The Ascent #3: What to do with low back pain.

At any point during your life you are likely to experience an episode of pain in your back with any varying degree of intensity and impact on life. Most people will experience this at some point and most people get better from it on their own, over time. Having had an episode myself, I understand the dramatic influence it can have on every aspect of your life. It changes every move you make, alters everything you do, and completely occupies your mind while you’re processing through it.

Knowing what a huge life experience this can be leads to the question: “What do you do about pain in your back?” Well, the first thing I do is figure out where we are in the process. Is this a fresh problem (acute stage) that started in the past few days or within a week? Is it a problem that’s been around for a couple of weeks or months (subacute)? Or is it a problem that’s been around, continuously, for years (chronic)? The important thing to distinguish is just because there have been episodes in the past and it has gone away and now it has returned, to me that means this is a new episode and I would stage it as a renewed acute stage rather than grouping it into chronic just because the history.

Why stage? By staging the condition it helps to guide how to manage it. Through outlining the management of different stages you’ll notice there are distinct differences in how to manage those stages in different ways.

Acute Stage(A few days to couple of weeks):

Objective- restore postural positioning and pain-free active range of motion

Approach- activity modification, active recovery, abdominal bracing with position changes (making sure not to hold breath), prone on elbows progressing to prone press ups, postural shift corrections against the wall (elbow on wall, hip shift toward the wall), single knee to chest, supine trunk rotations. Gentle muscle spasm management with massage, joint mobilization, stretching or trigger point release. Walking or cycling (upright position) for fitness. ALL COMPLETED WITHOUT A PROGRESSIVE INCREASE IN SYMPTOMS DURING THE ACTIVITY.

Subacute Stage(Couple of weeks to a few months):

Objective- reengage/reintegrate into usual physical and social activities

Approach- Exercise is key, fitness activities, weight training, aerobic activity, graded exposure (gradually increasing activity level with a specific regimented approach including allowance for symptom response and recovery). Continue prone press ups, standing lumbar extension, progress core stabilization training, if appropriate adding in deadlifting and lumbar extension strengthening.

Chronic Stage(Few months and beyond):

Objective- Functional activity participation emphasis, mindset change/shift

Approach- Change mindset from vulnerability to resilient (the body is strong and tough, not as vulnerable as it seems), sub-threshold loading with graded exposure to increased loads, aerobic activity, lifting weights or loading muscles and structures in different ways, dead lifts, squats, rows, push ups, pull ups, core strengthening/stabilization, maintaining range of motion with prone press ups and lumbar extension.

As with anything a one size fits all approach isn’t perfect and individualized approaches are often better or more appropriate. There are situations where some of these things would not be appropriate for certain conditions but in many cases these can be a good starting point or outline for beginning to move forward.

One of the biggest points to be made here is that back pain can make you feel fragile and vulnerable, but it gets better most of the time and the body is stronger and more resilient than it feels. Not being overcome by the feeling of vulnerability and moving forward with strengthening and movement is the best way to move forward with and active life.

If you have any questions or have decided it's time to do something about pain in your back, reach out!