Ethan Hammond is a mobility coach and performance therapist in England. He helps his clients address mobility problems using Yoga Tuneup and also acts as a CrossFit coach in his practice, E. H. Mobility. Ethan came on episode 3 of ConverSapiens to discuss the top 5 mobility issues he sees in his practice. In this excerpt from the show, he discusses the number one problem he sees – perceived lower back pain.
You said you see a lot of lower back pain in your practice.
Yeah, that’s one of the most common mobility problems in the first world. There are similar stats in America, but here in the UK, 80% of all cases of disability are from perceived low back pain. Many people have so much back pain that they are unable to work.
What causes that pain?
Pain receptors around the lower back are overstimulated. The exact cause of that depends on the person. There are a lot of things connected to the lower back, but chiefly speaking, when we get people sitting for approximately 16 hours a day, there’s a lot of muscles around the spine that will get short, especially in the front of your body. There’s a muscle called your psoas that attaches directly from your lower spine in the front, and it connects to your femur. If your femur is raised because you’re sitting down and the angle of your hip is closed, that muscle gets shorter.
Muscles adapt over time. Whatever you do habitually, your body gets better at. We understand that intuitively, but that includes muscle length. If you always hold your arm closed, like you’re trying to make your bicep big, and you hold that position perpetually for 14 hours a day, your bicep is actually going to become short. The same thing happens to the psoas. If you go through a couple decades of sitting all day long, which is a position that contracts that muscle, it can become shorter. Then when you stand up, it’s going to pull on your lower back, causing pain.
So the cause isn’t necessarily even within the back originally?
Right. Where you perceive pain is not always where the problem is. That may be where the problem is lighting itself up. It’s where your body’s trying to bring your attention to.
If someone has a mostly sedentary job, is there any strategy they could use to prevent that shortening of the psoas and the ensuing back pain?
Get a stand up desk. Try to stand up as much as you can. Humans function much better standing up and sitting down. Being sat down is a very lazy position. It actually makes you less alert because your body is partly turned off.
So you think standing may even positively impact things like productivity?
Yeah, because cognitive function increases when you’re standing. Your body is much more alert. It’s naturally more stimulated.
I have seen it advised that people with desk jobs take breaks to stand and walk around, if they can’t get a stand up desk. Do you think that’s useful as well?
Yeah, absolutely. Sitting isn’t a problem. It’s the habit of sitting. If you sit for five minutes at a time, that’s no big deal. But anyone who has ever driven for 14 hours straight, knows that that wrecks their body. That’s why when you’re driving you should find a rest stop every hour or so. Just get out and move around for a couple minutes and that will help to prevent the accumulation of that stress.
At one point a few years ago you said something about sitting in floor at home, instead of on the couch. Is that something you would still recommend? What’s the mechanical reason that makes you say that?
Yes! If you’re going to sit on the floor, then imagine what kind of shape your legs have to be into to accommodate that. You’re either going to be in a full squat, you’re going to be in a cross legged position, or you may be sitting on your knees in seiza. That’s not quite as popular an option, but it’s there. The difference between those positions and sitting in a chair or on a couch is that they force you to utilize full range of motion in your joints.
You’re not just going halfway and staying there, you’re using the entirety of that range of motion. You keep that range of motion because it’s being used. If you don’t use range of motion, then you don’t have range of motion. You’re also practicing a full squat over and over again when getting up and down like that. Most American adults cannot squat beyond halfway, halfway being 90 degrees in the knees and hips, because that’s the furthest ever go. It’s what they practice by sitting in chairs.
I’ll say, as a teacher I am used to standing and walking all day. When the coronavirus hit, that was the first time that I had sat down all day for a long time. That first couple days I could really feel it!
Yes, your body will start to change very quickly. If you are always sitting down, and you try to stand up, just standing up for 30 minutes is probably going to be really rough, and vice versa. If you stooped over all the time, then pulling your shoulders back is going to be really uncomfortable. And the reverse is true – if you have really good posture all the time and you start to slouch, that’s going to become pretty uncomfortable quickly.
I read a book called Healing Back Pain by John Sarno earler this year. His theory is that back pain might have an emotional root. He says there’s a mechanism in the body that holds onto emotional trauma in the form of muscle tension. Along those lines, I have heard of people having emotional responses during massages, for example, whenever the therapist works in a particularly tense area. Have you ever seen anything like that?
Quite a lot, actually. We like to designate these different systems in the body, right? We have the muscular system, the nervous system, the skeletal system, the endocrine system, the lymphatic system, the integumentary system, and all these other systems. Really, they’re all one thing that creates our body. We will designate different systems to help us study them, because if we can isolate things, we can better understand that one thing.
But it becomes important to put it all back together. When we’re training athletics, a lot of people have this idea that it’s just about how big your muscles are. You’re just training your muscles. Your muscles are how you move your skeleton, yes, but how your nervous system in your brain interacts with those muscles to create movement is actually more important. That has a lot more to do with developing your athleticism than “getting big muscles.” These things all work together. It’s the same, from a psychological point of view.
In the West, we tend to differentiate between physical well-being, emotional well-being, and mental well being, but in reality all those things blend together. There isn’t really too much of a distinction between your psychology and your physiology. They both work together. When you have emotional trauma, your body will have physical reactions to the stress it creates. When you are in a heightened level of stress, you get hormones called cortisol and adrenaline flowing through your body. Those create a whole series of responses in your body and your brain. Your mind is affected. Your ability to think shuts down. Your digestive system starts to shuts down. Healing and immunity shuts down.
Those systems are placed on hold when you’re in a fight or flight response because you don’t need them right now. So your body will respond physically and mentally under stress. People can begin to close off physically under that stress. Their posture might draw inward and turn into a slumping position. They can create a habit, if they are stressed out often, that leaves them hunched over. Their upper back can become extremely tense and tight. It does sometimes happen that a person in that state, when going through an upper back massage for example, can suddenly become extremely angry or start crying or start to feel sick. There can an emotional reaction because of the connection between your emotions and your physical body.
We talked about preventative measures for back pain, but if you are already are suffering from chronic lower back pain, is there something that you could start doing right now to begin addressing it?
Two things come to mind. If you have absolutely no tools whatsoever, try to hang out laying down on your back with your legs up on a wall. In the short term that might make the pain feel worse because your body will be able to really sedate itself, and the pain signals may be able to come through more heavily. But it will also be a very relaxing position, and if you practice it, it will help the tissues around your lower back to start to relax.
You can also use massage tools to work the area. As far as tools go, I recommend a soft, grippy, latex ball. Don’t use hard tools for self massage therapy. There are people out there who have metal tools for scraping people’s skin. I mean there are actual physical therapists who use them…. I’ve talked to a couple of people who have experienced care from those and they all talk about how excruciatingly painful it was to be massaged by them. Go figure! It’s made of fucking metal! A racquetball or some form of soft latex ball like that is a much better option. It’s got some rigidity to it, but it’s very soft, which means you can put it around bones and it won’t hurt you. It will not bruise you. Using a soft tool like that, you can start to massage around your lower back.
When you touch your body gently, it creates a whole cascade of sensations that get you to relax. Maybe you have heard of fascia, the connective tissue in your body. A lot of your fascia contains cannabinoid receptors. Cannabinoid sounds kind of like cannabis because those are the same receptors that marijuana stimulates. That’s part of what makes you feel really relaxed when you’re high. Those same receptors get stimulated when you’re hugged. They respond to gentle touch. When you create gentle pressure in the skin, it helps to stimulate relaxation. If you have that problem of over tension, simply creating some gentle pressure in that area will help to tamp down on the pain response and get things feeling better.
Let’s say someone who is in their 50s comes to see you. They have chronic back pain. They’ve had a sedentary lifestyle for the last 30 years because of their job. How long, on average, would it take them to be free of that pain?
There’s no real answer to that. The best answer is, it depends. It depends entirely on the person, and I’ll tell you why. There are people with herniated discs in their lower back who experience no symptoms. In your spine, you have the bones of your vertebra and then you have a cushioned disc in between them. Sometimes those can get pushed out a bit and you can see that on an MRI or an X ray. Some people will have that disk misalignment and be in excruciating pain.
Others could have even worse misalignment but be totally asymptomatic, with no pain and no perceived dysfunction. They can still move their spine well and may even be able to dead-lift and squat just fine, no problem. The symptoms can vary considerably. Sometimes, especially with asymptomatic cases, their spine will sort itself out on its own. Other times, you can look at an X ray, and see a very minor problem, but the individual is in immense pain.
If I get someone who has perceived low back pain, even if they’ve had it for years and years, some might work with me for an hour and they will be good to go for the rest of their life. For others, I might need to see them a couple of times a week for a long time. That’s a big part of why I teach self care and get people to do these things themselves. Then they can spend all their free time working on it. Everyone is different, so it can vary considerably. Some people will be fine after an hour, some people will be fine after a few months. It just depends.