dehydration and low back pain

What the hell is a chiropractor talking about dehydration for?

It surprises many people to know that there is relationship between dehydration and low back pain.

On it’s simplest level, dehydration contributes to fatigue.  As a result fatigue decreases performance at work and play and increases vulnerability to injury.  Fatigue also results in a loss of normal postural support which puts pressure on the joints and discs of your spine.

Hydration and joint lubrication

There are more direct reasons.  Firstly, spinal joints have fluid to lubricate them.  Dehydration can reduce that lubrication and cause friction.  Friction increases wear and tear on the joints and leads to inflammation and pain.

Second, discs require water for “shock absorption”.

The discs are the flexible spacers between vertebra.  In conjunction with the normal curves of the spine they contribute to “shock absorption” in the spine.  There is a high water content in the centre of the discs (70-90%).

As we age, we loose the ability to maintain water in the discs (and hair and skin=grey and wrinkles!).

Dehydration means we have less water available to “moisten the padding”.  Just like a sponge left out on the sink to dry out, the discs get thinner, stiffer and weaker.  The vertebral joints are vulnerable to injury as there is less ability to withstand the forces of bending and lifting.

Thinner discs also reduce the space between the vertebrae and therefore the clearance around the spinal nerves.  As the discs degenerate ligaments and joints around the vertebra can calcify and nerves between the vertebra can be impinged.  This is a significant source of lower back pain.

Hydration and disc nutrition

The discs also depend on water to transport nutrients into the disc to work normally.  There is no blood supply into the disc to do this.  Nutrients must be dissolved in the water around disc and is carried into them by a pumping action.  Again think of the disc like it is a sponge.  Compress it, fluid squeezes out, then reduce compression/move in a different direction-pressure is release and fresh fluid is absorbed back in.  In this way nutrients move into the disc to keep it healthy.  (Therefore movement is essential for the health of our spines-but we’ll talk about that in another blog)

Waste products and toxins from normal metabolism (and from healing an injury) are then removed from the discs dissolved in water.  Dehydration makes it harder for these chemicals to move away from the back to be processed elsewhere.  When the waste products accumulate there is more inflammation and gunk around the discs, joints, vertebra and muscles.  This is another source of pain in the spine.

How much water do you need to drink?

I get this question all the time and there is no straight response. There are a few different recommendations and formulas I have seen, from “EVERYBODY MUST” drink 2 litres of water per day, to 350mL of water per 10kg of body weight and even one group recommend 3.7L per day for men and 2.7L for women.  These are a bit prescriptive and don’t take body size/weight, activity levels or general health into consideration.  Best advice I have heard is to drink enough water so that your urine is clear to a light yellow/”straw colour” (whatever the hell that means-have a look at the pic below). 

Another good way to monitor hydration, and specifically if you are drinking too much (yes it is possible!) is if your urine is always totally clear and you are needing to get up through the night to pee multiple times.   (Again peeing through the night is a topic all of it’s own!)

Over hydration has it’s own problems.  Kidneys can be strained by overworking and increased urine output can cause electrolyte (salts in the blood stream) imbalances.  Headache, nausea, vomiting, seizures, and in severe cases, coma and death are the result of over hydration.

Do I have to drink water?

I hear this is question  often.  Water is the best source of water!  Soft drinks and sports drinks along with caffeinated drinks like coffee and tea have a diuretic effect (that is increased urine production effect).

These other sources of fluid can be a bit counter productive for hydration.  If you were stuck on a desert island with no water and a bottle of soft drink washed up-drink it-the net effect of having some fluid versus the diuretic effect of the soft drink is out weighed in this case.  Day to day when you are not at risk of death by dehydration, water is best as your urine production will be balance without the effect of diuretic chemicals pushing water out of the system.

What about sports drinks?

But what about sport/electrolyte drinks?  These are not required, unless you are working and exercising hard and sweating profusely in hot weather.  Signs they will be helpful are:

1. Muscle cramps particularly in the legs and feet.
2. Fatigue, weakness, and lethargy.
3. Nausea, vomiting and diarrhoea.
4. Headaches.
5. Dizziness, light-headedness and fainting.
6. Irregular heartbeat.
7. Changes in mental status: confusion, irritability, and even seizures in severe cases.

Try to choose a low sugar option or make your own.  A squeeze of lemon juice and a pinch of Himalayan sea salt will do the trick if you need some extra help on those really sweaty days.

How to drink more water

To help drink more straight water, one little tactic is to put a squeeze of lemon or lime juice in it.  Most people find it a more palatable/interesting.   You will therefore get through the amount required more easily.

Another good tactic is to fill a bottle (with the amount you’ve worked out you need) in the morning and make sure you have drunk it by the end of the day.

In a nutshell, to give your spine a good chance to maintain itself you need to keep hydration levels up.  Low back pain has to be treated as health issue.  Hydration plays a big part in your health in general.  Stay hydrated and you have one piece of the puzzle sorted.

Keep an eye out for other articles about health factors we all need to do to help our backs.