HOW DO I GET RID OF LOW BACK PAIN?

Low back pain is the leading cause of years lost to disability globally.  In 2015 over 500,000,000 people experienced low back pain at some point.  The lifetime prevalence of low back pain is estimated at 60% to 70% in industrialized countries, per the World Health Organization.  That means that 60% to 70% of people in developed nations will experience low back pain at some point in their lives. Additionally, recurrence rates (how likely something is to occur again within a given time frame) vary anywhere from 15% to a whopping 84% within 1 year.

The silver lining in all of this?  Most back pain incidences resolve within 4 to 6 weeks generally speaking.  Not all cases, but a lot of cases.  

Now, you may be asking, “Why are you bringing all this up when I want to figure out how to ELIMINATE my own back pain?”  For 2 very important reasons that are often not discussed in traditional methods of care.

1. You are not alone

2. It can get better

Before we talk about how we at Headquarters Physical Therapy approach low back pain, let’s talk about some of the more common myths of this phenomenon.  

Myth 1: Low back pain is caused by core and glute weakness

While core and glute exercises can be helpful for some when dealing with low back pain they are far from a magic pill.  There is no evidence to suggest that development of these muscle groups is superior to anything else for reducing pain. If this were the case, then some of our highest-level, professional athletes would never have back pain yet we know that that is not the case.  

Myth 2: Low back pain is caused by muscle “tightness”

Another commonly held belief about low back pain is that it is caused or contributed to by hamstring or hip flexor tightness or some combination of both.  Try as you may, you will be hard pressed to find any solid research that points to stretching being either a cure for existing back pain or an impactful preventative measure for back pain.  

Nevermind the fact that a definition of “tightness” doesn’t exist, from a purely anatomical perspective the length of your hamstrings and hip flexors has no significant bearing on your static postures and positioning.  This brings us to our third myth.

Myth 3: Low back pain is caused by sitting (or any other bad posture)

You’ve likely heard of the analogy that the discs between our vertebrae are like jelly donuts and when you sit in a rounded back position the jelly shoots out the back of the disc, hits a spinal nerve, and all of a sudden you crumble to the floor writhing in pain.  Allow us to apologize on behalf of the entire medical community if that is the analogy that you have been sold about your pain experience and have therefore tried to remedy your situation with countless pillows, posture trainers, and the self-criticism that ensues because you should “know better than to sit like a slouch”.  

Given that there is no reliable window of acceptability of “normal” posture it is therefore impossible to derive at a safe vs. unsafe dichotomy of posture and position.  There is also no reliable data to suggest that sitting in and of itself is hazardous to spine health. Can it be uncomfortable? Yes! But so can a lot of other positions that are far less demonized in society.  

So, no, sitting is not the new smoking.  Smoking is still smoking.  

Let’s look at our last and final myth.

Myth 4: Low back pain is caused by structural changes in the back

Here’s an all too common scenario: You have back pain that you ignore until you can’t and then you call your doctor.  Your doctor looks at you and pokes around and orders some imaging. The xrays and/or MRI’s come back showing some changes in your discs (maybe something called “disc degeneration”).  Your doctor says, “Your back hurts because of these things” and points to certain areas of your films that look like a rorschach test and uses words that have way too many syllables. Then your doctor tells you, “Don’t do any strenuous exercise because you have the spine of an 80 year old.”  You walk out of the office feeling hopeless and more confused. Six weeks later you get a bill for an amount that is going to force you into a diet of Top Ramen.  

The thing is, we have very solid evidence that points to the fact that these “abnormalities” that are often found on xray and MRI reports are 

1. More common in populations younger than we once thought

2. More common in asymptomatic populations than we once thought (almost as common as symptomatic populations)

Perhaps we should call these findings “normalities” instead?  A new way of looking at these findings is like the wrinkles on our faces or the gray hairs on our heads.  We might wish that they weren’t there, but they aren’t causing us much harm in the grand scheme of things.  

So now what?

The reality is that we can’t give cookie cutter advice for how to resolve your back pain.  Anyone who claims “If you just do A, B, C and X, Y, Z your back pain will go away” is doing you a huge disservice.  The reason why is that we’re all unique. Our symptoms and their alleviating factors will behave differently because we are all different.  We all have different thoughts, emotions, and physical tolerances and they all play an equally pivotal role in our back pain.  

What we can do is provide you with some general guidelines to follow.

1. Try not to worry - It’s been shown that catastrophizing has negative implications in dealing with pain.  Realize that your back pain is very likely NOT a result of something being broken that needs fixing.  You are a human being, you’re not a car.  

2. Try to stay active - Keep moving to tolerance.  Remember that there is no magic exercise for back pain.  If you feel like going for a walk then go for it. There’s no need to avoid discomfort altogether but you also don’t need to go hike Mt. Everest when you’re hurting. 

3. Gradually reintroduce and increase activity - Remember that 4-6 weeks is a common timeframe.  Slowly bring back your normal routines in a judicious manner and you should be ok.  But be gracious with yourself if you aren’t recovering as fast as you think you should simply because you’ve seen others get better in a shorter amount of time.  

4. Call us if you need help - This is where most physical therapy clinics would try to sell you on calling ASAP with some promise to alleviate pain with a magical treatment.  We’d like to take this opportunity to utilize a different approach. Truth be told we would not judge you if you wanted to try and manage this on your own for a little bit.  However, if you feel lost, if you feel like you aren’t making progress, if you are at all concerned about anything, or if you’d rather have someone walk with you through this ordeal from day 1 then feel free to call or email us. 

We’re here when you need us!