A lumbar support cushion may help you manage lower back pain when sitting

Sitting for long periods can cause lower back pain

A lumbar support cushion may help you manage back pain and ease some of your symptoms. Do you have a job that involves lots of sitting? If so you probably have experienced some lower back pain as the day has gone on.

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There are many different lumbar pillows on the market – plenty of choice for you.  First though, I will explain a little about why a lumbar support can help and highlight some things to think about before you buy one.

Many of us have lifestyles and jobs that require us to spend long, concentrated periods of time sitting. Office chairs are very rarely supportive of the lower back and many of us fail to take regular, frequent breaks.  As a result the lower back is subjected to stresses and strains that eventually cause discomfort.

The story is hear most often is this:

• At the beginning of the day the problem is not so bad
• As the day goes on you start to fidget
• You become aware of soreness
• This soreness worsens to a significant back ache
• The day ends and you go home and relax and it feels better  
• The same pattern is repeated the next day

The symptoms may have first started years ago as just a mild irritation but the longer the problem goes on the more uncomfortable it gets. Sometimes you can't even get comfortable in the evenings either.

The reason this happens is to with the stress and strains we are putting through our lumbar spines in these prolonged positions.  If you do not use a lumbar support cushion or if the chair you use has no decent low back support then you will sit in a more flexed position.

The Effect of Prolonged Sitting = Creep = Pain

Your spine is a nice strong solid structure made up of vertebrae separated from one another by spinal discs and supported by large muscles and ligaments. When we are on the move this system is wonderfully strong and supportive. The trouble begins when we start applying prolonged low loads to the system.

By sitting in a flexed position for hours you cause the ligaments at the back of the spine to be put on a gentle stretch. They resist this movement for a while but after time they begin to lengthen, the technical term for this is creep, which is a great way to describe it as the pain does creep up on you.  This creep continues causing stresses to the lower back tissues, the muscles fatigue and you start to get pain. If you move and relieve the tension the ligaments recover a little and that makes it easier to continue. However, in the laboratory, studies have found that it takes about 7 hours for the creep to disappear and the tissues to regain their normal properties. 1,2

A Lumbar support Cushion can reduce flexion stresses

The answer is to use a lumbar support cushion which sits in the small of your back. This physically prevents you from sitting in a slumped position and stops the prolonged flexion stresses. This helps reduce ligament creep and can significantly relieve low back pain from sitting .

There are a variety of different lumbar support products on the market. The most common are moulded pillows or cushions which sit in the small of your back – in the curve called the lordosis.

The other types are rolls or D shaped supports that do the same thing.

	This is a type of * lumbar support cushion that sits in the chair and creates a good low back support to prevent sagging. Advantages are they are robust, disadvantages are they are less spongy than rolls and they may not fit all seats, especially seats that have moulded sides such as sports car seats. Good for office chairs and nice and sturdy.
	The * Mckenzie Lumbar Roll is the lumbar support of choice for most physiotherapists. I own one and have had the same one for nearly 20 years (its very shabby after all that time but I love it). They come in a variety of degrees of firmness and width. Experiment to try and get the right size. Usually the medium size, medium density is suitable, the most common mistake is buying one that is too fat to be comfortable. More is not always better - it depends on your shape and how deep the curve is in your lower back.
	*The McKenzie Super Roll is like the roll above but slightly more suitable if you have a chair with some built in support already. The roll is flat at the back and curved at the front.
	Do you need an inflatable lumbar support? If you travel a lot or find it uncomfortable sitting when you are out this may be the answer. See the choice of nice light inflatable lumbar supports and rolls on offer.

The choice of which type of lumbar support cushion depends on several factors:

• Your posture – if you have a deep lumbar curve then you may need a deeper or fatter lumbar support cushion. If you have a more flat back posture then you will need a shallower posture support.
  
  
• Your chair – if your chair is very 'bucket shaped' or curved you may be better off trying a more substantial rigid lumbar backrest (if you can't replace the chair that is).  This will prevent you sagging backwards into the seat.  A regular lumbar roll or pillow may not offer enough support of the chair is very relaxed and has very poor lower back support.
  
  
• Which chair – you may need a different lumbar support cushion for different chairs. Don’t just assume it’s the office chair that’s the problem.  I regularly meet people who get up, sit for breakfast, drive to work, sit all day at a desk, drive home, sit for dinner, sit on sofa watching TV, go to bed.  Nearly their whole waking life is spent in a flexed position. Look after your sitting posture wherever you are.
  
  
• How much you get up – I have found from my own experience that if you get up and down a lot its annoying when the roll falls off the chair. You may want one with a fastening that goes around the chair back.
  
  
• Do you share- If you share you need a portable lumbar support cushion that you can carry around with you.
  
  
• Personal comfort – the theory is all very well and good but we all have different preferences. Our bodies are different shapes and sizes and its impossible to predict what will work for everyone. Experiment and don’t be afraid to break the rules to get something comfortable.

Key points when choosing a lumbar support cushion

• Experiment, try different shapes and sizes until you are happy
  
  
• Have several supports in different places so that you can take care of your lower back at home and at work
  
  
• Try a towel for size first – roll a towel up and use that. Try a fatter or a thinner towel and adjust. Soon you will discover your personal preference and that will guide you to the right lumbar support cushion purchase.

Lower back pain relief when sitting is not just about lower back posture

When I discuss this problem with my patients I explain that this type of postural back pain is caused by us exposing our lower back to stresses and strains that after a while it cant cope with. I usually approach the problem by first looking to remove some of the stresses by using a lumbar support but I also want them to think about ways they can make their spine better able to cope with the stresses put upon it.

So here are some other things to think about if you have back pain when sitting:

• Take regular breaks -  get up every hour and move about. Walk around, make a coffee, take a short walk. Take the pressure off your back.
  
  
• Set timers – You will forget to get up, most people do. You get engrossed in a job and before you know it 2 hours have gone. Download a timer from the internet and set it to beep at you.
  
  
• Stretch in the office – get your spine moving in the opposite direction with an extension stretch- instructions for this lower back pain stretching exercise here.
  
  
• Get fitter – don’t just sit around all the time. Improve your physical fitness with exercise. This will improve the health of all your tissues – not just your heart and lungs. The blood supply to your back ligaments will improve too. So think about ways to get slightly warm and out of breath for about 15 minutes every day.

 

References

1.  Hedman, T.P. & Fernie, G.R. Mechanical response of the lumbar spine to seated postural loads. Spine 22, 734-743 (1997).
2.  Solomonow, M., Zhou, B., Baratta, R.V. & Burger, E. Biomechanics and electromyography of a cumulative lumbar disorder: response to static flexion. Clin Biomech (Bristol, Avon) 18, 890-898 (2003).

23-Sep-2011

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