stiff and which muscles are over or underworking can really help to get a good exercise routine in place and allow more effiecient anterior and posterior tilt-ing. Once you’re able to do this you can work on core stability in which the key is not so much to smash your lower back into the floor, but rather to keep the pelvis from moving while you move your legs or arms.
If you can take one thing away from this post, let it be this. What we say matters. How we interpret what is being told to us can greatly affect an outcome in healing. If we get tied to the words “bad posture” we may not be able to learn how to create better movement and get back to resting in a centered posture. While ‘posture’ in itself may not be the reason behind your pain, bringing ourselves back to center sets our body up to function optimally and will likely lead to less pain. Sometimes this may mean we need to rest in a bit more anterior or posterior tilt. Only our body and our movement can determine which is better in the moment.
Cheers to a healthy back!