Updated June 4th, 2022
Introduction
More than 50% of people experience low back pain during their lives (1). That means more than half of you reading this article either have pain right now, have had back pain before, or you are lying because I think that number should be higher. Back pain is so common that they even mention it in songs!!
“I hopped off the plane at LAX, and I’ve got back pain again”
My first experience with this debilitating pain was four years ago. I was finishing up grad school and doing a whole lot of sitting to study for my PT license exam. I stood up to take a break from studying to throw a ball for my dog, which turned out to be the most pathetic throw of my life. Seconds later, I was on the floor in complete agony and the ball barely made it to Bailey (WHO WAS ONLY 3 FEET AWAY). I spent the next 4-5 days walking around with my upper body tilted to the right, to avoid shooting pain down my left leg.
Luckily, I had just taken a course on The McKenzie Method, which involves a series of movements and positioning to help reduce AND prevent low back pain. This program was a perfect match for my symptoms, which helped me feel back to normal within a few months. Although this method does not work for everyone, I have sworn by it for myself and **knock wood** I have not gone through this experience again since.
Like I said, this method doesn’t work perfectly for everyone. I have had patients feel much better after I teach them for just a few sessions. I have also had patients who did not improve or tolerate the positioning or exercises, which forced me to learn and implement other methods as well. I will take you through some of my typical treatments, along with some videos to ensure your form is correct.
But first, LET’S GET NERDY!!!
Anatomy
You can’t talk about the back without mentioning the core. Has anyone ever told you to engage your core? What did they mean by that? Suck in my gut? I will go through exactly how to engage your core in the treatment section, which is a pivotal technique to improve form during exercises and posture during daily movements. Just in case you are wondering….no this won’t likely give you a six pack. This is about improving your function and control so you don’t incur a back injury while starting your garden this year.
My beautiful artwork shown above is a big back muscle called the quadratus lumborum, we will refer to it as the QL. The QL is a major stabilizer for your back and is used during most movements, which means it is a common place for injury and/or tightness. We will go over some stretches for this muscle later.
Shown below is the musculature of the core. In order to protect your back from injury, all of the core and back muscles must work together during movements. One important core muscle is the transverse abdominis, which we will refer to as the TA. The TA is automatically contracted during many of your movements, unless it is weak or uncoordinated. Unfortunately, the TA becomes weak or ineffective for most people who experience back pain.
Types of Back Pain
What do you mean there are different “types” of back pain? I either have pain or I don't, right? Wrong. There are many aspects of back pain that will alter your course of treatment both at home and with a Physical Therapist. Here is a short version of the three main types (we will discuss these further in future articles):
1. Musculoskeletal
This word means exactly what it sounds like. This is a problem with muscles or bones (of the skeleton). This can be a muscle strain or tear (potentially the QL) or a fracture of a vertebra or associated structure. These injuries are usually movement related, often caused by moving too fast/far, falling, or getting into an accident.
2. Neurological
This type is where things can get a little confusing. Basically, this involves an injury to your spinal cord, connected nerves, or surrounding structures. Have you ever heard somebody say, “I have the sciatic” or “my sciatica is acting up”. It almost makes it sound like a terminal disease. What they are referring to is an injury to the sciatic nerve. This nerve can be tampered with by a structure near the spinal cord such as a disc or bone spur, or by a muscle in the back or legs. These types of injuries are usually a long time coming. Poor posture during rest and movement over prolonged periods of time usually cause these injuries.
3. Systemic
Systemic refers to the systems in our body other than the muscles, joints, and nerves. This can be anything from arthritis to kidney disease to complex disorders like fibromyalgia. Many of our vital organs send pain to the back when they are not functioning properly. This type of pain will usually cause a statement like, “I didn’t do anything different that would have hurt my back”. It will also likely come with an associated disease or health condition. We will discuss this type more in the future, but if you believe you fit into this category, it might be a good time to see your Primary Care Physician because exercises may not be the complete cure. (2)
Treatment Options
The beauty of Physical Therapy is that we learn the basics in school, then find out what works best for our patients on the job. As mentioned above, I learned The McKenzie Method early on in my PT career and I have been utilizing it with many patients since then. The basics of this method are:
Finding the proper balance between back flexion (or bending forward) and extension (bending backward). The average person bends forward more than 5,000 times per day! And most people may not bend backward at all unless their job requires it.
Tummy Time!! Yes, just like for infants, you also need time on your tummy. This position allows the back to completely relax for once. I usually have my patients start just with tummy time for about 5-10 minutes per day to get them used to lying on their stomach again. Usually someone who has more severe back pain will have difficulty staying on their stomach for more than that amount of time.
Progressing extension: if you can tolerate being on your stomach for a while and it is reducing your symptoms, then you can progress the amount you bend backward with the video below. If you still have pain just laying on your stomach, then this progression is not appropriate for you. (3)(4)
Check out our video on the McKenzie Method below!
Best Exercises
There are many variations of exercises that will help strengthen the muscles around your back and avoid future injuries. I have arranged the videos below in order of easiest to hardest. The first video is an exercise that can be done early on after an injury, as long as it isn’t significantly increasing your pain. Progression of exercises should be explored when pain and symptoms have reduced.
Pelvic Tilts - used to contract the TA
Dead Bugs
** Special bonus for those of you who do not currently have back pain and would like to know the proper form while doing a plank. Check out this video by our friend Kendra!! **
Conclusion
One of the most common (and frustrating) comments I hear from patients is “I have had back pain for 30+ years”. This is considered chronic back pain and is sometimes harder to fix than a recent back injury. Whether you have a 30 year history of back pain or were recently injured, Physical Therapy is a great option for getting this pain under control or even reversed. And yes, I believe it is the best option because I am biased. But there is a lot of amazing research out there demonstrating how effective Physical Therapy is for helping people with back pain! (5)
Stay tuned for more information on back pain in the future. You are not alone if you have back pain and I hope to help send you in the direction of better movement and less pain.
Wondering if you should use heat or ice on your back? CLICK HERE
References
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