Because back pain may recur, it is especially important for anyone with a history of back problems to take steps to reduce their risk of damage to the spine and related structures. Measures that can be used for prevention include paying close attention to posture and body mechanics (habitual ways of moving), stretching and strengthening particular muscles, changing daily routines to protect the back, and, if necessary, using special products to help reduce strain on the back.

Lifting Boxes - MasterfileImproving Posture

Contrary to popular belief, standing at attention like a military recruit—with the head and shoulders rigidly pulled back and the lower back excessively arched—is not correct posture and can actually be hard on the back. Good posture allows the body to follow the natural S-shaped curve of the spine. As simple as that sounds, however, poor habits, previous injuries, and even ill-fitting shoes can contribute to improper spinal alignment. Poor posture can strain muscles and ligaments and increase the risk of compressed nerves.

The easiest way to evaluate your standing posture is to stand sideways in front of a mirror when you’re not wearing any bulky clothing. Ideally, it should be possible to visualize a vertical line running straight from the front of your earlobe through the front of your shoulder, down the center of your hip, just behind your kneecap, and just in front of your ankle bone. Your chin should be parallel to the floor, not thrust outward. Alternatively, stand with your heels against a wall. If the back of your head, shoulders, buttocks, and calves touch the wall—and you can slide your hand between the wall and your lower back—you have good alignment.

To check your posture while sitting, sit in an armless chair with your side to a mirror. You should be able to visualize a line running through the same points of your upper body down to the center of your hip. Perpetual slouching with the shoulders rolled forward causes kyphosis. Mild kyphosis can usually be corrected through a program of exercise. More severe cases may require surgical correction.

Posture varies with age. As people get older and lose height because of disk changes, the curve in the lumbar region of the back tends to straighten, leading to a slight stoop, which is normal. In addition, the curve in the thoracic region tends to become accentuated with age. The following tips will help to improve poor posture.

Standing Posture

When standing, keep your head level and your chin slightly tucked in. Stand tall, stretching the top of your head toward the ceiling. Relax your shoulders and tighten your stomach muscles to tuck in your stomach.

Standing for long periods can be tiring and lead to bad posture. Distributing your weight so you are aligned vertically (a straight line from the point between your eyes to your chin, collarbone, breast-bone, pelvis, and midpoint between your ankles) can relieve fatigue and maintain good posture.

Good Posture While Sitting and Lying Down

When sitting, use a straight-backed chair, and sit with your shoulders against the chair back, your chest lifted, your arms on the armrests, and your upper back straight. An ideal chair includes armrests to support the weight of your arms, thereby reducing the pressure on your back. Avoid low, soft chairs that are difficult to get into and out of. Your feet should comfortably touch the floor, with your knees positioned slightly higher than your hips. You may need to place a foot-stool or thick book underneath your feet. When sitting for any length of time, it is important to get up and move around every 30 minutes or so.

When driving, adjust your seat position so that your knees are slightly higher than your hips and in a position that you can comfortably reach the steering wheel, brakes, and accelerator. Shift your hand position on the steering wheel frequently to minimize stress on the muscles in the upper back and neck.

When in bed, lying on one side with knees bent and a pillow between them helps to maintain the natural curves of the spine. Place a pillow under your knees when sleeping on your back.

Exercising To Protect and Strengthen the Back

Regular exercise can help people lose excess weight and improve their overall health. It can also help prevent back pain and injury. A review of numerous studies focusing on exercise to protect the back found that individuals who worked out regularly experienced less back pain and had fewer sick days due to back pain than those who did not exercise.

Exercises for back pain focus on strengthening the muscles in the back and abdomen and stretching the muscles in the back. Flexibility exercises for your hips and even your shoulders may also be needed, because improving your flexibility in these areas will decrease the demands on your back. Ask your doctor to refer you to a physical therapist, who can provide you with instruction on exercises such as the pelvic tilt, cat stretch, and “crunches” (partial sit-ups). Walking also is an effective way to strengthen the back and improve posture.

Avoiding Back Strain

In addition to correct posture and exercise, many other aspects of your daily life influence the health of your back. Some people simply need to improve the techniques that they use to perform everyday activities—lifting heavy objects, playing sports, or even getting in and out of a chair, for instance. Other people will need to avoid certain activities altogether.

Lift heavy objects properly

One study found that people who lifted objects improperly had twice the risk of a herniated disk as those who used the correct technique. To lift something safely, always bend at the knees and carry the object close to the body. The farther away from the body you hold an object, the more pressure is placed on your spine. Holding objects at arm’s length can increase the load on the lower spine by 15 times the original weight. For example, when a person carries a 10-lb box at arm’s length from the body, it is putting 150 lbs of pressure on the spine.

Choose activities wisely to avoid back strain

Depending on the severity of your back problem, you may need to stay away from activities that require sudden twisting movements, including sports such as golf, bowling, football, basketball, baseball, weight lifting, and tennis and other racquet sports. However, if your physician approves, you may be able to continue some of these activities as long as you modify your technique. In golf, for example, twisting movements during the swing must be minimized. In addition, golfers should keep their knees bent and spine straight when placing a ball on the tee or picking it up from the cup.

Maintain a healthy weight

Obesity places an extra burden on the lower back. It also increases the natural curve of the lumbar spine, forcing the vertebrae to bear weight at abnormal angles.

Quit smoking

Studies show that cigarette smoking decreases blood circulation in the intervertebral disks and speeds their degeneration. Smoking is also a major risk factor for osteoporosis.

Consider going to “back school”

Back schools are usually directed by a physical therapist, sometimes with the aid of a physician. They provide a safe, inexpensive, and effective way to learn more about how the back works and what can go wrong.

The school’s director can analyze how your working conditions, daily activities, and even your sleeping habits may be harming your back. The school can customize an exercise program for you. Some schools also give instruction in relaxation techniques. A family doctor or physical therapist will have information about nearby schools.

Publication Review By: Lee H. Riley III, M.D. and Suzanne M. Jan de Beur, M.D.

Published: 03 Aug 2011

Last Modified: 18 Nov 2011