Low back pain is the most common reason people come to physical therapy clinics for treatment. There are many reasons for it, including falls, sports injuries, motor vehicle accidents, or just bending forward to pick something up or to tie your shoes. Sometimes low back pain is just there when you wake up one day without any obvious reason. Low back pain can frustrate both patients and health care providers, however there are things you can do to help to decrease your pain and resume your normal activities.
Some of the things to consider when choosing treatments for low back pain include what caused the pain, what is the quality of the pain (is it aching, sharp, burning, etc), how is it progressing (is it getting better or worse?), if there is also leg pain (nerve impingement), which positions and activities make the pain better or worse, and what the goals of treatment are.
What Caused The Pain?
If the pain is traumatic in nature, like in a fall or motor vehicle accident, it may be beneficial to undergo an x-ray to determine if there has been a fracture. If a fracture was sustained then the necessary healing needs to take place prior to any exercises being performed. It is possible for a fracture to also be sustained when lifting, especially when performed by older individuals. Traumatic injuries can result in other low back injuries as well; such as muscle strains, ligament sprains, intervertebral disc injuries, nerve impingements, spinal cord injuries, and body alignment issues.
If the pain started due to lifting, especially when performed from a low position and combined with twisting and without bending the knees, this can lead to muscle strains, ligamentous sprains, intervertebral disc injuries, and nerve impingements.
What is the Quality of the Pain?
If the pain is more of a dull aching then it is more likely that gentle stretches and other exercises may be tolerated. However if the pain is sharp in nature then more healing may need to take place prior to the initiation of stretching and other exercises. If this is the case, then the RICE approach (Rest, Ice, Compression, Elevation) may be beneficial to facilitate the healing process.
Is it Getting Better or Worse?
If the pain is getting better since the initial injury, then this is a good sign that your body is doing a relatively good job of recovering already and this will likely improve your prognosis (your ability to recover). A focused examination and plan of care will help to pinpoint the treatments and exercises that will help you to recover more quickly and to a greater extent, so that you can return to your normal activities.
Are You Also Experiencing Leg Pain?
If you are also experiencing leg pain with your low back pain, then this may be evidence of a nerve impingement in your low back. Nerve impingements can cause pain, numbness, tingling, sensations of hot and cold, weakness, and paralysis in the areas of the leg that the specific nerve is responsible for. Impingement can occur at any location along the nerve pathway, but some common areas of impingement are in the low back, the sacroiliiac (SI) joint, and the hip joint. Weakness and paralysis are the most severe forms of impingement and require immediate attention so permanent damage is not sustained.
What Positions and Activities Make The Pain Better or Worse? How does this affect treatment?
If your low back pain is worse with sitting and forward bending, then it may be associated with a disc issue, and movements that may help to decrease your pain may include backward bending in standing and laying in prone. These exercises are performed to see what the effect is on your pain. If the exercises decrease your low back pain, or decrease and “centralize” your leg pain (move your leg pain up your leg, bringing it closer to your spine), then is is likely these exercises will help you and are added to your plan of care. If the exercises improve the range-of-motion of your low back or improve the strength of any weak lower extremity muscles after performing them, then this is also evidence that may be beneficial. Other core and lower extremity strengthening and stretching exercises are gradually added to the plan of care when appropriate.
If your low back pain is worse with standing and backward bending, then it may be associated with a bony vertebral issue, and movements and exercises that “round” the low back to open up the space between the vertebrae may be beneficial. These exercises include lying on your back and pulling your knees to your chest or sitting in a chair and forward bending. If these exercises help to decrease your low back and/or leg pain or symptoms (numbness, tingling, etc), and/or improve low back range-of-motion or leg strength after performing 10 to 20 repetitions, then they can be added to your plan of care. Core and lower extremity strengthening and stretching, as well as sport specific or functional activities are included in the plan of care when appropriate.
Note: If these exercises make your low back or leg pain worse, then DO NOT CONTINUE TO PERFORM THEM! This is likely not the appropriate movement pattern for you.
What Are Your Goals?
After determining which movements help with your pain and symptoms, more general strengthening, stretching, and functional exercises should be added to the plan-of-care depending on what level of function you need to return to. Do you only need to return to a desk job and have a more sedentary lifestyle? Then basic core and lower extremity strengthening and stretching may be sufficient. Do you need to return to a construction job requiring heavy levels of activity and lifting? Then you’ll likely require more intense core and lower extremity strengthening, ergonomic lifting technique training, and other job-specific training to ensure a safe and effective return to work. If you need to return to a specific sport, then your rehabilitation will include the appropriate sport-specific training and activities to ensure a timely and effective rehabilitation.
I hope this article was informative. Do you have questions or comments? Please add them below.