Here’s a different take on treatment…
Are you currently suffering from low back pain? Have you ever had an episode of low back pain in the past? If so, you are not alone. Eighty percent of Americans will experience back pain at some point in their lifetime and statistics show that low back pain becomes more common as we age. [1]
This may surprise you, but I have been dealing with low back pain myself. That’s right – just because I’m a Physical Therapist doesn’t mean I‘m immune to injury or pain.
In the past, I would experience low back pain without it being too debilitating. It would usually resolve within a few days or weeks and I would get on with my life. However, I have been experiencing mild right-sided low back pain and tightness consistently for a few months now. I am sure it is due to a hip injury I am currently dealing with, not exercising as much as I would like to, and putting on a few extra lbs over the holidays, but nonetheless, it is still concerning. Later on, I will discuss some exercises I am doing to address my pain.
Do you need an MRI?
Chances are if your pain has lingered or interrupted daily activities you have seen a doctor or done some of your own research. It can be very scary to read what you may find on the internet and you may rush to the doctor and think you need an MRI ASAP!.
The good news is generally MRIs and X-rays are not necessary unless you’re having the following symptoms:
- Sudden bowel/bladder incontinence
- Numbness in your saddle region (think where you’d sit in a saddle)
- Significant weakness affecting your balance or gait.
- Severe piercing pain radiating down your leg in a very defined area no more than 2-3 inches wide.
Many of the findings we see on MRIs are just normal signs of the aging process such as degenerative disc disease, spinal stenosis, and herniated or bulging discs. [2] These findings can be concerning, however, there is GOOD news! Research has found that these x-ray and MRI findings are consistently found in individuals WHO HAVE NO SYMPTOMS! This means that just because we see something on an MRI does not necessarily mean it is the cause of your pain. These are common medical diagnoses for low back pain, especially if you are over the age of 50.
How can a movement diagnosis help to treat low back pain?
Now that we understand that MRIs and X-rays are just a piece of the puzzle to finding a fix for your pain we have to look at how you move or more importantly don’t move. We know that many people who have the same x-ray and MRI findings could have little to no symptoms. It works the other way as well. We have seen some x-rays and MRIs that look like that person shouldn’t even be able to walk but their physical presentation just doesn’t match what their MRIs show. This is why a physical exam and a movement diagnosis are imperative in finding solutions to low back pain.
A movement diagnosis is determined after performing a movement assessment. During a movement assessment, a person is asked to perform several common movements (i.e. bending forward, bending backward, twisting, squatting, single-leg standing, reaching behind the head, and reaching behind the back). Certain criteria are expected for each movement and what we find in this assessment drives how we start our treatment.
The movement assessment is a holistic approach to determine why the person is experiencing pain. From this assessment, we can determine what movements cause the symptoms to increase and if a person’s low back pain is a result of hip tightness, Thoracic spine tightness, core instability, or a combination of all of these findings. This helps to determine where to focus the treatment on and what exercises to prescribe to treat the symptoms. Refer to our Mobility blog from last month and try the mobility tests Susan Peterson describes.
Improving the quality in which a person moves will reduce excessive stress and strain on certain body parts (i.e. the low back). Below are a few corrective exercises we use regularly when addressing mobility and strength/stability issues related to low back pain.
Mobility Exercises to Treat Lower Back Pain
When treating low back pain it is common to see patients with tight hips and/or thoracic spine. After all, these are the body parts closest to the low back and if they are restricted in their mobility, they will often place undue stress and strain on the low back. Below are some stretches to address the thoracic and hip restrictions that I am doing myself.
- Prone Quad stretch
- Lie on your stomach with a stretching strap around your foot.
- Pull the other end of the strap over your opposite shoulder bending the knee until a stretch is felt in the front of your thigh.
- Hold for 30 seconds and repeat for 3 repetitions on both legs.
- If you experience pain in your lower back while doing this exercise, place a pillow or two under your pelvis.
- Supine Active Leg Lowering
- Lie on your back with one leg flat on the floor (knee straight and toes up) and the other leg propped up on a bed/door jam with the knee straight and toes up. You should feel a mild stretch on the back of the thigh of the leg that is propped up, but it is important to make sure that the opposite leg stays flat on the floor.
- Keeping your back flat on the floor, raise your leg from the floor keeping the knee straight and toes up. Also, keep your hip, knee, and foot in line with the same shoulder.
- Hold for 3 seconds and slowly return your leg to the floor while keeping your back flat on the floor. Repeat for 10 repetitions with both legs.
- Side lying Thoracic Rotation stretch
- Lie on your side with a pillow under your head.
- With a foam roller or pillows in front of you, flex your top leg bringing your knee toward your chest and hold the knee in place on the foam roller/pillows using your bottom hand.
- Grab your rib cage from the bottom using your top hand and attempt to rotate your torso back pointing your chest toward the ceiling.
- Take deep breaths into your abdomen by breathing in through your nose and out through your mouth slowly for approximately 60 seconds.
- Repeat on the other side.
- Be sure to keep the top knee from sliding down.
- Relax your shoulders and don’t strain your neck to rotate.
Stability Exercises to Treat Low Back Pain
When performing activities such as lifting or squatting the low back should remain relatively stiff during the movement. Unfortunately, this is typically not the case when working with people experiencing low back pain. They are unable to stabilize correctly leading to excessive movement in their low back, which can result in pain and injury. As a result, we start with the fundamentals, which is diaphragmatic breathing and abdominal bracing, to get the core muscles working correctly and then progress from there.
- Supine 90-90 diaphragmatic breathing
- Lie on your back with a pillow under your head and your lower legs resting on a couch/chair. Your hips and knees should be bent at 90 degree angles and your back should be flat on the floor.
- Place one hand on your chest and the other over your abdomen.
- Take a slow, deep breath in through your nose (should last approximately 4-6 seconds). Then exhale out through your mouth with your lips pursed (i.e. like you are blowing air out through a straw). The exhale should also last approximately 4-6 seconds.
- Concentrate on having your abdomen rise during the inhale and lower during the exhale using your hands for feedback.
- Perform for 3-5 minutes.
- Supine 90-90 Abdominal bracing
- Begin in the same position as the Supine 90-90 diaphragmatic breathing exercise above – lying on your back with a pillow under your head and your lower legs resting on a couch/chair. Your hips and knees should be bent at 90 degree angles and your back should be flat on the floor.
- Take a diaphragmatic breath. Inhale through your nose and exhale out your mouth with pursed lips.
- Following the exhale and before taking another breath in stiffen your abdominal muscles by pushing your abdomen out.
- Maintain this “brace” while you resume normal breathing for up to 1 minute.
- Bird dog
- Begin in a crawling position with your hips directly over your knees and your shoulders directly over your hands.
- Next find your “neutral spine” by finding the midway point between a fully flexed and fully arched spine.
- Then create an abdominal brace by stiffening your abdominal muscles and maintaining your normal breathing pattern.
- Once you are stable, reach one arm out in front of you and the opposite foot out behind you. Hold for 5 seconds.
- Return to the starting position without putting your weight through your moving arm and leg and then reach out again.
- Perform with both sets of opposite arm/leg x 10 reps.
- Focus on maintaining a “neutral spine” throughout the whole exercise.
- If you would like additional tips to help you manage your low back pain, we have a free e-book you can download. Click here for access.
- We are available for a free 15 minute phone consultation to talk about how your pain is affecting you and to discuss your treatment options.
- If you are in pain and unsure about what your next steps should be, call us at (301) 539-3807 and ask how we can help.
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