I kid you not, 80-90% of people resolve their low back pain in 3 months with OR without a therapist laying a finger on them. This is when most people with low back pain give me a look of disbelief (sometimes even more), but it’s something we see clinically. Of course, there are special cases as well as ways to speed up the process and prevent the pain from coming back. If you have neurological symptoms such as accompanying pain that shoots down your leg, that can last as long as 2 years before you experience any relief. My point is that low back pain is the most confusing condition an orthopedic physiotherapist (yours truly) ever deals with. On top of that, there are more opinions about how to deal with it than I can count on my fingers. So why the confusion? For starters there are a lot of pain-provoking structures within that region including muscles, tendons, fascia, ligaments, nerves, vertebral joints, disks, and so on. On top of that, you can have nearby joints like the SI joint (the one that attaches the pelvis to the spinal column) seem and feel like low back pain. Did I mention psychological factors? Without getting into too much detail about the anatomy, here are some awesome ways to rid yourself of back pain that is ruining your life.
1. The Notion that Motion is the Back’s Lotion
This goes out to people who are stuck sitting for a large chunk of their day. The usual victims are desk employees and truck drivers. I like using truck drivers as an example since they can go a ridiculous amount of hours driving in order to deliver something on time. So let’s talk about John who drives an 18 wheeler delivering huge slabs of granite across Canada. He spends 12 hours a day driving to his destinations and delivering these bad boys. During that drive, he adopts a certain posture that he maintains without much switching except for the odd butt scratch. Afterwards, he has to get off the truck and unload the heavy granite right away. While lifting, he uses a combination of bending down and lifting while rotating his back which eventually leads to a sudden onset of low back pain. So why did this happen? When your body maintains a certain posture for long enough, tissues that aren’t needed such as muscles, tendons, and ligaments receive less blood flow. When this happens, they become more rigid and less capable of giving way to loads. Couple that with lifting heavy weights while these tissues are still “cold” and this leads to disaster.
Solution: Warming up the lower back is what I meant by motion being lotion. That’s right, I’m bringing the warm-up back (although I don’t know why it was even gone in the first place). Some good warm up techniques include alternating between bending and extending, and doing hip circles for 20 repetitions each. Make sure that when you get to the end of your range of motion, you add an extra push or pull to get more of a stretch. Ideally, you want to get to a point where your heart rate is increasing and you feel some heat build-up around your low back area.
Handy Home Exercise Plan: Try this nice exercise that will take you from the end range lumbar flexion (bending) to end range lumbar extension (straightening): Alternating between a child’s pose and a seal’s pose (see above). To emphasize the stretch, try holding each rep for at least 5 seconds before transitioning to the next. Do this for a total of 20 repetitions as a morning routine which has the benefits of lubricating your vertebral joints as well as promoting increased joint nutrition delivery and loosening things up.
2. Tuck your Belly in Before Lifting Anything
Clients will point directly to their lower back when asked where their pain is 9 out of 10 times. But because of that, they also assume that this region must be targeted to relieve the pain. That is only partially true. I say this because adding a hot/cold pack and/or electrodes directly on the lower back can provide some relief, albeit temporary. However, just like the knee, the lower back can also be the victim and not the cause of the pain. The culprit is usually the core although I’m not talking about your 6-pack. Deep to that is a muscle called the transversus abdominus (TA for short) that extends its muscle fibers horizontally towards both sides of the body before wrapping behind and attaching to the vertebral column. This muscle is activated when you draw your bully button in towards your spine or in other words make yourself look slimmer. Simply learning to draw your belly in before attempting to lift something goes a long way in:
- Bracing your spinal column by tugging at it from both directions to keep it rigid.
- Cueing more muscles to activate which takes pressure off of passive (non-contractile elements) structures like ligaments, joint capsules, and disks.
- Putting your spinal cord into a more neutral position which helps to relieve pressure off the vertebral joints.
But the core doesn’t just end with the TA muscle. It also includes the pelvic floor muscles, the diaphragm, and another muscle called multifidus. Addressing these muscles is a topic for another discussion but a good practice is to activate them while lifting an object. The pelvic floor muscles can be activated by “lifting” them. A good way to understand this is by imagining you want to hold in your pee or poop. The diaphragm is best activated when you take controlled, deep breaths while lifting and making sure that you breathe out while lifting an object up (i.e. concentrically), and breathing in while lowering it (i.e. eccentrically). To sum it all up, I want you to tuck your belly in, lift your pelvic floor, and take deep breathes all at the same time. Not easy right? I will never ask anyone to maintain core activation 24/7 because that’s not even remotely realistic. With practice, total core activation is a great way to brace your lower back before and during a lift to prevent injury.
3. Address Other Joints that can Contribute to Back Pain
It’s easy to think of the low back as an isolated structured encompassed by the lumbar portion of the spinal cord. Yes, it’s a big piece of the low back pain puzzle but no, it’s not the only villain. Take for instance the SI joint. Many things can happen to this joint to cause pain, but usually it’s one-sided stiffness (there are two SI joints for each side of the pelvis after all). The SI joint isn’t located in your “typical” low back pain region but it can refer pain to it. This means that low back pain can be the result of SI joint dysfunction! In fact, some studies suggest that 1/5th of low back pain cases are actually the result of this. So what does this mean for you? Either something or nothing but either way it’s good to have more confidence about the cause of your low back pain. The SI joint is more likely the cause of your low back pain if certain things aggravate it such as standing on one leg, climbing stairs, rolling over while lying down, getting in and out of a car, or anything that causes you to sustain a posture for a long time (e.g. prolonged sitting). If you’re beginning to think your SI joint might be the problem, try these 2 simple stretches that can be done in bed in the morning and evening:
- Lying flat on your back, use both of your hands to bring one knee as close to your chest as possible. Once in this position, add a bit of overpressure to cause more stretch for a 1-second hold and release. Try 30 seconds of this for each leg.
- Getting into a lunge position, keep your torso tall and maintain your back knee on the floor. Then lean forward by driving your hips forward as far as you can. Once in this position, add a bit of over-pressure to cause more stretch for a 1 second hold and release. Try 30 seconds of this one too for each leg.
I want to emphasize that these are 3 very actionable things you can implement right now to rid yourself of terrible back pain. There’s nothing difficult about these methods yet the toughest part tends to be consistency. Each of these 3 strategies require daily implementation to help reduce your back pain and prevent further episodes. That’s not to say this list will work for 100% percent of you and for that I recommend you see a rehab specialist like a physiotherapist for a full assessment. If you have any follow-up questions, feel free to post a comment or contact us through phone/email!
Let’s get rid of that back pain!