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Back pain while bending may hint at the underlying cause.
Ryan McVay/Lifesize/Getty Images
Half of all working Americans experience back pain each year, according to the American Chiropractic Association. Back pain is a leading cause of doctor visits and missed work. Most cases of back pain are mechanical in nature. In other words, back pain is usually not caused by disease, infection, fracture or inflammatory arthritis. Mechanical back pain is usually made better or worse by movements or body positions. For the lumbar spine, pain while bending can offer clues to the cause and point the way to effective management.
Lumbar Spine Anatomy
Five spinal bones, or vertebrae, make up the lumbar spine in the lower back. Each vertebra is connected to its neighbors above and below by a 3-joint complex. Intervertebral discs -- the shock-absorbing pads between the bulky portions of the vertebrae -- make up 1 joint at the front portion of the spine. Two smaller joints, called facet joints, connect the vertebrae at the rear. The configuration of these joints gives the lumbar spine relative stability while allowing considerable flexibility in forward and backward bending.
Problems With Flexion
Low-back pain on forward bending, or flexion, is often caused by problems with one or more of the intervertebral discs. People with flexion-intolerant low backs typically have more pain after prolonged forward bending or heavy lifting. They may also have increased pain when sitting. It is common for someone with a flexion-intolerant low back to have trouble straightening up after a long period of sitting. Someone experiencing this kind of pain typically takes several steps in a slightly hunched posture before assuming a fully upright posture.
Problems With Extension
Low back pain that is made worse by arching backward, or extending, likely originates in the facet joints. A person with low back pain with extension may be diagnosed with facet syndrome. People with this condition typically do not tolerate prolonged standing, which extends the lower spine. Walking is usually not as problematic as standing because the load on the spine is constantly shifting while walking. Sitting or lying with the knees bent often relieves this type of pain. Extension-related low back pain is usually only in the small of the back and may be worse on one side than the other.
Avoiding postures that unnecessarily aggravate the back is an obvious first goal in alleviating pain. For the flexion-intolerant back, this may include using a support behind the back when sitting to help limit flexion. Your doctor may recommend avoiding toe-touches, situps and similar exercises if flexion aggravates your low back.
If spine extension is a problem, high-heeled shoes should be avoided. Excessive belly fat may also create problems because the spine must extend to compensate for the extra weight. Keeping the low back muscles loose by stretching and keeping the abdominal muscles strong are good strategies for someone with facet syndrome.