The Link Between Sedentary Behavior and Low Back Pain | Podcast Ep. 383

Foreign hello and welcome to the Evidence Based Chiropractor. I am your host Dr. Jeff Langmaid. On today's episode. We're back with more research. It's a study that came out in 2021. So a pretty new study with a really interesting topic. This is a systematic review and it's about the association between sedentary behavior and low back pain. And again it's a systematic review and a meta analysis. We will drop the link to this study down in the show notes if you want to check it out. But there's a lot of really interesting take home messages. Probably not a lot of surprises for you but some things to keep in mind as you see patients in practice and just reinforces the idea that movement based healthcare is where it's at. We'll go through this study in great detail. One thing I love about it is that it's a review and a meta analysis. So they're really consolidating what's everything we know out there and what are the take home messages that we can use. And there's nothing better in my opinion than to be the foundation of your patient communication than that type of study. Now before we get started, I wanna say a few words about Patient Pilot by the smart chiropractor. If you are looking to double your reactivations, you gotta get hooked up with patientpilot. You probably have an email list. If you're listening to this and you're a chiropractor, you are probably underutilizing your email list. Our average doc is getting 26 plus reactivations each and every month by using automated email campaigns built into Patient Pilot. That sounds interesting to you? Schedule a demo. Head over to the smartchiropractor.com again that is thesmartchiropractor.com schedule a demo with our team. We'll be happy to ask you a bunch of questions and see if Patient Pilot is a great fit for your practice. But as I said at the top, we're talking research today. The association between sedentary behavior and and low back pain. So now why is this a big deal? It is a big deal because low back pain is a big deal. And a couple things that they highlight here that I didn't know. Of course low back pain is associated with deterioration of quality of life. It actually also has association with long term sickness in early retirement. So this is where I think a lot of that productivity or lost productivity come into play. Interesting to keep in mind almost everybody's gonna deal with at least one bout. Almost of low back pain during their lives. Another interesting fact that they had in this study and I'd not seen before is low back pain is more common in females and people between 40 and 69 years old. I knew the age range, but I didn't, I've never actually seen, I don't believe that it swayed towards females. Now, sedentary behaviors, they're defined, set that definition. They're defined as low energy expenditure activities performed in rest positions. And sedentary behavior can be a predictor of metabolic risk independent of physical inactivity. And that is a whole can of worms and a whole other topic that we can dive into on another episode. But our bodies are designed to move and that is why it's no surprise that movement based healthcare is the best thing you can do, Especially with a lack of movement. You know, not exactly world beating thoughts there, but it's important to really keep in mind because I consistently try to step outside being a chiropractor and with the curse of knowledge that we have, oh, everybody knows they should be moving. Everybody knows spinal motion is important. Everybody knows segmental, regional, whole body movement is important. Most people know it's important, but they might not know the actual risks on the other side of it, ah, if I don't move enough, I can get away with it. Because the bottom line is if you don't move for a day or a week as much as you could or you should, it's not like something changes physically, right? Where you're like, oh my gosh, I gained 40 pounds, I look different. That's a motivating factor for many people. This is a creep. And that is one of the biggest challenges. Almost anybody can get away without moving or exercising for a day, for a week. And then that slow, slow slide starts to happen. And it's almost imperceptible in many ways until it's not until. And that is a really, really important thing to keep in mind. The other aspect is people. You have people in sedentary behaviors with low back pain that then it hurts to move. And this becomes a demotivating factor. At the best case, it's a demotivating factor to get moving. At the worst case, there's ridiculous fear, avoidance behavior. One of my closest friends, about 40 years old, had a back injury a couple years ago and he was petrified to move. I mean, we're talking, you know, couldn't, wouldn't bend, you know, this and, and of course movement is exactly what he needed. But because of the pain he experienced, because of the Fear of advanced interventions, no matter what anybody said to him, which is important also to keep in mind. He had me living right next door as a very, very close friend, one of his best friends. He had other people, he has other doctors in his life giving actually good advice. And it still was hard to overcome those mental blocks. So imagine your who don't have a 20 year history of being a friend. Getting out there and having these important conversations is hard. And it doesn't happen in one visit, that is for sure. It doesn't happen in two visits. This is something that is like a tape repeated in people's heads. It needs to be said consistently over a period of time. It makes me think to a conversation I had with Dr. Jay Greenstein a couple weeks ago where one of the biggest challenges of chiropractic is early dismissal. Quite frankly, this is a whole nother story. But is early dismissal from care because somebody's feeling a little bit better? It's just a huge, huge problem because they probably haven't changed tying it to this, they probably haven't changed any behaviors yet. And that's one of the most important and impactful things we can do. So sedentary behavior is related with all cause mortality, and it's concomitant with being overweight, having obesity issues, diabetes and cardiovascular diseases. So as we all know, it's not good. But it's important to really understand and take the tar, not just overlook it, saying, oh, of course we know that. Because when you think that way, you might not be explaining it to your patient in the best way. And I always try to say think like a beginner. When I approach patient communication, when I approach even interviewing somebody on this podcast, it's I try to think like a beginner. That's how you lead somebody down the path and think about taking one step of knowledge at a time. Two steps of knowledge is just way too far. And I'll give you a direct example outside of this, you know, to highlight as a metaphor of how this works. I geek out on email marketing. I don't think anybody is. That's a shock to anybody listening to this podcast. But if I start talking about the intricacies of campaign flow and somebody's never sent an email, there's just too many two steps. There's too many steps of knowledge. So you gotta start with like, what is email marketing? What do you need to know about it? What's the first win you can get before you get to advanced strategy? And the same thing comes with your patients. You need to Be able to start where they're at. They might really not have a great understanding that movement is actually what they need. It's the healthiest thing they can do. It's recommended. And here's why that's the case. It not only helps you now, it sets you up for success later. And by the way, if you're in pain and not moving, chances are that's, you know, you waited too long, so to speak. So things have been building for a while. And that might not be the clearest example, but I think you get what I'm saying when we describe one step of knowledge at a time. So in this systematic review, they took a look at over 3400 records, and they whittled that down. It always shocks me, you know, they do an initial thing like, wow, 3,406 studies. And they included 49 because of the criteria to get in. So 49 studies, still a great, great sample size. And they found a couple things that was really, really important. Number one, they excluded a bunch of studies from the meta analysis, but they still pulled some key facts from them, and I think these are cool to highlight. So sitting behavior was associated with chronic low back pain and. And functional dysfunction. Weird way to put it. Among 70 call center employees, also, low back pain was reported more in school. Children playing video games more than two hours a day. Probably update that beyond video game if they're spending a lot of screen time, which is basically the same thing. So a couple key things there. Understanding who your patient is and what they do all day. Super, super important. I always think about it in terms of the person who leaves. And this happens. This is millions and millions of people. They leave their house each morning, hop in their car, they sit in that car for 30 minutes to an hour and 15 minutes. You're not moving too much on the way to an office. You get out of your car, you walk into the office, you sit in a chair, you get up a couple times throughout the day. You're basically sitting the entire time you get up at the end of the day, you hop back in your car for 30 minutes to an hour and 15 minutes to come home and sit down to eat dinner and then sit down to chat or watch TV at the end of the night. And you do that for days and weeks and months and years. And there's no surprise why there is so much back pain and such a lack of movement. A lot of it is just a time issue, but you got to make time. Of course. But my point of saying that is understanding what your patients are doing day in and day out is really, really critical. And, and not projecting who you are and what you do. You're up and moving. If you're listening to this as a chiropractor, you're probably up and moving all day, taking care of people, delivering adjustments, guiding exercise, and rehab, all of those things. Many of your patients, most of your patients, nearly all of your patients, that's not the case for them. They're typically going to be going into an office, driving a pretty decent commute to get there, and then sitting all day long. That is super, super impactful. And it's also important to keep in mind that no matter how much motivation you give, no matter how much inspiration they have to move, quite frankly, many people aren't gonna change jobs and they're gonna go back to those same activities. They might add in some movement each day after seeing you, which would be awesome. Can be really, really impactful to minimizing chronic disease long term. But if they're still sitting eight hours a day in a chair, two hours combined, one hour each way to and from work, and a couple hours at night, and maybe have a suboptimal sleeping position for six to eight hours at night, this starts to really, really stack up. And if they're not going to change their career and change their job, which many people aren't in a position to do, it's really important for you as the chiropractor to keep that in mind and understand that the time in your office is really important, number one. But the guidance that you give them to do things at home is also really, really important. And the third component of that is if they're not dramatically changing their behavior, chances are as time and gravity continue on, on their musculos, neuromusculoskeletal system, these issues will come back. One of the best predictors for future pain is previous pain. So if they're coming in with an issue, going back to the same activities, even if they add in a little something here or there, this is why I'm just such a big fan of touching base and having maintenance care with patients. Because most patients don't. Most people, I don't want to say most people don't dramatically change. They don't quit their job, change their lifestyle, start doing yoga eight hours a day and become, you know, a teacher. Right. It's not normal. So most people are going back to quite often, 80 to 90%. Most people is 99% of the same activities that, that drove them to the pain syndrome. To come into your practice in the first place. So if you're releasing them at the first sign of improvement, I'm gonna say just straight up, you're doing them a disservice. And I brought this up a couple times on the podcast, but I'm gonna take it to the 10th degree. Cause I think it's really important to frame. I used to practice in a couple different orthopedic groups. I would see patients come in literally every single day. That's that they, they mark down that they had a chiropractor. Chiropractor. They saw a chiropractor in the past and they're in there for a surgical potential evaluation. And I'm saying, you know, how'd you do, how'd you do with the chiropractor? It's like you've seen a chiropractor in the past. Oh, I did great. But then it came back and, you know, we're sitting there saying, well, why wouldn't you just go? And this is what I would say, of course we'll go back to the chiropractor and have a conversation about that. If you also, you know, what's good predictive analytics. If they had great success with you or a chiropractor in the past, they're probably going to have great success in the. But many people think they're discharged, the thing comes back, the pain comes back. Oh, that, that means that whole thing didn't work, even though they felt better at discharge. So this is why patient communication is so critically important in setting up super accurate expectations and also guiding and following your patients along. I'll make a little plug here for the patient pilot because this is where also automated email campaigns come in. If you are not teaching and inviting your patients week after week after week, not, you know, discounting and forcing, but teaching and inviting. If you're not teaching and inviting week after week through automated email campaigns, I can tell you you're hemorrhaging patients that you're completely unaware of because people make really weird decisions about their health because they don't know how to, you know, think about it differently. They have not gone through the schooling and education that we have in, and they're inundated with a model that is really, really opposite of how we approach things from a holistic and movement based capacity most of the time. So t to this study, this study's goal was to explore the association between that sedentary behavior and low back pain. The results did demonstrate the role in sedentary behavior as A risk factor for an increased incidence of low back pain in adults and children. And a previous study, this was interesting, showed that children spent 51.4% of their time in a sedentary lifestyle. So that is bad news, but it's good news in one way because those are things that we can change and influence. So prolonged screen time and standing time in adults were actually not associated with low back pain. But in children, prolonged TV watching, mobile smartphone use, console playing time, video time was associated with low back pain. Interestingly, smokers had a higher incidence of low back pain. An increased body mass index, bmi. Key one here in adults and children were risk factors. So what did they identify as some of the underlying pathways of why this is occurring? Well, decreased water supply to the disc in turn can lead to degenerative changes and disc herniations, reduced strength and muscular power and hyperloridosis. Those are some of the proposed pathophysiological mechanisms for why sedentary behavior contributes to low back pain. And specifically, prolonged sitting can contribute to postural changes as well as muscle strength changes. And of course you add onto that any obesity or overweight type situation and that causes overload on the spinal tissue. Smoking, of course can alter the blood supply to the discs versus vasoconstriction and atherosclerosis. And additionally the pecking on coffee here, I didn't like this, but coffee consumption is proposed to be associated with flushing magnesium from the body, which has the opportunity to increase contractions of paraspinal muscles. So all important things to keep in mind, their conclusions in this study were. According to their meta analysis, there's sufficient evidence from recent studies that indicate the association of different types of sedentary behavior with the occurrence or reoccurrence of low back pain in both adults and children. And they highlight the fact that over the last few years, thankfully we're on the tail end of I think you know what I'm talking about the last few years. But over the last few years, sedentary behavior worldwide, super, super got super jacked up, you know, to amplified proportions. And really, really great preventative strategies are needed to change the behavior patterns that set in over the last few years that were prevalent and predominant before. But man, they became entrenched as people were just working from home and not doing much of anything and really were unable in many cases to get out to the gym, et cetera. A lot of people fell off their normal habits and they haven't got back on yet. So great opportunity for us as movement based healthcare professionals as chiropractors to have awesome conversations to highlight why it's so important and to have really accurate discussions with our patients. Now, before we wrap up this episode, I'm gonna encourage you to schedule a demo with Kairo Spring. KyroSpring is an awesome EHR. They have predictive analytics AI capabilities. It's really cool. Check out the interview I did with Brian Albury last week on this show. But if you wanna hook it up and do a demo with Kairo Spring, they'll hook you up with a $50Amazon gift card kairospring.com offer kairo spring.com offer I'll drop that link in the show notes. $50Amazon gift card Hop on with them. I think they have a really fantastic system. They support this podcast. I'm gonna ask you to support them and I'll drop that link down in the show notes. Additionally, if you have not picked up your Power Step orthotics, please do so. They're another company that I love and they support this podcast so I'll ask you to support them. These orthotics were designed by a podiatrist over 30 years ago and they're just really really great. I'm looking at a pair right now in my studio and they will hook you you up with a pair for being a listene podcast. Head to pro.powerstep.com samplepro.powerstep.com sample use the code EBC for evidence based chiropractor EBC and they will hook you up with a free sample pair. Otherwise, I hope you 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 the evidencebasedchiropractor.com and join our MD Marketing membership today.