Low Back Pain: The Treatments & The Truths

Posted by Andrea Lawson in Training
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Athletes and non-athletes get back pain. Both sedentary and active folks get back pain. Men and women both get back pain. The point I’m trying to make here is that it’s almost inevitable that you will experience some type of lower back pain over the course of your life.

Dealing with low back pain can be frustrating. At the best of times it can not only interfere with your ability to carry out normal daily tasks, but also bring your training or athletics to an abrupt halt.

Back pain is common, can be expensive, and can take a lot of time and effort to properly address.

At the risk of sounding like a Debbie Downer, our back just so happens to be a S.O.B – so it’s important to be informed and realistic so that if and when an issue does occur, you know what to expect and how to deal with it.

Over the past seven years of working with injury rehab clients I’ve noticed the following trends:

  • A lot of people get subpar, outdated physical therapy or chiropractic treatment then deem all treatment as useless.
  • People fixate on their diagnostic imaging (MRI, x-ray, etc.), or waiting for this imaging to be done but pay little attention to the relationship of those scans to their symptoms and functional deficits.
  • Many are more concerned about maintaining a training effect while injured than they are about actually fixing the injury.
  • People spend a great deal of time researching to learn more about their injuries so that they can be informed consumers in dealing with doctors and therapists, but generally wind up more confused because of the varying opinions in the field today.
  • People accept their pain as “normal” and in turn tolerate it rather than addressing it.

 

In THIS post I explain how acknowledging and addressing your back pain is the key to recovery, as well as what you can do to prevent future onsets/flare-ups.

When it comes to avoiding or dealing with back pain, you should:

  • Address your posture
  • Ensure that you’re activating your glutes and core muscles properly
  • Build up general endurance
  • Strengthen your legs
  • Learn how to deadlift

 

However before you can address back pain, you need to accept the fact that you may never get a conclusive diagnosis for the root of your pain. In fact, according to a meta-analysis in the New England Journal of Medicine, 85% of back pain cases have no definitive diagnosis (1). So in other words, all of your imaging and scans may read as normal, but that doesn’t change or diminish the fact that you’re still experiencing pain. A fact I’m sure you’re all too familiar with if you’ve ever found yourself in a similar predicament.

On the other side of the coin, you may be completely asymptomatic, but have a glaring structural issue occurring in your lower back. In one of Eric Cressey’s articles entitled, Low Back Savers he highlights the fact that of the 98 asymptomatic backs doctors studied, “52 percent of the subjects had a bulge at least one level, 27 percent had a protrusion, and 1 percent had an extrusion [82% of subjects]. Thirty-eight percent had an abnormality of more than one intervertebral disk.” (2) And that’s just talking disc issues.

In a great study of elite Spanish athletes, spondylolysis (aka vertebral fractures) proved to be highly prevalent in a wide variety of sports—most notably, track and field throwers, weightlifters, rowers, and gymnasts—yet only 50-60% of those diagnosed under imaging actually reported having lower back pain. (3)

Before I completely overwhelm you with facts, let me cut to the chase.

 

The Truth About Back Pain

The message that I want you to take away from this post is, that diagnostic imaging can be useful, but is only part of the picture. A diagnosis (or lack there of) will not always be a reliable predictor of your functional limitations, your abilities, and/or your symptoms. Most of your injury rehab is going to consist of some trial and error with treatments, as well as consistency of adhering to a corrective exercise program.

Appreciate that pain is a variable of consideration, but doesn’t necessarily dictate the severity of your injury, outline your limitations, or serve as a measurement of your progress. Pain is subjective and can be affected by many other influences; such as mood, how rested you are, other external stresses, and even your personal perception of pain.

Treating Your Pain

There is not one clear answer when it comes to the best treatment protocol to address lower back pain. You will most likely need to try a few different treatments options. I recommend that you pick one type of treatment, and commit to it. If improvements are not occurring objectively—based on your practitioners assessment—and/or subjectively (how you are feeling?) after 3 to 4 weeks, then that particular treatment modality—or maybe that therapist—is not your best option.

Far too often people will seek out several types of treatment options at once. The problem with that tactic is that your body will never really have a chance to adapt and ingrate one particular treatment before it is bombarded by another.

Be picky about who you choose for treatment. Not all are practitioners are equal with their treatment practices, expertise, and experience. Ask around for recommendations, and do your research about the facility. Knowledge is power, and will save you money in the long-run.

You need to identify your triggers. What makes your pain worse? What makes it better?

Pain is an interesting variable that causes the mind to subconsciously and consciously alter movement mechanics in an attempt to avoid perceived situations of threat. It’s crucial that you appreciate that pain will cause a compensation to occur and you will need to address that compensation as your pain subsides – or you’re susceptible to host of new problems down the road.

Identifying your triggers will enable you to avoid completing movements or tasks that irritate your injury, and give your body a chance to recover. Doing so will also help prevent certain compensation patterns from forming. It’s a simple concept that is often overlooked.

Restoring proper movement mechanics can be a bit trickier. So it’s helpful to have someone complete a movement screen, (like The Functional Movement Screen) to help identify key imbalances that are present. Generally you know you have some sort of compensation going on if certain muscles are chronically tight and you obtain little to no relief with stretching or resting that muscle group.

FACT: If you’re currently suffering from low back pain, none of your training should cause an increase in pain during or after. As previously mentioned, training through pain will lead to further compensation and prolong your recovery time. Instead of training through pain, you need to address the compensation.

Please forget the saying “no pain, no gain.” It has no place when discussing injury rehab.

Broadly speaking, we can classify the majority of low back pain suffers into two main categories:

  • Flexion intolerant
  • Extension intolerant

 

Extension Intolerant is back pain that is aggravated by extension-based movement and is typically worse when standing than when sitting.

Generally those who suffer from this type of back pain will have short hip flexors, poor glute function, and a lack of anterior core stability. Conditions associated with extension intolerant individuals are spondylolysis (fractures), spondylolisthesis (vertebral slippage), and diffuse lumbar erector tightness.

Flexion Intolerant is back pain made worse by flexion-based movement. People suffering from this type of pain generally feel it more when sitting.

Common characteristics amongst these individuals are short hamstrings, poor glute function, and poor psoas function. The psoas is the only hip flexor active above 90 degrees of hip flexion, and typically, these folks will substitute lumbar flexion for hip flexion in these positions. Discogenic issues are commonly present among these individuals. Flexion intolerant back pain can be somewhat of an uphill battle, as most people have trouble limiting their sitting time.

The points above are just a few considerations that can help you better deal with low back pain, or a chronic low back condition… but the main point that I hope you take away from this (admittedly long) blog post is that understanding that there are many controllable factors (contributing to your back pain) will help you facilitate your recovery.

In other words, try not to get frustrated and be consistent. Success of your recovery comes down to you putting the time and effort into addressing and dealing with your pain.

If you need help with that, or would like to schedule a FMS test with us, please don’t hesitate to email me at andrea@balancemotion.com.

Pain is NOT something that you have to live with. ????

Andrea

 

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References:

1. Deyo, RA. Fads in the treatment of kow back pain. N Engl J Med. 1991 Oct 3;325(14):1039-40.

2. Jensen MC, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med.1994 Jul 14;331(2):69-73.

3. Soler T, Calderon C. The prevalence of spondylolysis in the Spanish elite athlete. Am J Sports Med. 2000 Jan-Feb;28(1):57-62.