Chances are if you’re reading this, you’ve experienced back pain at least once in your life. Low back pain is the leading cause of activity and work limitation in the United States. Around 1 in 6 people will experience low back pain for the first time this year and 1 in 3 people who’ve had it before, will experience it again this year. These numbers are increasing every year, unfortunately. The good news is 98% of low back pain is treatable with physical therapy intervention!
We don’t quite yet have factors that predict who will be affected by low back pain. Current literature does not support a definitive cause for initial bouts of low back pain. Risk factors for whom may be affected are multifactorial, population specific, and only weakly associated with the development of low back pain per the latest Clinical Practice Guidelines on low back pain via the Journal of Orthopedic and Sports Physical Therapy.
Low back pain can take a toll on our lives. We may not be able to perform our job, play with our kids, exercise with friends, or do activities that bring us joy. The goal of this article is to provide you knowledge about low back pain and how to manage it if it happens to you.
How Does Back Pain Happen?
This pain can come from a variety of different reasons: bending forward to pick up an object, twisting to get in or out of a car, performing a squat in the gym, long day of picking up objects at work or even a trip to the golf course to name a few. (Click here for tips to avoid low back pain when golfing: https://www.protherapymn.com/how-to-avoid-low-back-pain-when-golfing/)
All these movements stress the low back in different ways and can cause pain in some situations, but let us remember, it isn’t that sole movement that is “dangerous”. There are a multitude of factors that play a role; it may have been a history of repetitive movements, too heavy of a single movement for our back to handle, or a change of direction that the body was not prepared for.
Acute vs Chronic Back Pain
Back pain comes in different time frames. Acute back pain occurs quickly, or rapidly, while chronic back pain is a long standing history (months to years) of back pain that is there for the majority of days/weeks. Chronic back pain can also have acute “flare ups”, where the pain is worse than a typical day for days or weeks.
There are many types of acute onset low back pain that have different symptom classifications: mobility deficits (stiffness), radiating pain (pain down the leg into the calf or foot), or referred pain (vague pain in the hip, thigh, calf or foot). Early on in low back pain, these classifications may be completely separate or muddled together.
These types of low back pain can be caused by different structures and movements of the low back. These can be related to muscles, joints, nerves, and intervertebral discs.
What should I do if I have low back pain?
- Should I go to the emergency room? There are very limited situations that lead us to recommend the ER as the first line of defense. These situations are RARE and include difficulty going to the restroom, numbness or loss of feeling in the genital area, or history of a major trauma or fall from a height (car accident, fall from a tall ladder, etc.) Emergency room attendance for low back pain without any of the previously listed symptoms or mechanisms of injury will potentially increase cost for you as a patient and may delay the time until you get better. Low back pain should not be over-medicalized, ER’s are not designed to handle musculoskeletal pain and thus historically “treat” it with imaging and medication.
- Should I take pain medicine? We recommend avoiding opioids and other prescription drugs for acute back pain. Non-steroidal anti-inflammatories (NSAIDs) like ibuprofen, Advil, etc. may be beneficial early on to help with pain, we recommend only taking the label recommended dose.
- Should I get an X-ray or MRI? Imaging should not be the first line of care for acute low back pain. MRI’s can have a place and time in the course of care, but typically should not be utilized in early lines of defense. If there is little to no progress after ~6 weeks then we may recommend imaging.
- Should I rest and ice after injury or keep moving? KEEP MOVING! The best solution to low back pain early on is to find a movement to promote spine range of motion, muscle activation and flexibility, and promote healing! Utilizing an ice pack with a layer between the ice and skin for 20-30 minutes may help decrease pain early on, but alternate with bouts of movement as tolerable.
How Do I Get Started With Moving?
The rest of this article will focus on exercises to do day 1 after an acute low back injury or flare up. Icing your low back may help with controlling pain. These exercises will focus on moving the low back, activating muscles in and around the low back to help support it, and decreasing sensitivity to movement.
When your low back is feeling stiff or painful, it is important to understand that the area is very sensitive to movement. That is why these beginning exercises are easing into small movements of the spine. Ideally there is little to no pain with these movements. Find a range of motion that is comfortable to you to start. (Further tips to avoid low back pain when working from home: https://www.protherapymn.com/4-simple-tips-to-prevent-low-back-pain-while-working-from-home/)
Exercises For Low Back Stiffness:
Quadruped Cat/Cow: starting on your hands and knees, let your belly button drop down towards the ground extend (arch) your back in a comfortable range (cat). Hold this position for 1-2 seconds, then begin to round your back as much as you feel comfortable. Repeat this for 60-90 seconds
Quadruped Rock Back: again starting on your hands and knees, rock back towards your heels until you feel a stretch in your low back. Hold for 3-5 seconds and return to the starting position. Repeat this for 60-90 seconds.
Supine Low Back Rotations: laying on your back with your knees bent, let your knees fall to one side (hold for 1-2 seconds) then return back to starting position and let your knees fall to the other side. Repeat this for 60-90 seconds.
Exercises For Core And Hip Muscles:
Pelvic Tilts: Start on your back with your knees bent, feet on the floor. Attempt to “tuck your tail between your legs” and press your low back into the ground with just your core muscles. Hold this position for 1-2 seconds and repeat for 60-90 seconds. To make this more difficult, when you hold the pelvic tilt position, try to slide your heel away from your body until the leg is nearly straight, then return the heel to the starting position (heel is sliding on the ground the entire time) and repeat this for 5-8 times each side.
Bridge: perform a pelvic tilt, from there push use your hips to lift your low back and hips off the ground such that your body is in a straight line (knees, hips, and shoulders). Hold for 1-2 seconds and repeat for 10-15 reps.
Birddogs: on your hands and knees, lift your opposite arm and leg off the ground and extend these two body parts away from the body as far as they can away from each other (arm goes forward, heel goes back). Keep your low back and core firm like you are flexing to take a punch in the gut. Only go as far as you’re able to without arching your back. Repeat 6-8 reps on each side.
Exercise if you have numbness/tingling/pain into your foot:
Prone Press Up: laying on your stomach with your chest flat, gradually press up onto your elbows and hold this position for 3-5 seconds and return to the starting position. Repeat this as needed to decrease symptoms into your lower leg. The goal of this is to draw the symptoms from your foot, you may feel an increase of symptoms in your low back, that is normal, but should decrease symptoms in your foot.
The best thing you can do when a bout of low back pain occurs is to keep moving to the best of your ability. We want to find a pain free movement to promote healing and keep the spine moving and muscles around it active! Especially early on in the rehabilitation process.
What else should I do?
Schedule an appointment with us at PRO Therapy at either our Northeast or Coon Rapids clinics (https://www.protherapymn.com/contact/) to progress these exercises and get your low back stronger and more resilient, preventing low back flare ups and pain in the future. The quicker you start physical therapy, the quicker you will see results of decreased pain and increased function. Our goal will be to find modifications to keep you working, active, and working out as well as reaching your individual goals!