Question
Hello Dr. Leatherman,

I am a 44 year old woman,active & fit with no history of injuries, with low back fatigue-I have had it for about a year, I would not describe it as painful at any time, it doesn't radiate to my legs.  It is worse when I am standing in one place, like at a concert, museum, or in a line.  When I'm moving it takes much longer for me to notice it-I could potentially be at my job for 12-14 hours, moving around & not be bothered too much by it.  When I am feeling it, leaning over is what makes it feel better.  I also notice that in bed it's uncomfortable in my low (lumbosacral) back to sleep flat on my stomach.  I have to pull one knee up so that my low back is bent to be comfortable.  I saw my primary care physician yesterday for a physical & mentioned it to her, when I showed her where it was she commented that it was very low, so I might not benefit from core strengthening, although she gave me some handouts & referred me to a site, spine health.com.  She said if I wanted to pursue it they could do some radiographs or an MRI.  Does what I've described lead you to think of anything in particular or do you have any recommendations?  Thanks very much for your time.

Susan

Answer
Dear Susan,

Even though your low back issues are non-specific and when you have pain it is low, you can still benefit from low back rehabilitation, and core strengthening.  

The entire low back and pelvis are connected and interrelated not only with bony anatomy, muscle and ligaments, but with an additional tissue called fascia.  Fascia is a connective tissue that supports the entire body, and can be the source of problems in addition to muscular fatigue and joint stress.  All of these areas need to be addresses to figure out what the best approach to care should be.

One thing that concerns me is that you stated you cannot sleep on your stomach.  Tis not a good sleeping position anyway, as it places increased stress on the joints of the spine and pelvis by creating increased extension.  It also requires you to place your neck in a strained position either to the left or the right.  The best positions for spinal support are flat on your back with a pillow under your knees, or on your side with a pillow between your knees.

Now, at this point I am not expecting any injury or pathology due to the fact that fatigue as the day gets long is you main complaint.  Conditioning of the lower back, hips, buttock and abdominals is probably the best approach, as well as flexibility training.  Endeavors such as Yoga and Pilates would be a great benefit as they both accomplish the above goals without creating too much stress on the body...remember it is a building process so start slow.  If you have any increase in back pain, or any new complaints, then I would suggest that you then have it checked out further, and a chiropractic physician is the obvious choice as we are experts in spinal kinematics, dysfunction and rehab.  Good Luck Susan, and feel free to write back with any further comments or questions.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net