So you are now having a bout of severe lower back pain. Know that you are not alone. About 80% of adults will experience a course of low back pain in their lives. Low back pain is the most common cause of occupational disability and to missed work days. Back pain accounts for more than 264 million lost work days in one year—that’s two work days for every full-time worker in the country. In a large survey, more than a quarter of adults reported experiencing low back pain during the past 3 months. Low-back pain costs Americans at least $50 billion in health care costs each year—add in lost wages and decreased productivity and that figure easily rises to more than $100 billion.
Most low back pain is acute, or short term, and lasts a few days to a few weeks. It tends to resolve on its own with self-care and there is no residual loss of function. The majority of acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move. The vast majority of these acute cases can either self resolve, or resolves with self care. Id like to help you fall into that camp.
The longer your pain lingers, or more frequently it reoccurs, equates to a more difficult case. These recurrent or chronic low back pain case are more apt to need professionally help. This does not mean to jump to a surgeons office, or hop on an opiate train. First line treatments should be chiropractic, rehab, physical therapy, dry needling, better self care, or other non invasive strategies.
Even if you fall into that camp of recurrent or chronic, this material can still help you to get on the right track if you are currently in a flared up state.
Often patients report their lower back pain was brought on by some action; lifting something, a new workout, an odd bend incident. Sometimes it’s some inaction, a period of sedentarism. Maybe a particularly long car ride, or during quarantine they binged watched all 8 hours of Tiger King. Occasionally they’ll blame mental or emotional stress, like global pandemic. All too often though, it’s the story of I just woke up with it. Any can be frustrating but hopefully the following steps help.
The first step is painfully obviously, but worth stating: if a movement hurts, don’t do it. If it hurts to bend forwards, don’t think that forcing yourself to bend forwards will help. You’re apt to just aggravate it more. There might be a plethora of things you do and do not realize they are gradually injuring your back, read about these ab exercises that are apt to injure spines:
Let’s first talk about finding positions of relief, or what we call, directional preference. The concept of directional preference can be described as “positions that cause your pain to improve.” It is the cornerstone of McKenzie therapy, and one of those things where “60% of the time, it works every time.” In most cases, we take a direction that hurts to bend, and perform the opposite. Generally this means if it hurts to bend forwards, we bend backwards. Flexion intolerance is the most common, and regardless of what your painful motion is, I will recommend starting with this extension version if you’re under 60 years old. We test it in the office, and you can test it at home like this:
For non-responders to the previous section, or to older spines, we will bend forwards. The seated version is more attainable, but the lying on your back version would be preferred. If these start to generate increasing pain, simply stop and disregard this test, it’s clearly not for you.
If you need to do the seated variation for any reason, start in a sturdy chair. Have you’re knees very wide and lead forwards, reaching down and grabbing the inside of your ankles. Pull yourself down into flexion. Return to seated and repeat 10-20 times. Get up and retest.
Not every back pain case will respond to directional preference. Its best at that point to move on to controlling your pain. Depending on the severity of your pain, we want to challenge your movement tolerance, but not push so hard as to further irritate it.
In a crawling position, on your hands and knees, start to explore lumbar range of motion. Arch your back upwards and downwards. Its common to feel that the ‘motor’ or the region creating this motion is in the chest and shoulders, try to change that. Try to feel that your motion is originating at the pelvis or belt. Feel that as you tuck your tailbone down, your back flexes upwards. As you arch your tail bone upwards, the back arches down wards.
This position has the spine in a minimally loaded position, less than standing. The act of quieting the shoulder and generating movement from the pelvis helps improve spinal coordination. When arching, on either extreme you may feel pain. Do not push through this. Simply arch the other direction and then come back down roughly to that point. Through multiple repetitions you can gradually improve your range.
Find a point that, near the bottom of your arched down position that is comfortable and try to feel strong there. Feel your spine being long and sturdy. We will be exercising from this position shortly.
I have a more detailed description of core stability here, but it is worth reiterating.
Walking is about as natural of a movement as our bodies can perform. If have detailed a walking program for stenotic backs here if you scroll down to the walking section, but I feel it is important to reiterate and put it in video form.
If walking feels good on your spine, then you are encouraged to walk to your hearts desire. The fluid gentle motion of this strong walking is arguably the best spine exercise known to man. It truly is “mans natural state.” Ive discussed this concept of humans being designed for two things before: Walking (contralateral support) and Throwing (Ipsilateral support) in relation of DNS, read more about it here.
Acute low back pain is common, aggravating, and at times disabling. Most cases will self resolve with minimal intervention in a week or less. Recurrent, chronic, and injury induced cases require more effort to resolve. This should progress from dedicated self care, to non invasive care (Chiro, therapy etc) to minimally invasive such as medicines or acupuncture, to more invasive. I hope this information helps you take control of the situation. If it doesn’t though, reach out to our office and hopefully we can be of service.