How We Approach Back Pain
Let’s address the elephant in the room, there is no magic cure for low back pain. What we know is that it’s common, it’s almost like the common cold in that it comes and goes and sometimes we don’t know why. The good news is that in the vast majority of cases, it resolves independent of treatment approach within 6-8 weeks. With respect to the causes and contributing factors, there are many! One cause that may feel familiar to you would be tissue issues like muscle strains, joint irritation, discogenic low back pain, etc. However, it’s not always possible or necessary to know whether these tissues are affected in your situation. Some things that may not make as much sense can include stress, lack of sleep, worry, anxiety, past experiences, mood, hormones, and a host of other things besides an unhappy tissue. Lot’s of things could be going on when you have back pain, and it’s rarely if ever one thing.
Regardless of the facts surrounding why we get back pain, there’s no arguing one simple fact - IT HURTS. It can also really interfere with your ability to engage with the things you love, work, or daily activities. Further, for some people it doesn’t get better within that 6-8 week timeframe and becomes a long-term burden. With this in mind, we said there was no magic cure. However, there are approaches that make sense that can help you manage low back pain and get you back to what you love. In this blog, we’ll be discussing how we approach it using principles backed by scientific evidence that leads to an individualized approach depending on your particular story.
Rule out red-flags
First and foremost, it’s imperative to rule out red-flags which are potentially serious conditions requiring further medical attention. Back pain can sometimes (although very rarely) be a symptom of a more serious issue. Our first priority is to see if there are any red flags. This is something we are always paying attention for, but in the vast majority of cases back pain is not a serious condition.
Identify triggers
After we’re confident that you’re dealing with back pain and not something else, we want to identify the types of movements, forces, and activities that trigger your pain. For example, we often find that people experience pain with flexion of the lower back. This is the movement that occurs when your lower back rounds and when you bend over to pick something up. In this type of presentation we might find that it hurts after sitting, with activities that involve bending (gardening, doing dishes) , and exercises like squats (namely at the bottom portion of the lift), deadlifts, and kettlebell swings.
One important note is that a movement hurting (in this case flexion) doesn’t equate to that movement being bad.
Any movement can become sensitized. The reason we identify triggers is so that we can begin to implement short term strategies to help relieve symptoms, which we’ll discuss next.
Calm things down
The next thing we do is use your triggers to inform the available options to help you desensitize your lower back.
The main guiding principle here is variability
Think of holding a hot coffee cup…would you give that cup a death grip? Or would you constantly switch fingers to try and make sure one finger doesn’t get burned? My guess is the latter. This is how we view variability or movement options when one movement is particularly sensitive.
In the flexion case, we could temporarily reduce the amount of flexion occurring in your daily life. For example, we could recommend a lumbar roll when sitting so that your back has a little less rounding. Further, we could recommend movement snacks that involve extension (this could be as simple as lying on the ground for 5 minutes intermittently throughout the day). Lastly, we could modify exercises or activities such as deadlifts so that they have less flexion and allow things to calm down.
Build things up
Once your symptoms are settling down, it’s a lot easier for us to start building you back up.
The main principle being used here is habituation.
Habituation is the phenomenon wherein repeated exposures to a stimulus leads to less sensitivity over time. Everyone has gone in a cold swimming pool, and at the beginning it’s freezing! However, as you’re in the pool you start to warm up. This is an example of habituation, where the temperature hasn’t actually changed at all, what has changed is that your body has become less sensitive to the temperature of the pool. This is an important protective measure of your body because it alerts you to changes, things that could potentially be harmful to you.
Lets take a look at the previous example. If your back hurts with flexion, then we might start doing a little bit of flexion. This might involve movements like cat-cows (arching and rounding your back) or even slowly resuming normal deadlifts/squats little by little. It could also involve specific exercises that load the uncomfortable movement programmed as accessory exercises.
In theory, this is very simple; however, in practice this process can be quite challenging and it’s what makes rehab and recovery such a delicate balance. The reality is flare ups do occur, pain is complex, and things don’t always go the way we plan. So many factors can influence back pain, but it’s important to not miss the forest for the trees and trust the process, your body, and yourself to strike that balance over time.
Get back to what you love
When back pain is occurring it often makes you singularly focused on the pain. This is normal, your back is important and it’s natural to be focused on eliminating the pain. But when you look deeper, ask yourself what that pain means…what is it keeping you from? You may realize that the real motivating factor here is not necessarily just getting rid of the pain, but getting BACK to things that you really love or value.
Our goal is to figure this out with you. Whether it’s powerlifting, running, sports, or playing with your kids, we want to help you get back to doing those things with even more confidence than you had before getting hurt.
The main principle here is meaning.
Without this goal, we are just trying to minimize your pain. Instead, we want to help you maximize your life.
In practice
This process is messy, difficult, and scary.
The main principle here is navigating uncertainty.
If you don’t know what steps to take, find someone that can guide you, who you trust, and who can help you take control of your health and get back to what you love.
If you are interested in learning more about low back pain check out our free PDF below