Did you know that only a small percentage of individuals with low back pain require surgery, opioids and/or injections? The majority of individuals can manage treat and fix their back pain. These statements make treating low back pain sound easy. Unfortunately, it is not easy – treating low back pain can be very challenging and can require great effort. The good news is, as a medical community we tend to over complicate low back pain treatment. In reality it is not complicated – it does require a large amount effort focusing on self-awareness, symptoms recognition, exercise progressions, and consistency over time.
Back pain treatment can be broken down into two separate phases- correction and maintenance. The correction phase focuses on fixing the problem. The correction phase may include assessment of spinal loading (posture, positioning, repetitive activities) and muscle imbalances (muscle strength/instability, muscle length/tightness). The maintenance phase focuses on being proactive and consistent with activities over a period time that were fixed in correction phase.
Let’s talk about the most common form of back pain. The majority of back pain is triggered by asymmetrical loading of the spine, which effects the spinal discs. As a whole we spend too much time in a bent forward position, also known as a flexed position. If the spine bends forward excessively, too much in comparison to bending backwards, the disk will begin to build up on the back end of the spine. This irritates the soft tissue in the low back which includes muscles tendons ligaments and even nerves. Poor posture repetitive bending and leaning forward all attribute to the number of time the spine bends forward.
What is the fix? Well, did you know that the average person will bend forward 35 times to every 1 time they bend backwards. The fix is to reduce the ratio of flexion to extension. Proper body mechanics with repetitive bending and/or daily activities, as well as, monitoring posture (remember poor posture bends the spine forward) help reduce the number of times the spine flexes forward.
One of the most important activities is bending backwards exercises. This can be done while standing, against a wall, or on the floor. By increasing the number of times, the spine bends backwards, we can easily change the flexion to extension ratio.
Due to the pain, muscle tightness and muscle strength changes may occur. In the presence of pain, muscle tends to atrophy or shrink. These muscles needed to be strengthened to provide spinal stability and to increase activity tolerance. Remember, when in pain the body begins to tolerate less and less activity before it begins to experience pain. Muscle strengthening helps to increase this tolerance during normal daily activity.
Muscle length also changes when in the presence of pain. Muscle tend to increase tone and shorten when pain is present. The body does this as a defense mechanism to help protect the area that is injured. It is important to note that pain is the body’s alarm system that alerts the brain that a particular body part or joint is in danger. The muscle tightens up to protect that area.
As activity patterns and muscle imbalance are corrected, the pain should subside. Unfortunately, just because the pain subsides does not mean that one gets to return to their previous activity. Individuals need to maintain new habits and avoid old. Low back pain, if managed correctly, may take several months to permanently reduce symptoms; therefore, consistent posture and spinal positioning in addition to an exercise schedule for maintenance are important. Many times, maintenance exercises and activities are the same or very similar to the exercises that reduced the individual’s pain. The good news is, typically the exercises can be performed at a less rigorous intensity and frequency than initially required.