Back pain sucks!!! If you're currently experiencing back pain, I feel for you. Back injury directly and massively affects your quality of life, so getting pain-free is the highest priority. This post is for anyone who has recently injured or re-injured their back. Here is what to do to avoid further injury and to recover as quickly as possible.
Step 1: Getting out of Pain
Visit a "Qualified" Doctor
First, go see a doctor if you’ve had a traumatic event like a fall and to rule out more serious forms of back pain like tumors, cardiac conditions, and disease. Consult your doctor before embarking on new exercises or self-diagnosis. You may have a specific condition that could be worsened by exercise - check to be sure.
When I say "Qualified" I'm not talking about a doctor who has gone to the best school, works in the best hospital, or has years of experience seeing thousands of patients. These traditionally "qualified" doctors are likely to waste your time focusing on the symptoms and recommending drugs or surgery to "fix" your pain.
“A thorough assessment reveals the cause of pain better than any image.”(Page 6, Low Back Disorders by Stuart Mcgill)
It’s estimated about ⅓ of 20 year olds have a disc bulge without any pain, and that number climbs as we age. [Source] X-rays and MRIs help us identify specific structures that might be creating pain, but these images alone are insufficient to diagnose the cause of chronic pain. Pictures are not linked to pain!
I spent years going from one doctor to the next to get expensive images of my back, but never once did a doctor review my posture, movement, or function to explain the CAUSE of my pain. Most doctors deal only with symptoms, so make sure you find a doctor who applies a functional and holistic view to chronic pain.
Here are qualified clinicians that can help you diagnose your back pain.
Complete a Functional Diagnosis
After you’ve visited a McGill Clinician to rule out more serious forms of back pain, you should have a better idea of what causes you pain so you can stop “picking the scab” and allow your tissues to heal. Back pain is almost always made worse by one particular motion, posture, or load that the individual unknowingly repeats.
Just because you've visited a doctor doesn't mean your problems are solved. No doctor is perfect, and your back pain is ultimately YOUR RESPONSIBILITY.
Begin by starting a list to describe your pain. Some people avoid making a list because they think they “already know what hurts,” but this arrogance will see that a solution is never found. To heal yourself, you must study yourself and practice pattern recognition.
Here are a few questions to answer as you compile your list.
Does the pain get better or worse depending on the time of day? Does your pain gradually build throughout the day or is it greatest upon waking?
Are there particular activities or situations when you notice your pain more? Things like bending forward or to the side, sitting in a car or on a plane, rolling over in bed, reaching, or sneezing?
If sitting causes you pain, how long until you notice?
Do you feel better or worse after exercising? Do particular exercises make your pain better/worse?
Does your pain worsen when stress increases or with the changing seasons?
Are certain muscles habitually tight or do you notice areas of your body that store tension?
Write down details to every pain you feel because these are pieces of the puzzle that is your chronic pain. Look for patterns in postures and movements so we can avoid triggering your pain and allow your body to recover. It’s a miracle how quickly you can heal yourself once you stop triggering your pain and adopt the right protocol.
This is just the tip of the iceberg. To perform a complete functional diagnosis including common back pain causes, posture analysis, trigger point testing, movement analysis, and muscle testing, check out my book "What's Wrong with My Back" by entering your email to get instant access.
Avoid Triggering Your Pain
Once you've identified the motions, postures, and loads that cause you pain, the first step is to simply avoid these! We need to provide your low back with some pain-free time to recover. This is not a long term solution, but if you're constantly triggering your pain there's no drug, surgery, or exercise that's going to help.
If the activity that causes you pain is unavoidable, do everything in your power to adjust. For example, if sitting causes you pain, avoid sitting for long periods of time, adjust your seat to provide relief, or choose other positions that cause less pain.
No matter the cause of your pain, there's always something you can adjust. I've helped hundreds of people overcome chronic pain, and the people who see results are those stubborn enough to NEVER GIVE UP!
Even changing your mindset about your pain can have a significant impact. Instead of seeing your pain as torture from God, see it as a challenge to overcome. With all things in life, it's difficult to enjoy the journey when it's happening, especially with back pain. However, your attitude will determine your success, and if you see your pain as a challenge to overcome you're much more likely to succeed than if you see it as an enduring sickness.
Step 2: Stay Out of Pain
Once you've identified what causes your pain and you've avoided your pain triggers, you should find that your pain has diminished significantly. Oftentimes this is all a person needs to be pain-free. Greater body awareness and empowerment to understand you are in control of your pain can be enough.
For other people, it can feel like they have a lower back made of fragile glass, and even though they understand the cause of their pain it can seem impossible not to trigger it.
This is where habit change and strengthening play the biggest role.
Habit Change
The solution to chronic musculoskeletal pain is habit change. There's no easy fix one time, and this is why so many people seek drugs or surgery.
Pain medication does nothing to address the cause of your pain, it’s addictive, and can include harmful side effects. Not only that, but the drugs can allow you to continue activities that are causing further damage by allowing you to dull the pain - a terrible solution!
Back surgery is a pain treatment with diminishing returns. It’s estimated 30% of people make progress after a second surgery, but only 15% make progress after a third surgery [Source].
“The notion that surgery will eliminate back pain does not have statistical support. People have to manage their postsurgical backs just as much as they would their nonsurgical backs.” (Low Back Disorders, Stuart McGill, pp. 14)
In order to experience long-lasting pain relief, the only solution is to change your daily habits. Make mobility and strength training a part of your regular routine.
Mobility Training
A muscular imbalance can cause joint dysfunction at the hips that puts excess strain on the low back. Stretching tight muscles can directly help back pain.
The couch stretch can provide immediate relief to some people by stretching habitually tight hip muscles. Performing this stretch for 2 minutes per side morning and night is a good start if you suspect you have tight hips.
There must be balance above and below the lower back, and the prayer stretch can help to open up the area above the low back.
Stretching can be helpful for back pain, but all stretches are not equal. At yoga classes, the instructors would have me stretching my lower back, and while that felt good in the moment, when I got home my pain would be worse!
When a person with tight hips bends down, they move with their low back. When a person with a tight thoracic spine reaches up, they move with their low back. Back pain is most commonly caused by OVERUSE of the low back! Contrary to what you’ll see on instagram, the low back is often one of the most relatively flexible areas of the body.
People with chronic low back pain are more likely to have hypermobile low backs (Biering-Sorensen, 1984) and use the low back more during daily movement (Taylor, Ugbolue, Gao, Gu, Baker, Dutheil, 2023).
While stretching the low back might provide temporary relief, it's not addressing the cause of pain/tightness, and it can further aggravate the back. Even though your low back might feel tight, it's more likely that your hips are even tighter! This is called relative flexibility, and most people would benefit from moving at the low back less, not more!
The only way to understand this is to try it yourself. Next time your low back feels stiff, before you stretch your low back, stretch your hips with a couch stretch and your thorax with a prayer stretch. Notice that your back no longer feels “stiff” without any needed low back stretching! This way we are addressing the cause of the back stiffness, not just the symptoms!
Note: the ideal stretches for your body might differ from the two recommended. To find the ideal stretches for your body by performing a full body assessment, get a copy of "What's Wrong with My Back?" to learn more.
Strength Training
Doing crunches and sit-ups only made things worse, but I found great relief in training my glutes heavy with hip thrusts and Romanian deadlifts.
I learned from Dr. Vladimir Janda that sedentary living causes certain muscles to get short and tight while other muscles get long and weak. Certain muscles need to be stretched, while others need to be strengthened. If you go to the gym and tighten up muscles that are already tight, you’ll make your pain worse!
Many people have back pain because tight hip flexors prevent their glutes from working, which is called reciprocal inhibition. This problem gets worse once the overactive hamstrings dominate the glutes, something called synergistic dominance.
For a sedentary person, the most important muscles to stretch are on the front of your body, and the most important muscles to strengthen are on the back of your body.
All the stretching in the world won't lead to permanent change unless you STRENGTHEN. The glutes are a primary key to balancing tight hip flexor muscles.
Back Pain Conclusion
Your body is designed to be pain-free. By identifying the habits that cause you pain, you empower yourself to be in control of your pain. By stretching tight areas and strengthening weak points, you are bulletproofing your body so you never need to experience chronic pain again.
These two steps I've described above will help to get you on the right path, but you are the only person who knows what's best for your body. Listen to your body, trust yourself, and know that any pain you go through is an opportunity to strengthen your character and will power. You can do this!!!!
Your back pain is unique. If you want a customized program that meets your needs, work with me directly.
Hope this helps! - Tom
Comments