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  • Writer's pictureWorld Half Full

Anxiety affects back pain more than posture


It’s widely believed if you sit up straight and keep good posture, you’ll prevent back pain. Well, that may not be all there is to it. A new review of research suggests that habits and mental processes such as anxiety are more likely to have an impact than lousy posture. Three researchers — Peter O’Sullivan, professor of musculoskeletal physiotherapy, Leon Straker, professor of physiotherapy, and Nic Saraceni — from Curtin University in Western Australia say anxiety about maintaining good posture can create stress and undo all the efforts people make to maintain good spine health.

“Back pain is more likely to persist if a person becomes overly worried and fearful about their back pain, or overprotects their back and avoids movement, physical activity, work and social engagement,” they say in a report published in The Conversation.

“People’s spines come in all shapes and sizes, so posture is highly individual. Movement is important for back health, so learning to vary and adopt different postures that are comfortable is likely to be more helpful than rigidly adhering to a specific good posture,” they argue.

Clinicians commonly define “good” posture as sitting “upright”, standing “tall and aligned”, lifting with a squat technique and “straight back”. On the other hand, they warn against “slump” sitting, “slouch” standing and lifting with a “round back” due to the risk of damaging the spine and creating back pain.

However, the researchers found a surprising lack of evidence for a strong relationship between good posture and back pain, saying that ergonomic interventions for workers, and advice for manual workers on the best posture for lifting, have, in fact, not reduced work-related back pain.

Certainly, those whose back pain is caused by a fracture, malignancy, infection, or nerve compression — up to 5% of back pain sufferers — should seek professional care. For the remainder, though, back pain is due to sensitivity in the back structures rather than tissue damage. In this case, “too much focus on maintaining ‘good’ posture can be a distraction from other factors known to be important for spine health.”

Those factors include moving and relaxing the back, undertaking regular physical activity, building confidence and keeping fit and strong for daily tasks, maintaining healthy sleep habits and body weight, and caring for one’s general physical and mental health.

As people are more vulnerable to back pain when their health is compromised, the researchers advise that, first up, people reduce stress, be active, and ensure they care for their mental health.

The role of diet

Apart from stress, anxiety and depression, other risk factors for chronic spinal pain include lifestyle factors such as reduced physical activity, obesity, chronic inflammation, poor sleeping habits and low vitamin D levels.

Numerous studies show chronic back pain can be helped through diet, specifically anti-inflammatory foods, those rich in antioxidants, for example. Fred Tabung, a nutritionist at the Harvard School of Public Health, says many of the micronutrients the immune system requires to function at a high level are found in a diet comprised of wholefoods. There’s also emerging evidence indicating the role of the gut-brain axis in chronic pain.

An anti-inflammatory diet includes brightly coloured fruits (cherries, all berries, red grapes, pomegranates, and watermelons) and vegetables (carrots, beetroot, sweet potatoes, leafy greens), wholegrains (oatmeal, brown rice), seeds (flax, chia), beans and nuts (peanuts, pistachios), olives, avocado, probiotics (yogurt, kefir, sauerkraut), beverages (herbal teas, green teas), herbs and spices (basil, cinnamon, clove, ginger, rosemary, garlic, curcumin, onions, oregano, turmeric, cayenne pepper).

Chronic low back pain has been linked to a vitamin D deficiency. A study of 68 patients who were both deficient in vitamin D and suffered from chronic low back pain found treating them with vitamin D supplements significantly reduced low back pain and improved function. Exposing your skin to sunlight for several minutes daily is also advised.

Turmeric contains curcumin that’s been shown to help reduce inflammation. Most studies recommend combining curcumin with black pepper, as this can enhance curcumin absorption by more than 2,000%, thus making it more available to the body.

Foods to avoid include processed foods (white bread/pasta/rice, chips, crackers, and pastries, sugary drinks and snacks); fried foods, especially cooked in partially hydrogenated oil; saturated fats found in meat and dairy; and caffeine and alcohol.

Back pain affects millions of people. Eighty percent of the US population will suffer back pain during their lives, especially as they age. Americans spend at least US$50 billion annually to treat it. In 2017, back pain was the main cause of disability worldwide and was the leading reason for workers’ compensation claims and lost work hours and productivity.

People’s spines come in all shapes and sizes, so posture is highly individual. Movement is important for back health, so learning to vary and adopt different postures that are comfortable is likely to be more helpful than rigidly adhering to a specific good posture.

Study authors

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