Everyday I have at least one patient who tells me their back hurts when they get out of a chair. They usually come to me with a long history of MRI images showing arthritis in their facet joints, bulges, herniations and degenerative disc disease. So what causes back pain when getting out of a chair? Good question! The short answer is that muscle activity (tightness) is different is people with and without back pain. Let’s dive in!
What doctors will tell you: Facet Joints, Discs
Most docs are going to take an x-ray or MRI and point to the structures they see and assume that is the direct cause of your pain and discomfort. Now I don’t want to dismiss this, because somethings those structures could be causing your pain. But if you go back to some older blog posts – you can see that MRI’s aren’t that reliable when it comes to teasing out back pain.
Just a primer – the below explanations are usually the symptom of something else (muscle imbalances). If the muscle imbalances are never resolved, your pain won’t ever go away.
Here’s the breakdown of facet / disc causes of pain from seated to standing.
Facet Joint Irritation
When you go from seated to standing, your facet joints go from opened to closed. If there is irritation or arthritis in these little facet joints, they are going to feel better when you are seated and they are open. When you stand they can be irritated and lock up on you.
Another common explanation is that prolonged sitting causes a loss of hydration in your disc (due to pressure changes and other complex mechanisms) and this causes your facet joints to be closed while seated. Then when you get up and walk and move, the disc slightly rehydrates creating more space at your facet joints.
Both of these explanations are true and accurate. But they are the results of a bigger – and more importantly treatable and correctable issue. Let’s dive in.
The Root Cause Of Your Backpain – Muscle Imbalances
The real root cause of your back pain is muscle imbalances. It’s well known that if you’ve ever experienced back pain, you will have different muscle activity than someone who doesn’t have back pain. A study in 2018 in Clinical Biomechanics titled, “Muscle activity in specific postures differs between individuals with and without a history of back pain in sitting” highlights that there is a big difference in this muscle activity in those who have back pain and those who don’t.
If your muscles aren’t doing their job correctly, you’re going to have uneven stress and wear and tear on your facet joints and discs.
You have 2 sets of muscles that stabilize your back – the superficial back muscles and the deep stabilizers. When you have back pain, even a tiny tweak a long time ago, your nerves can get a little irritated and shut down how your deep stabilizing back muscles fire. So to pick up the slack, your superficial back muscles start overworking. This leads to stress, wear and tear and muscle spasms. Eventually the deep stabilizing muscles atrophy and get weak and now you have a perfect recipe for chronic back discomfort.
How Do I Treat My Backpain?
Pain is complex and it takes a complex approach to treatment. Unfortunately you can’t just inject cortisone or take a muscle relaxer and expect this stuff to go away. So if your doc is just pointing to a picture, saying this is the cause of your pain, Rx’ing muscle relaxers, steroid packs, offering cortisone injections or burning your nerves with an abalation then you’re in a long journey of discomfort. You’re only treating the symptoms – and symptoms come back if you don’t address the cause.
My approach is exactly the opposite. I want to comprehensively physically evaluate your back and find every contributor to your discomfort. This means assign your muscles and posture, assessing ligaments and nerves. The good news is I have tools to treat each of these problems.
By using electro-acupuncture and dry needling we can calm down tight overactive muscles and stimulate and wake up under active, atrophied muscles. We can use electro-acupuncture to treat irritated nerves. By using prolotherapy I can stimulate loose and damaged ligaments to regenerate. By using peri-neural injections I can treat irritated nerves contributing to your discomfort.
This comprehensive approach is going to be way different than what your regular doctor will do an way different than what any physical therapist can do. So don’t settle for a bandaid, you have options that don’t involve unnecessary surgery. You don’t have to live with Backpain for the rest of your life.