Low back pain is one of the most common causes of disability in the US.
8 in 10 people are likely to have an episode of low back pain in their lifetime.
The good news is that the majority of these cases resolve completely.
Unfortunately, however, the recurrence rate is rather high, and a few individuals do go on to have persistent pain.
So what can we do to prevent this?
Low back pain is complex and there are different types of low back pain that may need to be managed differently. By no means do I intend for this post to give you all the answers on this topic.
What I do want to do is share some simple do’s and don’ts of how to manage the most common types of low back pain that do not involve serious injury or pathology.
I’ve done my best to base these recommendations on current evidence and our evolving understanding of pain and treatment strategies.
So, let’s start with some things you absolutely should NOT do if you experience low back pain...
...DON'T fear the worst
Again, low back pain is fairly common and most episodes end up resolving completely. So don’t fear the worst. Rather, know that you have good reason to be optimistic, and there are several things you can do to help yourself get better...more on that in a little bit.
….DON’T get on the internet to find answers
That might seem contradictory since you’re reading this post about low back pain on the internet. But the fact is there is a lot of bad and outdated information on the internet. Plus, you're likely to stumble across scary terms like "degeneration" and "disc bulging" which can create unnecessary fear. These terms actually just describe normal findings in most people, even those that don't have any pain.
….DON’T ignore the pain
The opposite of being overly worried about your back would be ignoring the pain and pushing through activities that make it worse. And that's not a good approach either. Pain is your body’s alarm system meant to protect you, and if you ignore these signals and continue to provoke the pain, it may be harder to turn the pain off.
….DON’T rely solely on passive strategies
What do I mean by passive strategies? Massage, electrical stimulation, needling, manipulation, adjustments, etc. None of these things are bad in and of themselves, and they certainly might useful tools to help you improve. But they are most effective when combined with active exercises that help you build self-efficacy rather than creating dependency.
So, here’s what you should DO instead…
….DO stay active
Find some low-intensity exercise that doesn’t increase your pain, and use that to keep moving. That might mean walking, biking, swimming, or something else that doesn’t hurt… the key here is to break a sweat and get the endorphin release from exercise to help reduce the pain.
….DO work on improving your lumbar spine mobility
Often when you have low back pain, your movement becomes stiff and guarded. Working on improving your range of motion gradually can help reduce the pain and protective guarding.
Here's a simple exercise that can help you target your lumbar spine mobility...
Many people with low back pain tend to be sensitized to spine flexion. This can be challenging because we tend to spend a lot of our time in spinal flexion (i.e. sitting) or performing flexion activities (i.e. bending over to pick something up or tie your shoelaces).
For this reason, many people respond well to extension exercises. Moving the spine opposite of the painful direction can give your body a break and serve to “reset” the nervous system, decreasing sensitivity and pain.
Below is an example of an extension exercise called a "press up." You can use this as a test to see if you have full mobility (able to lock out your arms without your hips leaving the table) without any pain. If you are limited or do have pain with this movement, perform a few reps to see if the pain decreases with gradual improvement in the range of motion. If it does, this is something you can repeat multiple times a day until it's all clear with full range of motion and no pain.
....DO work on getting stronger
It's a common belief that core weakness or instability causes low back pain. However, you might be surprised to know that research isn't clear on this. So while we might not be able to say that core weakness causes low back pain, there is still good reason to work on strength. Getting stronger can improve your confidence and decrease the nervous systems protective pain response. So rather than focusing on just the core, developing trunk (abs, obliques, back extensors) and hip strength in general can aid in building strength and improving your tolerance to activities.
Here's an example of a great exercise that can help build trunk and hip strength simulatneously...
Barbell good mornings are another great option for posterior chain strengthening, including the back extensors. Focus on hinging at the hips while maintaining spinal position. When done correctly, you should feel tension in your hamstrings. I recommend starting with a light weight and slowly building up.
Lastly, I"m a big fan of deadlifts as a way of reducing low back pain and improving strength. But don't just take my word for it. Zach Long (The Barbell Physio) has a great write-up about the research behind this (read here).
….DO work on improving your mechanics for high load activities
Getting your mechanics dialed in for high load activities, such as weightlifting, can help ensure that you aren't placing additional stress on your low back. Enlist the help of a coach or clinician who is well-versed in these movements. Don't progress the loads until you demonstrate mastery over the movement and with consistency over time.
Hope this information helps some of you. Thanks for reading!
If the pain persists or there are more serious symptoms like numbness/tingling, pain shooting into your legs, difficulty going to the bathroom, pain at night that isn't relieved by changing position, etc., go see a medical professional.
Joby Philip, PT, DPT