Lower Back Pain

Ever had drop-to-your-knees low back pain? Can’t stand up straight? Pain first thing in the morning? Pain getting into and out of the car? Pain when you sit up or sit down? Can’t bend forward to tie your shoes early in the morning?

These are all really common signs associated with flexion intolerant low back pain—it’s a completely normal and treatable condition that many of us will experience at least once in our lifetimes.

It is actually a micro-injury to the discs in our spine—the outer layers of the disc get aggravated by repeatedly bending forward and rotating—after years we irritate these outer layers and one day, bang—you’re a hot mess and can’t move.

The good news is there is treatment for low back pain and it doesn’t have to involve surgery or long extended trips to the chiro or PT!

• The best treatment is education, understanding what caused the injury, how you are provoking it, how you can make it better, and what treatments can help to speed that process along.
• This is patient-centered health care Its focused on you helping yourself improve, without relying on other people (doctors, physical therapists, chiropractors) to constantly “fix you” or put you “back in alignment.”

Let’s think about how this type of pain starts. Basically, it starts because we sit all day long. We round (flex) through our low back and put stress on the posterior portion of the disc. Then, we forget how to hinge at the hips and squat and deadlift. We use our low backs to bend over and rotate, further increasing the stress on the spine and discs.

Then, one morning we bend over to brush our teeth, or pick up a pencil and boom—to the floor you go. It wasn’t that “one bend”—it was a pattern of bad movement. But you can get out of pain and heal without surgery.

Sciatica, or pain going down the back of the leg is also incredible common for these conditions. Its 100% treatable once you understand the cause, stop the movements that provoke the symptoms, and start moving better.

Many people often seek medical advice when they have this type of low back pain they commonly see the medical doctors, who honestly don’t have a ton of training in musculoskeletal pain and injuries.

Your MD means well, but they don’t know how best to help – so they give prescriptions for pain meds and muscle relaxers, and maybe some general advice such as stretch and strengthen. This is well intended, but it’s probably bad generic advice.

1. Our society already has an issue with over-prescription of and addiction to pain meds. Pain isn’t the problem, it’s the alarm bell telling us there is a problem. It’s telling us we’re moving poorly and injuring ourselves. Instead of listening to our bodies and correcting the problem, we’re masking the issue and putting a band-aid on a crack in the dam. Boom.
2. Stretching. think about this, we sit all day, we wake up, have breakfast sitting down, we drive to work, we sit all day at work, then we go home and sit on the couch. See image of the guy below. Does his low back look like it needs to be stretched? We basically sit in a position of “stretch” all day long! We are over-stretched in our low backs!

Additionally, somewhere we got the idea that stretching our hamstrings was a good idea – typically stretching provides short term relief (we stimulate stretch receptors in our muscles, that gives us a temporary feeling of relief, which then ramps back up by INCREASED pain after the stretch response goes away…we make ourselves worse by stretching).

3. “Strengthen the core” – think of your favorite ab exercises. I’ll list the most popular exercises – crunches, v-ups, Russian twists, hanging leg raises/knee raises, bicycles, oblique side bends, mountain climbers, etc.

Now think of what we are creating with those movements – flexion of the low back, stretching, and basically we’re provoking the mechanism of injury. We’re making out problems WORSE with most of our “favorite” ab exercises.

Also – look at the images above/below of what we’re doing with constant sitting posture – we get super long and tight in our back muscles because they’re constantly stretched. By contrast, we get short and tight in our hip flexors in the front of our hips because we sit all day long.

One of the hip flexors attaches to the front of the lumbar spine (low back) – when its tight it adds anterior compressive forces to the low back, and increases tension. Then we do our favorite ab exercises – leg raises, knee to chest, back extensions, v-ups – basically all of these exercises INCREASE the load on hip flexors – which makes our low back pain WORSE!

We need better advice, and a better way to treat low back pain.

1. Understand the mechanism of injury – get assessed by someone who is trained in biomechanics and rehab – we need to stop “picking the scab” and let the injury heal.

In this phase pain can be treated short term with soft tissue work, acupuncture, trigger point dry needling, and sometimes adjustments. The more important issue is education – figure out what movements are making it worse, do the movements that make it better.

2. Stop the movements that make it worse. Do movements that make your pain better. Typically stretching (toe touches, hamstring stretches, knee to chest, side bends) may provide temporary relief, but actually make the condition worse.

3. Box squats, hip hinging, and deadlifting are going to get you out of pain. Stabilize the lumbar spine – don’t stretch it. Take the stress off your injured region and let it heal.

4. Do movements that make it better. This is different for each person, as we are all “built” differently, and is why seeing someone qualified in biomechanics and rehabilitation is important.

Certain spine movements will help different types of low back pain. They are different for each person, but typically cat/camel and extension based exercises will help to treat flexion intolerant low back pain.

5. To build safe “core strength” we need to focus on lumbar spine stability – not mobility. Core stability exercises like dying bug, bird dogs, planks, and Turkish get ups are great for creating stability in the lumbar spine to build muscular endurance and prevent the potential for re-aggravation.

6. When you’re on the path to recovery – continue your journey by getting stronger – this is the fun part – you get to learn how to do safe strength exercises to live a better quality of life long term.

A huge issue for our aging population is weakness and disabilities associated with falling – we need to be stronger in our hips – squats, deadlifts, lunges – these are movements that we use EVERYDAY! And we need these muscles if we want to enjoy our quality of life when we are able to retire.

When searching for someone to help you with low back pain – find someone that understands your injury, they will educate you on what is hurting and helping your condition, and can use many different “tools” to help you get out of pain more quickly.

Avoid those individuals that require you to come in for extended treatment plans, or only have one solution to fix your issue. You may require several visits to get out of pain – but the plan should incorporate active care – ie. education, soft tissue work, mobilizations, and exercise – instead of only relying on “what they can do for you” – you need to be empowered to help yourself.

Finally, they can help you design a program that will strengthen your weaknesses to help you prevent future injuries and live a better quality of life.