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Lower Back Pain Standing

Do you have lower back pain when standing up from a sitting position? This is a symptom that means that there are specific problems in your back. Let’s dig in.

What Are The Parts of Your Low Back?

Your low back has vertebrae (spine bones), discs, facet joints, ligaments, muscles, and nerves (1). To see how they come together and what the facet joints do, watch my video below where I build a spine from scratch:

RELATED: Sit Bones Pain

Why Do You Have Lower Back Pain when Standing up from a Sitting Position?

When you’re seated, the facet joints in your lower back are in an open and slightly flexed position. When you stand up, these joints compress. If they are painful or have arthritis, you’ll have pain as you stand up because this puts pressure on the painful joints. In addition, if there is any type of movement of one vertebra forward on another (called spondylolisthesis), then this shift will have occurred as you sit. This is called degenerative spondylolisthesis (2). When you get back up, the vertebrae will come back into position after a few seconds, leading to that awkward “walk it out period” that starts out painful and ends up more normal.

What is the Best Sitting Position for Lower Back Pain?

If you have a degenerative facet joint problem, the best position is to place a pillow in the small of your low back. This will maintain the normal low back curve and allow you to sit longer with less pain when getting up. At home, this can be easy to do, but when you’re out, an easy thing to use is a rolled-up jacket or sweater. In a pinch, I’ve even used my cell phone!

Is There Something That Can Help without Surgery?

First, physical therapy should be your first choice. If that fails, a new procedure that uses precise injections of your own concentrated blood platelets or bone marrow concentrate (containing stem cells) may be the answer. This is called the Percutaneous-Functional Spinal Unit procedure. The more traditional procedure that’s often used is lumbar fusion (3). This means that the spine bones are fused together using rods and screws. The problem is that not only is this a big surgery with poor outcomes, it can also lead to adjacent segment disease (4-6). To learn more about that problem, see my video below:

Is There a Better Way?

Remember, that lower back pain when standing up from a sitting position is caused by a sloppy spine. Meaning, because of degeneration, one vertebra is slipping slightly forward on another. This is causing the facet joints to get beat up and become arthritic. Hence, any treatment needs to stabilize the spine by tightening ligaments and reducing the pain in worn facet joints.

Common Causes of Low Back Pain While Standing

Annular Tear

To understand annular tears, let’s first review the anatomy of the spine.  The lumbar spine is comprised of 5 boney building blocks called vertebral bodies. Sandwiched between the vertebral bodies are the lumbar discs.  Each disc is comprised of an outer fibrous ring, the annulus fibrosis that surrounds the inner gelatinous center, which is called the nucleus. The disc absorbs the forces of daily living. The annulus has multiple layers of collagen that provide important support.  The annulus is similar to the sidewall of a tire which provides important stability for the tire. Through trauma or degeneration, the outer annular fibers can become injured and or weakened. 

Read More About Annular Tear

Degenerative Scoliosis

Degenerative Scoliosis, also known as Adult-onset Scoliosis, is a medical condition that involves a side bending in the spine. The bending can be mild, moderate, or severe with side-bending to either the right or the left. The term degenerative means generalized wear and tear and is common as we get older. Degenerative scoliosis is the curvature of the spine that occurs as a result of degeneration of the discs, small joints, and building blocks. The Degenerative Scoliosis curve is often located in the low back and forms a ‘C” shape. There is a convex and a concave side. The convex side is the open side where it curves outward.

Read More About Degenerative Scoliosis

Ehlers-Danlos Syndrome (EDS)

isorders that affect and weaken the connective tissues such as tendons and ligaments. It is a hereditary disorder which means you are born with it.  EDS has many different signs and symptoms which can vary significantly depending upon the type of EDS and its severity.   It most commonly affects the skin, joints, and blood vessels.  Joints are typically hypermobile with excessive joint range of motion because of a defect in collagen formation. In most cases Ehlers-Danlos syndrome is inherited. That is to say that you are born with it. The two main ways EDS is inherited are: autosomal dominant inheritance and autosomal recessive inheritance…

Read More About Ehlers-Danlos Syndrome (EDS)

Failed Back Surgery Syndrome

Failed Back Surgery Syndrome also called failed back is a clinical condition in which patients who have undergone low back surgery continue to have pain and dysfunction.  Said another way the surgery that was intended to reduce pain and increase function FAILED. That’s right, the surgery failed. You had the surgery, struggled with the pain postoperatively, diligently participated in physical therapy and yet the pain and limitation are still there.  Unfortunately, this occurs frequently.   Estimates range from 20-40% of patients who undergo low back surgery will develop Failed Back Surgery Syndrome. Pain is the most common symptom of Failed Back Surgery Syndrome…

Read More About Failed Back Surgery Syndrome

Hamstrings Tendinopathy

Your hamstrings are the thick muscles in the back of your thigh that are responsible for the movement of your hip, thigh, and knee. The hamstrings are made of three distinct muscles: Semitendinosus, Semimembranosus, and Biceps Femoris. What is Hamstrings Tendinopathy? Tendons are thick pieces of connective tissue that connect muscle to bone. They function to transfer the force generated by muscle contraction into movement. Hamstring tendinopathy, also known as a “calf strain,” is an injury to the affected tendon. It usually occurs when you bend your knee or extend your leg, putting too much force on the hamstring tendon….

Read More About Hamstrings Tendinopathy

SI Joint Syndrome

The sacroiliac joints reside between the sacrum (the tailbone segment of the spinal column) and the prominent wing-like iliac bones that form the pelvic girdle. There are two SI joints, one on the left and one on the right (highlighted in red in the image above), and along with the symphysis pubis joint at the front of the structure, they are critical for transferring forces and energy back and forth between the spine and the lower limbs. There are a number of reasons that an SI joint can become painful and inflamed, leading to SI joint syndrome. Trauma, such as a fall injury to the tail bone or a forced injury from a car accident for example, obviously can create problems in the SI joint…

Read More About SI Joint Syndrome

Spondylolisthesis

Spondylolisthesis means that one vertebra is slipping forward or backwards on another. This causes the hole where the nerve exits (foramen) to get smaller (also called foraminal stenosis). It also causes more wear and tear on the facet joint which can lead to arthritis or what’s called “facet hypertrophy”. spondylolisthesis recovery The amount of slippage is graded 1-4, with grade 1 meaning that the one vertebra has slipped up to 25% on the other vertebra. Grade 2 means that one bone has slipped from 25-50% with higher grades indicating more slippage. The vast majority of patients are grade 1 to 2.

Read More About Spondylolisthesis

Torn Discs

The spinal discs are shock absorbers that live at each level between the vertebral bones (1). They have a tough outer annulus part and a soft inner gel part (nucleus pulposis). The outer covering can get damaged which can sometimes be seen on MRI and other times requires additional testing to identify. These tears are called: a torn disc, a disc tear, an annular tear, and when seen on MRI a “High-Intensity Zone” or HIZ. They can cause pain, mostly through ingrown nerves. There are torn disc findings that can be seen on MRI (HIZ) and these can be either asymptomatic (i.e. not painful) or…

Read More About Torn Discs
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Meet the Perc-FSU Procedure

In the Perc-FSU procedure, the doctor injects healing platelets or bone marrow concentrate (containing stem cells) into the ligaments and facet joints using both ultrasound and fluoroscopy guidance. To learn more, see my video below:

The upshot? Lower back pain when standing up from a sitting position is caused by a sloppy spine. Getting this treated by fusing the spine is problematic. However, non-surgical treatments are available. _


References:

(1) Allegri M, Montella S, Salici F, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Res. 2016;5:F1000 Faculty Rev-1530. Published 2016 Jun 28. doi:10.12688/f1000research.8105.2

(2) Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016;11:39–52. Published 2016 Dec 1. doi:10.1016/j.jot.2016.11.001

(3) Yavin D1, Casha S1, Wiebe S, Feasby TE, Clark C, Isaacs A, Holroyd-Leduc J, Hurlbert RJ, Quan H, Nataraj A, Sutherland GR, Jette N. Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis. Neurosurgery. 2017 May 1;80(5):701-715. doi: 10.1093/neuros/nyw162.

(4) Ratliff JK, Lebude B, Albert T, Anene-Maidoh T, Anderson G, Dagostino P, Maltenfort M, Hilibrand A, Sharan A, Vaccaro AR. Complications in spinal surgery: comparative survey of spine surgeons and patients who underwent spinal surgery. J Neurosurg Spine. 2009 Jun;10(6):578-84. doi: 10.3171/2009.2.SPINE0935.

(5) Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;2016(1):CD010264. Published 2016 Jan 29. doi:10.1002/14651858.CD010264.pub2

(6) Saavedra-Pozo FM, Deusdara RA, Benzel EC. Adjacent segment disease perspective and review of the literature. Ochsner J. 2014;14(1):78–83.

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