The 3 Things You Should Know about relieving your Low-back Pain

Low-back pain can be a mysterious and often confusing riddle to solve. Even among some of the most elite scholars there is still a tremendous debate regarding the best approach. Statistically speaking, the low-back pain epidemic accounts for 264 million lost days of work, and it is the single leading cause of disability. One-half of all working Americans admit to having some kind of back-pain symptoms yearly. Additionally, 80% of the population will experience low-back pain in their lifetime. If there was agreement as to the solution, one would think those statistics wouldn’t be so high.

Unfortunately, to find a consensus regarding a solution might be like the explorer Ponce de Leon looking for the fountain of youth. As I talk with clients and patients about their low-back pain experience, it becomes abundantly clear that finding something like the fountain of youth would be exactly what they are looking for.

When I ask patients to talk about their goals before we start a physical therapy program, all patients say, “to become pain-free.” And many times, that is a very reasonable expectation. However, I would emphasize that there is a trade-off to achieve such a goal. You see, pain is a good teacher and pain can teach us a few things about the way our bodies should move. For many people who have injured their back they may have difficulty bending over to get something off the floor. So, what do they do instead? They try to do a squat with a very straight back as to not put any extra pressure on it. Biomechanically this makes sense. Forward flexion of the spine places greater than 50% more pressure on the discs in your back. So, loading up the back in this way would cause more strain, especially when the structure is already injured and inflamed. I tell my patients if you “act like you are in pain, when you are not in pain, then you won’t be in pain.” What I mean by that will become even more clear as I explain the phases of recovery.

To treat the low-back effectively you must do these three things in a phased approach:

1. Calm down the inflamed tissue around the injury,

2. Condition or re-condition the surrounding muscle tone,

3. Use the improved muscle tone to protect the involved joint injury.

Low-back pain is an epidemic and the prevalence is getting worse mainly because people don’t recognize what is going on when they injure their back. No matter what is injured when you injure your low-back—whether it was the disc, ligament, facet joint, and/or muscle—your primary objective is to calm down the inflamed tissue. The better a person is able to do this, the faster their pain will go away. Interestingly, it is ironic what people try to do instead. I have seen and talked to many patients that try some very common and uncommon treatment ideas. Most of them are not actually the best things for an injured back. People may try stretches and exercises that other health-care professionals may have taught them, or others may even make up their own exercises. Common things people try include hot packs, topical creams, Epsom salt baths, cryotherapy, forward and backward stretching, hamstring stretching, twisting stretches, manipulation (both self and chiropractic), deep tissue massage, foam rolling, inversion tables, surgery and others. All these approaches are trying to remedy the pain as quickly as possible. In our current culture of wanting quick answers and having little patience, the push for a quick fix to the back-pain problem has become even more popular. The average time it takes to recover from back-pain is about 6–8 weeks, where many times someone’s first or second bout of low-back pain may last only a week or two if you don’t do anything. Unfortunately, I talk to many clients who attempt to speed up recovery with the approaches listed above and actually slow down the process or occasionally even make it worse, sometimes causing a lifetime of chronic pain. Recommendations for this first phase of recovery include treatments such as ice packs, electrical stimulation, modalities like therapeutic ultrasound, gentle traction, soft-tissue work, and most importantly refraining from reloading the injury.

Once a person has successfully progressed through this first phase, then the second phase of conditioning or re-conditioning the surrounding muscle tone should begin. I caution that this second phase should be done in a way as not to compress, twist, flex or extend the spinal area that was recently injured. Such motions could lead to a setback. Unfortunately, some of the typical stretches one might find on the internet fall into this category. In fact, during this phase there could be some immediate reduction in symptoms with “internet stretches or exercises,” but those can actually lead to a rebound setback. Such a setback might not cause rapid or sharp pain immediately, but often symptoms return later that day, the next day, or even two days later. The goals for this phase of recovery are to increase the muscle tone around the injured spinal segment(s), not to stretch it. Recommendations for this phase of recovery are level 1 stabilization exercises with either a neutral spine position, slight pelvic tilt, or sometimes even a reverse (anterior) pelvic tilt depending on symptom reproduction and mechanism of injury.

Finally, the most important phase of recovery for a long-term solution would be the Protection Phase. During this phase of recovery, the person needs to use the improved muscle tone to protect the injured joint. The muscle tone developed in the re-conditioning phase should now be used to protect those injured spinal segments. This is done in two ways: first, by using the pelvic tilt, neutral spine, or reverse tilt techniques not just with exercises but in daily activities; and second, by incorporating proper Body Mechanic principles in all activities of daily living. By doing these two things you can protect the injured area, allow the body to heal at the fastest rate, and prevent future injury. A way to think of it is like this: “Act like you are in pain, when you are not in pain, and then you won’t be in pain.”

If you have any questions regarding the three phases of recovery for back pain, what Level 1 stabilization exercises are right for you, whether you should use a pelvic tilt, neutral spine, or reverse tilt technique, or what Body Mechanic principles are, then I would encourage you to contact a fellowship-trained physical therapist.