Acute Lower Back Pain

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.

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:

1. Laying on your belly with the hands stacked under your forehead, palms down, relax.  Stay here for 1-2 minutes, feeling your breath flow down into your belly. You may experience stiffness or discomfort as you go through these steps, but be patient and see if pain actually reduces after temporarily increasing.
2. Raise up a touch by stacking two fist under your chin, like two blocks. Try to stay here for 1-2, if your pain increases then return to step one, and try to process one more time before giving up.  If this position is relieving, or your pain at least doesn’t increase, stay here for 3-4 minutes.
3. Raise up higher, propping the elbows under you like an Egyptian sphinx.  Again if this position is increasingly painful after 1-2 minutes, you should drop back to the previous stage and repeat it. If you can stay her for another 3-4 minutes, do so.
4. Press off of the elbows, and onto the hands.  If thats manageable then do this motion 5-10 times.  If its a bit much, you might do better simply staying on your elbows
5. Get up, walk around a moment and retest your painful movement

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.

1. Lying on your back, its ideal to have your legs supported in a 90/90 position and rest there for 1-2 minutes.  This is a  position of relief for almost all mechanical back pain cases. Mathematically, its the position where the least possible compression is going through the back.  I use it as a recovery position for severe cases, you should too. Bed rest is never recommended, but some periods of rest might be needed in severe cases.  We rest because of pain, not for it.
2. If getting the legs supported is not logistically possible, start here.  Laying on your back grab the knees and pull them into your chest.  Continue to hold the knees as you piston the legs to about 90 degrees and back into your chest.  Its likely that you need your knees wide, especially if you have much belly.  Pull the knees more towards your arm pits.  Pumping them back and forth at a casual pace.  You might repeat this ~20 times.
3. Lower your feet back to the floor, in a hook lying position.  Knees bent, feet flat and wider than your shoulders.  Let your knees fall from left to right, back and forth casually 10-20 times.
4. Get up, walk around a moment and retest your painful movement

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.

1. Explore your pain free range of motion (Cat-Camel)
2. Learn to brace the spine and move about the hips (Big Three and Hip Hinging)
3. Walk

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.

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.

1. Stand tall, comfortable and proud.  You might benefit from lightly bracing your abdominal wall.
2. Walk with swagger.  A strong arm swing from the shoulders not the elbow, and as tall athletic of posture as possible.
3. Walk to the point at which your pain first starts to creep on.  Do not push through.  Stop there or even earlier.  Rest as needed and repeat the process.

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.