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Loading Based Back Pain

May 22, 2019

Load is a common cause of chronic lower back pain (Lower back pain that has lasted longer than three months).

While we often want to find a particular injury that is responsible for our pain, in the case of loading pain there isn’t necessarily an underlying injury. Rather, the pain arises from the back being sensitive to being loaded in a particular direction.

When the back is in a neutral position, load going through the joints is able to be dispersed across the full surface area of the joint. However when the back is in flexion or extension, that same load is dispersed across a much smaller area of the joint. This effectively increases the load on that smaller portion of the joint, which can create pain.

There are effectively three types of loading-based lower back pain.

  • Flexion loading disorder
  • Passive extension loading disorder
  • Active extension loading disorder

These can potentially be present in conjunction with other causes of lower back pain as well.

Flexion loading disorder

Pain arises from loading the lower back into flexion, a flexion loading disorder is often the cause. Tasks that typically irritate this pain include prolonged sitting, lifting tasks, and sustained or repetitive bending tasks such as gardening, vacuuming, mopping, sweeping etc.

Flexion loading disorder

Passive extension loading disorder

Pain arises from adopting passive postures which load the back into extension. To maintain neutral pelvis and lower back posture during standing, you need to maintain muscle tone in deep abdominal muscles and gluteal muscles. Otherwise the pelvis will passively drop into a tilted forwards position, which will push the lower back into extension. Tasks that typically irritate this pain include prolonged standing, walking or running, or sometimes even lying on your front or your back.

Passive extension loading disorder

Active extension loading disorder

Pain arises from actively holding your back in an extended position. These people tend to feel that pulling their back into extension is a “good posture”. They generally have pain in tasks that commonly irritate flexion loading pain, but this is because they perform tasks such as sitting, sweeping, mopping, vacuuming etc in an extended posture.

The good news is that loading based pain is fairly easily treated, particularly in comparison to other causes of chronic lower back pain.

How do we treat it?

The aim of treatment is to reduce the load on sensitive parts of joints in the lower back. Strategies for this can include:

  • Training posture awareness and movement patterns to disperse load more evenly across joints
  • Taping to encourage less pain-provocative postures and movement patterns
  • Manual therapies and exercises to increase range of movement in neighboring joints
  • Reducing the length of time spent performing pain provocative activities

Because pain comes from ‘load’, many overweight patients see an improvement in their pain if they lose weight through diet and exercise.

Do you need help managing your lower back pain? See our physiotherapist in Aubin Grove today!

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