265- How Sitting Can Wreak Havoc on Your Low Back

Welcome to the Evidence Based Chiropractor, where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid and today we are talking research and it is a good one. How bad is sitting for your low back and lumbar spine? So we're going to take a look at today study that came out 2014, lumbar disc changes associated with prolonged sitting. We're going to break it down, talk about the clinical implications and more. Before we get started, I want to talk about Jane. Jane is a new sponsor of this podcast and Jane isn't just your admin. Jane is a powerhouse with a can do attitude and is a force to be reckoned with as a full practice management solution that offers everything from streamlined scheduling, online booking. You definitely know you need that simplified billing and more. You could count on Jane to have your back while you're in and out of the office. Jane has one simple monthly rate. No onboarding fees, no contracts, period. You can see it in action and schedule a live demo by heading over to Jane App Cairo. That is Jane App Cairo. I'll drop that down below and if you have a specific question you'd like to ask, feel free to hit them up. Support at. I have known that team for a while. I know most people that don't have Jane are super frustrated with their EHR and emr. Check out Jane Jane App Cairo and I'll drop that down in the links below. But as we talked about at the top, today we're talking about lumbar disc changes associated with prolonged sitting. It is a big deal. We know people are spending a ton of time whether they're working from home, whether they were commuting. Remember those days, maybe a year ago or so. People spend a lot of time in a seated position. And we also know that most people aren't taking the breaks that they should for their spinal health. Right? They're not getting up and moving around every 15 minutes. People are in like these fixed positions for hours and hours on end. And I'm gonna say go even one step farther because maybe a year ago, you know, you were doing that at the office and there was, you know, maybe the company bought ergonomics type stuff so you had a good chair. You might have, you know, now people are working from home and like these crazy. This might sound familiar. If you look at Your spouse or partner as well, people working from home. These are crazy situations. Like places that were not meant to be offices are now offices and people are in like cramped quarters. Non ideal. You're sitting with like a kitchen, you know, chair, you know, instead of an actual ergonomic chair, you're at the table instead of at a desk. All of these ergonomic factors play a huge role. And people are spending tons of time in these static seated positions. So we know that that's hazardous, but the real question has been, okay, we know that that's probably suboptimal, but what's really going on? Are there changes associated with that in the lumbar spine or do we just think it's not a good idea? So this research breaks that down and I think it's really, really impactful. So as they've broken down in this study, they say as the economy and workforce moves from a manufacturing based economy towards a service based economy, they sedentary jobs have increased. I think we've seen that a lot of people work on the computer, sedentary workers, more stationary and less active. That's true. Sedentary job typically involves majority of the day seated in front of a computer or workstation. And multiple studies have shown that prolonged sitting can lead to an increase in low back pain. The static seated position has been showed to increase intradiscal pressure. It can increase pressures that have been shown to lead to disc bulges, protrusions, and potentially even herniations. And additional studies have evaluated the ensuing degenerative cascade, which can lead to further degenerative changes, including ligamentous hypertrophy, facet arthritis and stenosis. So these are big deals if you're advancing the degenerative cascade. We're all going to have some arthritic changes as time goes on, or degenerative changes to a certain degree. Question is, are the choices you make each and every day making those come about faster and more aggressively, or are you doing everything you can to slow them down? So these people in this study, they had lumbar and sacral MRIs performed at the start of their workday and, and then four hours later. So in the control group, they kind of just did their thing. But in the active group, I guess you'd say they arose out of their chair every 15 minutes and engaged in 5 seconds of lumbar flexion, 5 seconds of lumbar extension, 5 seconds of lumbar bending to the right, and 5 seconds of lumbar bending to the left before returning to a seated position. So it's not like they were doing 30 minutes of fitness. Let's count that up right there. Flexion extension, 10 seconds, 20 seconds less. Literally, they were taking less than 30 seconds every 15 minutes. So not really a big deal. It's not like it took them, you know, half hour to get through this. And what they found was that L4 L5 was significantly decreased in its disc height at the end of the day for those individuals who did not go through those simple 20 seconds every 15 minutes. So let's start to break that down, dive in a little bit more, and really highlight the findings of this study. These researchers found, quote, clinically, the majority of lumbar disc degenerative changes occur at L4, L5 and L5 S1. Research has shown multiple reasons, including biomechanical forces, to account for the increased pressures at these discs. Results of this study support these clinical findings. The largest change in disc height with prolonged sitting was found at L4 L5. Age and hours sitting were found to be significant risk factors for development of disc herniation at L4 L5, and our findings are in agreement with this kind of relationship. Findings of this study may also suggest the prolonged sitting of as little as four hours may also be a factor in increasing pressures of the L4 L5 disc. These changes in pressures over a sustained period of time may lead toward a disc degeneration cascade. So that's pretty serious. I'm going to take a look at one more of their conclusions. Quote, Analysis of the data shows the greatest change in disc height is at the L4 L5 level after prolonged sitting without intermittent breaks. Findings also show that L4 L5 disc height changes are not significant with brief positional changes every 15 minutes. So there you have it. Basically, what these researchers found is unequivocal as far as this study is concerned, which is if you take intermittent breaks throughout the day. And they did this based on mri, right? So this was not like guesswork. They literally image the person at the beginning of the day. They image the person four hours later. And they said, okay, let's measure this to a tenth of a millimeter and see exactly what's going on. And they found that L4 L5 had a significant amount of compression for those individuals who did not get stand up, move around, flexion, extension, side bend for 20 seconds every 15 minutes. Furthermore, they're also kind of compounding that, which is what I agree with, which is most people could probably get away with that for maybe a day, maybe a week, maybe a month, maybe a year. But as you start to get into, you know, weeks become months, become years, become decades. This is the stuff that really adds up, right? We're all under gravity on this planet, and we're all going about our day, and we're dynamic beings meant to move. And when we're in a static seated position, we just see that that can just wreak havoc on the lower lumbar spine. And that makes sense because when. When you're seated, you're taking, of course, your hips, quote, unquote, out of it. You're sitting on the bottom of your pelvis, and you're just basically stacking everything up on top of the lower lumbar spine. It's getting the brunt of the brute force. You might even move your head around looking at your screen. But your lumbar spine might be in a really, really static position for hours on end for some people. And that takes place day after day after day after day. And ultimately, that creates a very challenged position for those lower lumbar spine discs to be in. We also see that L4, L5 tends to be the biggest challenge aside from L5 S1, literally because of the angle. It's sort of the angle that sustains maximum force in most people. So when we take all of this into a court and we look at this from a clinical sense, it's very, very important for us to be able to do a couple things. Number one is make sure that we are properly evaluating L4, L5, L5S1, on the patients that come in. Because if they're sitting for a long period of time, you're gonna wanna check out the motion, check out the segmental motion, check out the regional motion, check out the whole body motion. See how they're moving biomechanically. That's an indication that something might be up at that level even in the absence of abject pain. Secondly, functional motion, right? We wanna make sure that it's functionally moving and enabling the person to do the things they'd like to do and not setting them up for failure down the road. The second, for your patients that you have currently active in practice right now, making sure that you're getting out there and having these conversations, letting them know, hey, you know, getting up and moving around. I mean, think about this. Somebody comes into your practice, maybe they're there for anywhere from five minutes to 30 minutes, and then they're spending. And then they come back three days later. And in that three days, they spend eight hours, nine hours, 10 hours a day in a seated position. And then they're like, well, your progress is a little slow in practice, Doc. Yeah, no kidding. You have to address these things head on and let people know, hey, if you're sitting, you know, eight to ten hours a day, the work that you're taking away from the work that we are getting, the positive things that we're getting done in the office here. So we see in the research, it's really great. If you take every 15 minutes, get up, move. Here's how you do it. Bend forward, bend back, bend to the side, bend to the side. Let me see you do it. Great, that looks good. Do that every 15 minutes. Set a notification on your Apple watch. Basically do what you need to do to make sure you're getting up and doing that because it's going to help you get results faster. In our practice, when you start telling people that they're going to be able to get results faster in your practice, they start listening because it is a reward, not a punishment, right? So let people know. Truth and consequences. Hey, the truth of the matter is you're sitting all day long. That's gonna make things difficult for us unless you go about and do these things. So that's the second component. A third component of this is this is a great topic to get out into your community, even for those people that aren't in your practice. Right? Adding value through the content you put out. It's what we do at the smart chiropractor all the time and it's what we do at the evidence based chiropractor on podcasts like this. And is how do you showcase this to people that aren't yet your patients? And this is great information to be able to get in and do an ergonomics workshop, even if it's virtually. This is great information to be able to get in and showcase your expertise, whether it's through video, whether it's through a blog post. You can choose how you want to get it out there. But showcasing this information furthers the no trust and like factor that you accumulate within your community as you talk about things that make sense and you talk about things that are applicable to, to the lives of the people in your community. And with an overwhelming majority as they kind of broke out in the beginning of this study, with an overwhelming majority of individuals in sedentary jobs, for just lack of a better way to put it, this is something that's going to resonate with tons of people as you get out there and talk about, hey, if you're struggling with low back pain, here's something you can proactively do to ensure that you're getting the best results from your care, wherever that care is. Hey, if you want to slow down the degenerative cascade, here's one way to think about that and do that. Or if you've noticed that you've had back pain in the past, if you know that you have disc degeneration, if you know that you have arthritic changes in your low back, guess what, here are some things that you can do to proactively slow that process down or just put some chips on your side of the table, right? These are just positive, little positive things that people can do each and every day that ultimately stack up over time. And if we can help guide the people in our community towards better health, towards better care, towards a better life, a better quality of life for longer, then I think we're doing a fantastic job as chiropractors and this study is a great one to dive in. We're gonna feature it this year in 2021 for our evidence based chiropractor members to get out there to build relationships with medical doctors in their community. We, we're also, we've already featured it in some of what we're doing with the smart chiropractor, which is all of the automated content, automated email, automated social media, streaming video to your screens and much, much more. So you guys can check that out. I'll drop those links down in the show notes as well. And as we come to a close, I want to encourage you, if you have not done so yet, please check out shield. I had Dr. Brown on a few weeks ago. He's a great guy. And if you're looking to get factory direct pricing for your braces, 10 units and more, head over to shield@super secretsales.com ebc Again, that's super secretsales.com ebc Their founder, Steven Brown is offering a complimentary Shield tens and E stim unit plus free shipping on your first order. There's no reason not to go over there and check things out. He's going to give you a free TENS unit and free shipping on your first order. His shipping is fast, he has factory direct pricing and he has a great selection of products that are available right now@supersecretsales.com ebc so take the research that we talked about today. Utilize it with the conversations you're having with people in your community and in your practice throughout this week. If you have any questions whatsoever, hit me up. Jeffevidencebasedchiropractor.com have a fantastic week in practice and I will talk to you soon.

Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit theevidencebasedchiropractor.com and join our MD Marketing membership today.