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Have you ever had Low Back Pain?

medicinebymovement
Feb 2710 min read

If you haven’t, there is a good chance you will.  Studies show that Low back pain is an extremely common problem that most people experience at some point in their life. (2). Research also suggests if you’ve had low back pain, the recurrence estimate within a year can range from 24-80% (2).  Females, aged 40-80 have the highest prevalence, but it remains one of the most common injuries across the world, regardless of sex or age. (1)


With this being one of the most common injuries, it is surprising to me how many clients I see who have no idea what to do when they experience low back pain.  There are many different causes, which we will dive into shortly, but the bottom line is this…backs like movement!  Almost all causes of Low Back Pain will respond well to some gentle movement.  Our bodies like this.  We were not meant to stay in one position.  One of the worst things we can do is lay in bed for multiple days, yet that is what so many people report they do.  And I get it.  It’s scary when your back “seizes up.”  When a movement caused the pain, we are on high alert to not do it again, so we often don’t move at all.  Now, I don’t think you should go climb a mountain with an acute case of low back pain, but specific and intentional movement is important.  That is why the majority of people get better much quicker when they attend PT shortly after an episode of low back pain. (3,4,5).  Physical therapy reduces the amount of time in pain, the use of medication, as well as occurrence.  Less cost of medical treatment and imaging is required with patients that received PT, and/or have a skilled exercise routine. (5). Exercise is more effective in decreasing pain and disability from low back pain than control treatments or physician consultation. (3)

Being educated on whats going on with their body, what to avoid, and things that can be helpful make a huge difference.


One thing that most people should try doing is walking.  Not a huge walk.  Start with 10 minutes.  Let your arms swing and try to avoid the “Frankenstein walk.”  It may feel a little scary and uncomfortable for the 1st minute, but it should start to improve fairly quickly.  Now, there are a couple things that don’t like that weight bearing motion, so if you try this and it doesn’t start to feel like it’s improving within a couple minutes, or it makes it worse, stop!  But, for the majority of people, this is a great place to start.  


So, what are some common issues we see in the back and movement we can do for them?


Degenerative Disc Disease, or a “Bulging Disc.”


Disc’s are our spine’s cushion.  They are there for shock absorption.  You have a disc between each vertebrae.  The outer third is a bit more fibrous, while the inner 2/3 is more fluid-filled.  Unfortunately, as we age, the fibrous part becomes a bit more brittle, setting it up to break down easier. Add in some increased activity, especially bending forward and lifting a load, or heaven forbid trying to lift something heavy and twisting, and there you have a little tear in the protective fibrous area.  I explain it kind of like a peanut butter and jelly sandwich.  If the disc then becomes compressed, the jelly starts to bulge out the side.  Weight bearing, or gravity compresses this, but also flexion-based activities (bending forward).  

The majority of disc bulges happen laterally, or to the side.  These respond really well to what is called extension-based exercises, or an extension directional preference.  This helps to decompress the disc, and for lack of better words, “sucks it back in.”  Now, occasionally you can get a central canal bulge.  Unfortunately, when this happens, it will not like extension activities because it is pushing it into the spinal canal.  If this is the case, the best thing for it is traction. Meaning separating the spine.  I get people asking all the time if an inversion table is appropriate.  While this is certainly accomplishing the desired effect, I would do it cautiously as it is not specific to any 1 area, and instead tractions everything.  This can often cause a muscle spasm, so if you try it, do it slowly and for a short amount of time.  See below for a couple of my go-to extension-based exercises, as well as a couple self-traction ideas.


Extension-based exercises


Self- Traction Ideas




*Degenerative Joint Disease, or “facet syndrome.”


You have a facet joint on either side of each vertebrae, where it comes together and meets the one above and below.  These are important in letting our spine move when we rotate, bend to the side or bend froward and back.  Just like any other joint in our body, we can “sprain” the joint by over stressing it, or it can break down over time and basically form osteoarthritis.  Both of these respond virtually the same way.  They won’t like to be compressed more.  Meaning, they won’t like extension (bending backwards), or side bending or rotating to the side that is injured.  All of that compresses that joint more.  If it is a true facet joint sprain, it may not like bending away from the affected side either as that joint is “unstable.”  Avoiding end range extension and rotation is key in getting it to calm down, and then working on general mobility and core stability moving forward.  See below for a couple of my go-tos for a flexion-based preference, or facet syndrome:  



Following the self mobilization, here are some general mobility exercises that work well for this, as well as most acute low back issues:


-See below under prevention for the beginning phases of core stability, which would be key here as well.


*Spinal Stenosis

This is also a flexion-based preference injury.  Spinal Stenosis is a narrowing of the spinal canal. This is usually from arthritic changes. Bending backwards (extension) irritates this more, as it closes off the spinal canal even further. Flexion, or opening exercises create more space, and are helpful. This includes pulling knees towards the chest, bending forward, as well as stability exercises. 



See above under facet syndrome for some of these exercises.



*Muscle Strain

This is a general term for “overusing a muscle” or placing more load on a muscle than it can handle.  There are many muscles in the low back, but some of the common ones affected are the Lumbar Paraspinals, the Quadratus Lumborum, as well as some of the gluteal muscles.  Most of these do well with gentle stretching, and in an acute phase-supporting the area with a soft back brace, heat or ice, TENS units, or manual work including dry needling.  It is very important to work on core stability following this and figuring out any muscle imbalances to avoid re-irritation in the future.  See below for a couple go-tos for muscle strains in the low back:



Cat - cow is a great way to get the back moving. Think about breathing out as you round up into the cat, and in as you sag down into the cow and stay in a pain-free range
Cat - cow is a great way to get the back moving. Think about breathing out as you round up into the cat, and in as you sag down into the cow and stay in a pain-free range

Child's Pose is another great way to stretch the low back. This targets the upper back more than the low back, but it is a great way to stretch some of the muscles attaching to the area. The idea is to stretch the arms forward as far as you can, then sit back on your heels. If knee flexibility does not allow as shown above, consider sitting back on a pillow or something for support. To get a larger stretch on one side, slowly walk your arms to the opposite side.
Child's Pose is another great way to stretch the low back. This targets the upper back more than the low back, but it is a great way to stretch some of the muscles attaching to the area. The idea is to stretch the arms forward as far as you can, then sit back on your heels. If knee flexibility does not allow as shown above, consider sitting back on a pillow or something for support. To get a larger stretch on one side, slowly walk your arms to the opposite side.

QL (Quadratus Lumborum) stretch is great to target the lower, outside of the back. If stretching the left side, cross the left leg in front of the right. Keep both knees as straight as you can, then raise the left arm up overhead. If this feels ok, then side bend to the right. I like to grab onto the door panel and then press your hips to the left until you feel a gentle stretch on the side or slightly through the back of the left side. Consider tightening your abs and pressing the hips slightly forward to increase the stretch.
QL (Quadratus Lumborum) stretch is great to target the lower, outside of the back. If stretching the left side, cross the left leg in front of the right. Keep both knees as straight as you can, then raise the left arm up overhead. If this feels ok, then side bend to the right. I like to grab onto the door panel and then press your hips to the left until you feel a gentle stretch on the side or slightly through the back of the left side. Consider tightening your abs and pressing the hips slightly forward to increase the stretch.

Prevention:

Lifting mechanics, ergonomic and posture are huge contributors.  That is a blog all in itself, and if it’s something you are interested in, stay tuned this month for some info on it, or join our 6 week Low Back Pain course!  Apart from that, general mobility, and core stability exercises are essential.  Please see below for my go-to Core stability exercises, and follow my Instagram and Facebook Treatment Tuesday posts for videos and more info on these!



The Transversus Abdominis is a core muscle that attaches to the center of our belly, and wraps around to the spine. When it contracts, it mimics a corset, or cinches up like a back brace. We tend to overpower this muscle with the Rectus Abdominis (the six pack muscle), which is an important muscle, but does not stabilize the spine as much as flex it forward. To engage the Transversus Abdominis, lay on your back with knees bent. First, think about pulling belly button in towards your spine like you are trying to get some skinny pants on. Then, at the same time, think about trying to "stop yourself from passing gas." Or, essentially, doing a kegel. If you place your fingers just inside your hip bone while doing this, you should feel a very subtle muscle puff up. If it moves your hand a lot, you are probably trying too hard and engaging the obliques or rectus. To get a better idea, move one hand into the small of your back. When you tighten up, you should still feel the muscle puff into the hand on top, but you should not feel any movement in the low back. If your back pushes into the hand, you are engaging the Rectus. If this is the case, try more of the pelvic floor part- or stopping yourself from passing gas and less of pulling the belly button in. Once you have the hang of it, you can progress with different leg movements- heel slide, marching, leg extension. Keep in mind, the goal is to be able to move the leg, without the back moving at all. Keep the hand in the small of the back for feedback throughout, and keep your motions small!
The Transversus Abdominis is a core muscle that attaches to the center of our belly, and wraps around to the spine. When it contracts, it mimics a corset, or cinches up like a back brace. We tend to overpower this muscle with the Rectus Abdominis (the six pack muscle), which is an important muscle, but does not stabilize the spine as much as flex it forward. To engage the Transversus Abdominis, lay on your back with knees bent. First, think about pulling belly button in towards your spine like you are trying to get some skinny pants on. Then, at the same time, think about trying to "stop yourself from passing gas." Or, essentially, doing a kegel. If you place your fingers just inside your hip bone while doing this, you should feel a very subtle muscle puff up. If it moves your hand a lot, you are probably trying too hard and engaging the obliques or rectus. To get a better idea, move one hand into the small of your back. When you tighten up, you should still feel the muscle puff into the hand on top, but you should not feel any movement in the low back. If your back pushes into the hand, you are engaging the Rectus. If this is the case, try more of the pelvic floor part- or stopping yourself from passing gas and less of pulling the belly button in. Once you have the hang of it, you can progress with different leg movements- heel slide, marching, leg extension. Keep in mind, the goal is to be able to move the leg, without the back moving at all. Keep the hand in the small of the back for feedback throughout, and keep your motions small!


Once you have the Transversus Abdominis down, a couple progressions I like are a bridge with leg extension (top) and a bird dog (bottom). The goal of both of these is the same as the transversus exercise. To keep the back steady and not moving while trying to move the legs and arms. You will think about engaging the same muscles, and for added feedback, try balancing a stick or a cup on your hips and back to let you know if a hip dips or your back moves!
Once you have the Transversus Abdominis down, a couple progressions I like are a bridge with leg extension (top) and a bird dog (bottom). The goal of both of these is the same as the transversus exercise. To keep the back steady and not moving while trying to move the legs and arms. You will think about engaging the same muscles, and for added feedback, try balancing a stick or a cup on your hips and back to let you know if a hip dips or your back moves!

There is another important muscle called your Multifidus that functions similar to the Transversus Abdmonis, but sits in the back by your spine. It's main function is to stop you from falling forward when you are bent over. To engage this, it is a bit complicated and I usually spread it out over multiple visits. The good news is, the two exercises above do a great job in activating it. So, for sake of time in this blog, we will stick with that. Once you have these basics down, there are endless fun and exciting exercises to progress to. A couple I really like planks, and plank progressions, as well as RDLs. Anything functional is great, so progressing into tall kneeling, and then standing works well. Remember, you can make any exercise a core exercise, just by switching the focus to stabilizing the spine with the above exercises while performing just about anything!


If this blog was of interest to you, and you'd like to learn more, reach out any time: www.medicinebymovementwellness.com or 907-623-8708. If your interest is in the treatment of your low back in particular, I highly encourage you to sign up for my 6 week Low Back Pain Course!

Starting Tuesday, March 25 from 12-1pm at 311 Price Street, and continuing each Tue from 12-1. Available via zoom, as well as a recording.


*Instructed by Alicia Haseltine, a physical therapist with 20 years of experience treating low back pain.  


You will meet as a group 1x/week to go through specific exercises and treatment techniques to help with your back pain, progress your strength and flexibility, and prevent future problems.  


Videos and information given weekly as homework ranging from proper nutrition to help with your pain, ergonomic set ups to avoid aggravating the back, education in LBP and activity, as well as specific exercises and stretches based off your current function and pain levels.  


This is the perfect transition for those folks that have participated in Physical Therapy, and are ready to be discharged, but don’t feel totally comfortable continuing to work on their own.  It’s also the perfect class to learn new tricks and techniques to prevent future LBP, and just to strengthen your core and improve your overall function! 


Cost is $200 for the course, which is just over $30/session. This is often less than the cost of a co-pay if you are attending PT. 


Unsure if this is for you?  Come to the FREE Low Back Pain workshop on Friday, March 21 from 12-1 and learn some general exercises, as well as more about the program.


Thank you for your time!

Alicia Haseltine PT, DPT, CMPT








References:

1.  A systematic review of the global prevalence of low back pain

Damian Hoy, Christopher Bain, Gail Williams, Lyn March, Peter Brooks, Fiona Blyth, Anthony Woolf, Theo Vos, Rachelle Buchbinder

The Official Journal of the American College of Rheumatology

First published: 09 January 2012 https://doi.org/10.1002/art.34347Citations: 1,988


2. Best Practice & Research Clinical Rheumatology

Volume 24, Issue 6, December 2010, Pages 769-781

Best Practice & Research Clinical Rheumatology 

The Epidemiology of low back pain

Authors: D. Hoy, P. Brooks, F. Blyth, R. Buchbinder 


3. Joint Bone Spine Volume 75, Issue 5, October 2008, Pages 533-539

Joint Bone Spine

Exercise and nonspecific low back pain: A literature review

Authors:  Yves Henchoz, Alexander Kai-Lik So 


4. Does it Matter Which Exercise?

A Randomized Control Trial of Exercise for Low Back Pain

Long, Audrey BScPT*; Donelson, Ron MD†; Fung, Tak PhD

Spine 29(23):p 2593-2602, December 1, 2004. | DOI: 10.1097/01.brs.0000146464.23007.2a


5. Physical Therapy for Acute Low Back Pain

Associations With Subsequent Healthcare Costs

Fritz, Julie M. PhD, PT, ATC*†; Cleland, Joshua A. PhD, DPT, FAAOMPT‡; Speckman, Matthew§; Brennan, Gerard P. PhD, PT*; Hunter, Stephen J. MS, PT, OCS*

Spine 33(16):p 1800-1805, July 15, 2008. | DOI: 10.1097/BRS.0b013e31817bd853

 
 
 

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