• Jacob Reynolds PT, DPT

A Beginner's Guide to Low Back Pain

PREVALENCE

Did you know that low back pain (LBP) is the 3rd highest reason Americans visit the doctor?

In fact, this number is so high it is considered an “epidemic.”

The economic burden low back pain has on the United States is estimated to be as high as $100 billion annually.


DIAGNOSTICS

So you ask, if the prevalence is just as high as the common cold, why are we, the healthcare system, so bad at treating and helping individuals manage LBP?

Well as it turns out our approach for diagnosing and treating LBP was off.


In the past we have used highly sensitive imaging techniques such as magnetic resonance imaging (MRI) or Computed Tomography (CT) scans to diagnose these conditions. However what we now know about these tools is that their findings are not actually strongly correlated to symptoms of LBP.


In fact, some studies show that upwards of 30% of individuals who display “abnormal” findings on MRI or CT actually have no back pain symptoms at all. Other research shows that 75% of individuals who have a disc herniation as confirmed by MRI have no sciatic symptoms.


Point being, sometimes these tools are too sensitive. They do a great job of detecting every minor abnormality, but those abnormalities rarely correlate to symptoms.


SO WHAT IS CAUSING YOUR SYMPTOMS?

Predictors for low back pain include variables such as age, sex, job demands, activity level, and psychological factors.


Things that are not predictive of low back pain include variables such as: genetics, core strength, spine flexibility or family history of back pain. This might come as a surprise to most, but research has yet to show any significant link between these variables and low back pain.


What we must understand is that our bodies are systems. Therefore, we must address the system as a whole, not just one part. We typically find a combination of variables that correlate to low back pain related dysfunction, including: biomechanics, instability, lack of coordination, joint mobility, muscle imbalance, nutrition, sleep, or stress.


WHAT TO DO ABOUT THIS?

Generally, we know that increasing activity level reduces our symptoms. We also know that joints get nutrition through movement. They actually heal when we move. This is why in the morning we may feel stiff after a long night of sleeping and then as you get up and move we loosen up. Our joints are receiving lubrication through that movement. Which explains the achiness we may have in our back when we try to over protect it by not moving it.


Surprisingly, large portions of low back pain symptoms are fear driven. After an injury we have fear of hurting our selves again, so we avoid movements that have triggered episodes in the past. An injury may lead us to feel that our spines are fragile, when really our spine is extremely strong and can endure significant loads.


TRY THIS

Multiple times per day find a space on the ground and perform the following exercises. Do these four exercises on a daily basis to reintroduce good movement back into your life. You are allowed to repeat them multiple times per day. Experiencing aches and pains along the way is okay. Trust and understand that your body is a strong system and that movement will ultimately be the launching point for you to regain control over your back pain.


Cat-Cow – on all fours (hands and knees) round your back up like an angry cat rounding your pelvis and tucking your chin, holding for a few seconds, then extend out the other way, arching your back, extending your head, and sticking your buttocks out. Do that at a slow pace 10-20 times.


Prone Press – lie on your stomach and prop up on your elbows, trying to extend through your low back. Hold this position for a few seconds, then lay back down on the ground, moving between positions of propping on your elbows and laying flat. Do this 10-20 times.


Lower Trunk Rotation – Lie on your back with your knees bent and your feet on the floor, slowly and gently drop both your knees to the same side. Then rotate your knees to the opposite side. Repeat this 10-20 times.


Assisted Squats – find a doorframe, counter top, or back of a sofa. Then hold on and sit your bottom back is if you were going to sit in a chair, ensure that you are sticking buttocks out and not allowing your pelvis to round out, your knees should be at a 90 degree angle, hold for a second and push back up, repeat that 10-20 times.


Jake Reynolds is an orthopedic physical therapist at Functionize Health and Physical Therapy. He specializes in treating athletes, both elite and recreational level, with expertise in swimming and running athletes. His methodology includes a whole body approach, helping individuals find the source of their symptoms by understanding their story and addressing the entire system and not just one specific body part. Jake received his Bachelors in Exercise and Sports Science from the University of Alabama, completed his Doctorate in Physical Therapy at Mercer University, where he also completed his residency in orthopedics. Areas of personal interest include sports, pain science, neurodynamics, manual therapy, and clinical reasoning.

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