Over the last couple of months,s I have been working on a lot of people with odd back problems. The oddity is that these back issues come on without any apparent cause. I see this normally a few times each week, but now most of the back issues I see are of this type. I have decided to call this “lockdown back” and I want to discuss what this is and why it is happening to everyone’s backs.
This Covid 19 lockdown has altered our normal lives in so many ways. I have people who are showing up in my office that say other than their visit to me, they have not been out of the house in months. All their normal out-and-about activities have been put on hold in favor of watching television and puttering around the house. That means their normal level of physical activity has been tremendously reduced. Not only that, but their exposure to activity variety and uneven terrain has been totally eliminated. Instead, all their movement have been confined to flat indoor floors – no natural terrain. Why does this matter?
Human bodies are designed in a very unbalanced manner. Most other creatures are so well designed with balance in mind that they can actually sleep standing up, but not us. Even birds are better designed for balance with their legs attaching above their center of mass. Their heaviest parts are suspended below their hips making balance much easier. So what does that mean for us? It means that we have to have a ton of nerves and tiny balance muscles that constantly adjust our stance to keep us from falling over. We have a highly complex balance-computer in the back of our brain that manages all this for us without us needing to be consciously aware of what all is happening. This is the root cause of the lockdown back. Unlike the nerves for conscious movement which are permanently hard-wired in place, balance nerves are constantly changeable. They come and go depending upon use. They are like our muscles – use it or lose it. Well in this lockdown we are not using them so they are going away.
Inside every muscle are tiny sensors that constantly tell the brain how tight or loose the muscle is (spindle cells). Inside every tendon and ligament are similar sensors that talk to the brain (Golgi tendon cells and joint mechanoreceptors). These cells coordinate their information with the position sense cells in your inner ear to produce our sense of balance. Without their continuous input, the coordinated movement would be impossible. An excellent example of this was demonstrated back in the ’50s with a college basketball team while offseason. Half the players were instructed to keep one arm in a sling continuously for two weeks. After two weeks of not using that arm, every player developed a frozen shoulder syndrome. They could not move their shoulders because any attempt to move caused the muscles to all go into spasm. This is because the muscles lost their coordination with each other. There was no injury, no arthritis, no problem you could see on x-ray; the shoulders were just frozen.
This is the same thing that is happening to the patients I am seeing lately. They all start their problem description the same way – “I didn’t do anything!” Generally, their pain is worse in the morning after a night of laying and not moving, and then it is a little better as they get moving during the day. The trouble could be anywhere – feet, legs, hips, low back, mid-back, shoulders, or neck. Even elbows and hands are getting into the picture. Everything is easy to adjust to relieve the pain, but without a solid plan and commitment to move and challenge the balance system, the trouble will come back. You literally have to regrow the tiny balance nerves to the sensors in the muscles, tendons, and joint ligaments as well as the coordination connections in the brain stem.
We have a secondary condition as a result of all the challenges right now, and that is a general increase in inflammatory chemicals in the body due to stress. When we are stressed several days in a row our brains release an inflammatory chemical called interleukin 6. It makes everything hurt like the flu or sometimes just challenged areas. Another problem with being stuck indoors that also increases inflammation is eating too much crap food – too much sugar, vegetable oils, starch, preserved snack foods, and the like. Most people I have seen are putting on a bit of weight. Every pound of weight put on generates increasing levels of inflammatory chemicals. Excess weight is not just annoying, it generates pain chemicals that make things hurt more. Basically this whole stuck indoors thing is not working for us.
What do we need to do about this? We need to move more. Not just move on flat surfaces but move on surfaces that challenge our balance mechanisms. Step one, if you are going to be indoors, spend your days barefoot. The more feeling stimulation you get to your feet the better. Socks or moccasins are fine, but not flip-flops, sandals, or anything where your feet can not feel the texture of the floor.
As you are standing around, practice standing on one foot for as long as you can. Spend a few seconds in a doorway or by a counter so you can practice standing on one foot with your eyes closed. You may only be able to stand for one or two seconds initially, but with practice, you will get better. Also, try moving around your body while on just one foot. Bend forward, swing your arms around, swivel your hips, move the raised foot back and forth, you get the idea. As you get better try upping the difficulty by standing on a soft surface, like a couch cushion. Make the standing a challenge.
Another favorite balance activity is stuff done with a big therapy ball. Just sitting is a good place to start, then advance to rocking on the ball, sliding forward and back, trying to make the ball go in a circle. Start using both feet on the ground then advance to doing things with just one foot down. My personal favorite is doing the Superman flying position belly down on the ball. Initially, I will start with both feet on the ground, then one foot, then no feet. To really mix it up I like to twirl from my front down to my back down with one foot on the ground. Occasionally I can twirl with no feet on the ground at all. The Superman position is good for building lower back strength so your back does not grab you when you try to lift something.
If you have stairs in your house, they make an excellent exercise tool. Just trotting up and down the stairs a couple of dozen times is an excellent workout. You may have to start slow and few, and build up to faster and more times up and down the stairs.
If you really want to get into this balance training, I would recommend buying a rocker board and a balance board. The rocker board is just a board that tilts back and forth when you stand on it, while the balance board can tilt in any direction. Or if you have several as I do in the office, you can have fun walking from one to another – step on the rocker then to the balance, and back. What we are trying to simulate is the experience you get hiking up and down a loose rocky wilderness trail. This would be the type of activity that our body was designed to handle and that would keep it in perfect balance shape.
Balance activity does not really take all that much time each day, but it does need to be consistently done forever. There is never a time while we are breathing that we do not need balance activities. This Covid lockdown is encouraging us to become comfortable staying at home on the couch watching TV while eating junk food. This will destroy us. Comfort is the slow killer. Our bodies need regular challenges to be healthy. Comfort is lovely in small doses. It is like chocolate candies – wonderful in small doses very occasionally. Lots of it all the time will kill us.
Hopefully, this gives you some direction to make this lockdown a little less of a mess.
Take care,
David