Within physical therapy, we often see that your cause of low back pain is explained by often wear and tear and aging on the one hand and on the other hand our posture or the position of the spine.
Leg length difference?
One of the most well-known examples is a "leg length" difference. We often hear that a previous therapist has indicated that the lower back complaints are due to a difference in leg length. When we take a critical look at the perception of leg-length difference in practice, there are many snags in this.
Changes in attitude is often something a therapist or practitioner has taught themselves. Compare it to this example when you are looking for a red car you start seeing them more often too! In this we cannot blame them either because you are looking for something to treat. But in most cases a leg length difference is not very noticeable or less than 1 cm. And when your leg length difference is less than 1 cm it is probably not relevant to developing symptoms.
(Maybe it's also just really hard to do?) In 2016, a study was published where two experienced chiropractors were unable to get agreement on a group of people they had to assess for leg length difference. Comparison of Supine and Prone Methods of Leg Length Inequality Assessment.
And not only the previous study shows that pointing out a leg length difference as THE reason for your low back pain is very slippery ice. Back in 1984, a study appeared in the Lancet which clearly indicates that a leg length difference has little to no impact on developing low back pain. Does unequal leg length cause back pain? A case-control study
Extremes are often very interesting and often tell us a lot. An example is people who have had leg amputations. When we look at this group of people we see that the factor of leg length difference does not affect whether or not they have low back pain. By this I mean that people with a leg length difference do not have more or less back pain than the group without a leg length difference.
Interesting? Read more here. Low-back pain in transfemoral amputees: is there a correlation with static or dynamic leg-length discrepancy?
Another well-known example is the tilt of your pelvis. This of course goes nicely together with a leg length difference because one possibly causes the other. I do not mean that a different position of your low back and also your pelvis is not made up. But the influence it has on the development of low back pain often is. It often comes down to this: a tilt or twisting of your pelvis is often imperceptible. The idea that a slight variation in position is the cause of your symptoms is very unlikely. Onzelage back is simply not that vulnerable.
Another example is a back that is too hollow. As with our pelvis, there is an awful lot of variation in the hollowness of our lower back between people. We simply don't know how much hollowing is bad. When is it too much? When we go back to looking at the evidence we often see that there is none!
So you have to ask yourself, is treating, or wanting to change, an overly hollow back really helpful? People who are so panicky about a too hollow back are often also the people who say that long sitting or office work is so bad for your back. While this is just the opposite of this posture? Do you still get it?
A small kernel of truth
As human beings, we walk on two legs. This is probably why there is quite a lot of pressure and strain on our low back. If we compare this with people who often sit in a deep squat position (the hollow back now becomes convex) as people often do in Asia, we do see that in this group the spine is less subject to wear and tear. Even in animals that walk and move on 4 legs, we see wear in the areas of the spine where the curvature is sharpest. But even if it were the case that we in the Western world develop more wear due to our way of sitting and moving, this does not mean that we also experience more pain in the low back. The degree of wear and tear is not a measure of the degree of pain experienced.
This brings onto us the other often stated cause for your back pain. Wear and tear! A great example of this is the twin spine study:
Twins from the United States, Canada and Finland were followed over an entire period of time. This study looked at several factors that could potentially play a role in the development of osteoarthritis symptoms, or wear and tear. In this study, we are specifically concerned with osteoarthritis located in the spine. The conclusion of the study is that wear and tear in the spine is largely hereditary. This hereditary factor weighs many times heavier than, for example, a heavy profession or a sport where one can expect where the spine is loaded a lot. Now you're probably thinking; great then! But what also turns out is that more physical activity and muscle mass actually have a favorable effect on not developing more osteoarthritis in the spine. In twins where one smokes and the other does not, we do see more osteoarthritis.
The belief that our spine is a fragile block box that needs to be straightened or just gets crooked has often led people to have less confidence in their own bodies. They are truly convinced that something is wrong while in 99% of all cases we speak of a normal anatomical variation. The danger is that people risk becoming their "diagnosis. What you can do about your symptoms though we are going to discuss in our next blog!