Sedentariness

Cases studies
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Sedentariness is one of the factors that increase the risk of pain. Form a medical standpoint, it is best to avoid sedentary habits, but sometimes duties at work make this a not practical possibility. Moreover, modern life constantly encourages us to sit down and drives us to seek a comfortable life in which we avoid all physical effort. We normally use an elevator to go up - or even down - a few flights, and we use the car to travel a few hundred meters.

The good news is that we can take simple and effective measures to offset the harmful effects of sedentariness. This site deals only with those aspects relating to the back and back problems, but it is also possible to counteract the harmful effects of sedentariness on the metabolism and the cardiovascular system. If you lead a sedentary life, it is worth consulting your doctor to find out more about these measures.

What is it that increases the risk of back pain in sedentary persons?

There are several factors:

Lack of muscular strength ("muscular atrophy"). Sedentariness causes loss of muscular strength. Weakness of the back or abdominal muscles has been shown to be one of the factors that increase the risk of new or persisting pain. Muscular weakness renders the musculature liable to overloading and spasm in response to apparently slight strains. Moreover, the less muscle mass there is, the more exposed is the vertebral disc and other structures in the spinal column, the less is this able to withstand loads, and the greater is the risk of some spinal disorder.

Lack of physical activity. In normal conditions, the different muscle groups involved in the functioning of the back, such as the abdominals and the paravertebral musculature, coordinate with one another to maintain a posture or maintain balance in movement. This coordination depends on nerve reflexes, which need to be repeated in order to work properly. Physical inactivity causes loss of training and deterioration of these reflexes, so that the muscles contract in the wrong way or at the wrong time and become susceptible to spasm.

Posture. When you are sitting down, the load is greater on the frontal part of the vertebral disc. Because the disc is flexible, this tends to increase the pressure on the back wall, so that if this posture is maintained, there is a heightened risk of breakage or deformation of the wall and consequent fissure, protrusion or herniated disc. In normal conditions the back muscles protect the disc, so that the risk is greater if the muscles are weak.

Bad postural hygiene. When we are sitting we frequently adopt bad postures, producing an unnecessary increase of pressure on the vertebral disc. In the long term this implies greater risk of fissure, protrusion or herniated disc and forces the muscles to work harder, which can provoke spasm. The liability is even greater if we adopt bad postures when working sitting down, for example at a computer. However, disc lesions or muscle spasms are far less likely if the muscles are strong and trained.

Excess weight. Excess weight is frequently associated with sedentariness and is one of the factors that increase the risk of back pain. The mechanics of this are explained in the relevant section. In this case the risk is also greater if excess weight is associated with low muscle strength.

Can back pain have prejudicial consequences in sedentary people?

Yes,if they do not take steps to offset some of the risk factors associated with sedentariness.

Possible negative consequences are:

-The pain can become chronic. In sedentary people, there are normally several risk factors for new or persisting pain. This means that if pain appears, there is more risk of it becoming chronic.

- Disability can become chronic. Sedentary people habitually exercise little physical discipline on their bodies. This is normally associated with an evasive attitude to pain, subjects typically tending to seek repose and avoid any activity they believe might bring on or augment the symptoms. This increases the risk of the pain lasting longer, and more importantly, of physical and work disability becoming chronic.

How to prevent and treat back pain in sedentary people.

There are a number of effective measures to prevent back pain in sedentary people:

A minimum level of physical activity. However demanding working hours may be, it is always possible to maintain a minimum level of physical activity, and this is especially important for sedentary people. It may need as little as getting used to making day-to-day journeys on foot rather than sitting in the car, metro or bus, or taking the stairs up a few flights rather than always taking the lift. If possible, it is even better to do some aerobic sports like running or swimming. With 20 or 30 minutes on alternate days, you will begin to note a considerable difference. If you are going to start doing a sport regularly, you should first consult a doctor to assess your general condition and you should observe the rules of postural hygiene in sport, with which you can do almost any of them with less risk to your back.

Know and observe the rules of postural hygiene when seated. These teach you how to sit and work in the best and safest posture for your back. If your habits are sedentary, this means getting up every 40 or 50 minutes and walking about or bending gently backward.

Maintain or develop the back muscles. If done correctly and regularly, some aerobic exercises like swimming may be enough to keep your back muscles and your general physical condition in good form. Specific exercise programs for the back are only effective for these muscles and not for general fitness, but they require less time and can be alternated with aerobic exercises when you have time. There is a section on this site that shows effective exercises for this.

If you experience pain, you must apply the right treatment. This site contains a section that lists all the existing treatments for back pain, and there is another that indicates the common patterns of treatments that have proven effective.

If the pain that a sedentary person suffers is shown to be an organic disorder of the spinal column, such as a herniated disc, the treatments indicated for that disorder should be followed. These are indicated in the section dealing specifically with fissures, protrusions, and herniated discs.

But before treating a herniated disc, we need to show that this is really what is causing the pain. Thirty per cent of healthy people who experience no discomfort have protrusions or herniated discs which cause them no trouble, and signs of vertebral disc wear can be observed in almost everyone aged over 30.

Therefore, any X-ray, scan or magnetic resonance of a sedentary person will normally show wear of the vertebral disc, and there will probably be deformation or breakage. But the image alone is not enough; if there are no symptoms or these do not correspond exactly to what the image shows, then it is not necessary to apply a specific treatment.

Thirty per cent of the healthy population exhibit protrusions or herniated discs that produce no symptoms. One day, such people may suffer common back pain due to improper functioning of the muscles or to a muscular spasm. In any case it would be wrong to attribute such symptoms to the herniated disc, and it would be counter-productive to operate.

Therefore, complementary examinations like X-rays or magnetic resonance should only be performed when there are concrete grounds to support this. If there are no such grounds, it is pointless to conduct these examinations given that their results will not modify the treatment. It could even be counter-productive, since the observation of a herniated disc may confuse the diagnosis and lead to incorrect, unnecessarily aggressive or even counter-productive treatment.

It is therefore essential to study the characteristics of the symptoms and determine whether or not these correlate exactly with the organic disorders shown by the image. This means that the clinical history and physical examination are even more important sources of information than magnetic resonance. It would be wrong to diagnose a herniated disc without first interviewing and examining the patient. Only if the patient's symptoms and the result of the examination correspond exactly to the image does it make sense to diagnose this as the cause of the pain and establish a treatment on that basis.

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