Relief for chronic back pain is attainable

Published on Monday, April 1, 2024

By: Andrea Wright Dillworth

Anyone with chronic back pain knows how debilitating it can be. Things we take for granted like sitting comfortably in a chair and getting a good night’s sleep can feel elusive to those who struggle with an aching spine.  

Back pain is among the most common medical issues, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. It can be brought on by an accident, a fall, heavy lifting, arthritis, or age-related degenerative changes to the spine.  

According to a national survey, roughly 8.2 percent of American adults have chronic severe back pain; nearly 75 percent of them have problems with mobility, social activities, self-care and work.

Ryan McGlawn, professor of physical therapy, said his patients most often complain of lower back pain, some including leg pain, sometimes accompanied by numbness or tingling in the lower parts of the body.  

There is no simple, easy fix.  

“Management of chronic back pain is complex and should incorporate multiple health professionals who can address the physical impairments and psychosocial and behavioral factors,” said McGlawn, a board certified clinical specialist in orthopedic physical therapy. “The emphasis of the treatment should be on improving function, coping, and self-management rather than on resolving pain. As a physical therapist, we will focus on functional changes.” 

It’s no surprise back pain can feel at its worse at bedtime because your sleep position can affect the spine’s alignment, pressure points and overall comfort, said Sherry Colson, professor of physical therapy. There is no one sleep position that will alleviate pain for every sufferer, in part because of individual factors including the condition of your back. 

 “One size does not fit all,” said Colson. “It also depends on your preferred position. In general, someone's back and joints need good support. Putting a pillow between your knees can increase comfort if you are a side-sleeper. Pillows under the head should be supportive, but too many pillows can aggravate back pain.” 

The byproduct of waking several times during the night because of pain could also mean you’re not getting the recommended seven to eight hours needed to restore and refuel.  

“Time spent in cycles 3 and 4 of the sleep cycle is when the body heals,” said Colson, a Certified Exercise Expert for the Aging Adult from the Academy of Geriatrics-APTA. “Hormones such as GH are released during these cycles, which help the body repair itself. An increase in cytokines occurs during sleep, which helps reduce inflammation and decrease pain. Sleep positions that offer good support can reduce back pain and help avoid disruptions during sleep time.” 

Unfortunately, it can be hard to figure out which sleep positions are causing the pain since we tend to move around a lot during the night.  

McGlawn said his No. 1 recommendation is to lie with a McKenzie lumbar supportive roll around your waist; it will support the lower back and stay in place when you move. A 3-inch diameter roll is a good size to start with, but the size of the roll depends on the person’s specific needs.  

“If someone is a side sleeper, the roll should fill the natural hollow in the body between the pelvis and ribs. If you lie on your back, the roll should support the lower back in a moderate lordosis. 

“I have always referred people to purchase the McKenzie cervical and lumbar rolls as they have been the ‘gold standard,’” he said. “The McKenzie Institute is world-renowned and provides training to health care providers and resources to patients.” McGlawn is also a certified clinician through the institute.

A supportive roll can also be used when sitting to support an upright posture and help decrease back pain. 

There’s a reason, by the way, that sitting at a desk eight hours a day can leave a back out of whack.  

“Sitting will increase pressure between the discs and promote a flexed posture,” Colson. “We all must be sure we are sitting ergonomically with a good chair and correct positioning to minimize joint discomfort.” 

McGlawn recommends using a lumbar roll, even if the chair has a lumbar support built into it. It should be no more than 4 to 5 inches in diameter when not in use. When in use, the roll should compress to around 1.5 inches. You should also schedule times to stand and perform postural exercises to help combat back pain caused by sitting.  

A physical therapist can assess your workspace and recommend the correct sitting position, McGlawn said.  

“When you correct your sitting posture with the use of a lumbar roll and the correct ergonomic desk setup, there may be additional discomfort from the new postural position you are learning to be in,” he explained. “This discomfort is from a postural origin and will improve as you maintain a better posture. Also, you may feel discomfort in other areas when starting an exercise program. The discomfort is to be expected, and the exercise program should be continued with supervision from a physical therapist. They will guide you through the process to help reduce pain and improve function.” 

If you’re already noticing aches and pain in the back region, don’t ignore them, because they could get worse. Back pain, or any pain, is not an expected result of aging and shouldn’t be accepted as a sign of getting older. The experts recommend you see a healthcare professional who can establish a good plan tailored specifically to your needs, which includes addressing any physical impairments, lifestyle modification, and psychosocial factors. Once you have a plan, be diligent in following the recommendations. 

If you’re among the lucky who can sleep and sit, unaided, without pain, consider yourself lucky. But do take precautions to decrease the chances you will be joining the achy-back club. There’s nothing you can do about genetics, the primary contributor to lower back pain. But there are some factors you may be able to manage that also contribute to back pain, including your weight, strength and flexibility; physical factors including heavy physical labor and poor posture; and psychosocial factors including depression, anxiety, stress and job satisfaction.  

In short, your focus should be prevention. 

“Keep moving,” said McGlawn. “A more sedentary lifestyle may promote more chronic low back pain.” 

Colson adds: “Maintain a recommended weight range, get good sleep, and exercise. Practice good posture. Use good body mechanics at work and home. In other words, take care of your back.” 

The above article appears in CONSULT, UMMC’s monthly e-newsletter sharing news about cutting-edge clinical and health science education advances and innovative biomedical research at the Medical Center and giving you tips and suggestions on how you and the people you love can live a healthier life. Click here and enter your email address to receive CONSULT free of charge. You may cancel at any time.