A short guide on Lower Back Pain & treatment

A Short Guide to Lower Back Pain and Management Strategies

Managing your back pain while living your life is key.

Low back pain has a high prevalence in most countries and is one of the top conditions that people go to physio for. The hard part is figuring out the contributing factors to the back pain and how we are going to address them. As a physio, we are often starting with movement patterns, loading management and overall exercise – this helps us determine if your body/back was underprepared for what you were asking it do to (too much too soon). Another reason we want to know these things is to see if it is more about repetitive strain (too much too often).

Slowly but surely, we are also starting to ask about other aspects of our patient’s lives. Things like sleep, nutrition, stress and enjoyment, all play a role in how pain can manifest in someone’s body, this is espeically true for back pain.

Contributing Factors to Back Pain

Have a look at this metamodel below. Each and every one of those dots can represent a contributing factor to someone’s pain. Our goals are to pick a few, target them, and see if we have made sustainable changes for the patient’s pain and quality of life.

Back pain and contributing factors that capture the biopsychosocial aspects of what causes back pain

This image is a bit overwhelming, which is often how it feels to have back pain.

Strategies to treat your lower back pain

There are a lot of aspects you can touch on to start helping yours.

Lifestyle habits:

Stress management – take 2 minutes of your day to do the deep breathing exercise of Box Breathing
Sleep quality – put your phone away 10 minutes earlier than usual, in the morning – drink your coffee without scrolling your phone
Nutrition intake – include one more piece of fruit a day than usual
Social connection – call a family member or close friend once a week

Movement Management

My movement management plan is always to start people at a level that isn’t too painful but gives them a guide of what they can do.

Acute Phase

Continuing walking as able
Frequently changing positions to whatever your current tolerance level is
Seated or lying back arching and flattening (think cat cow but very small movements)
Upper back rotations and arm wall angels
Gentle movements in standing (or whatever position is most comfortable)

Foundations

Squats to a box (sit to stands)
Lower back rotations
Breathing exercises and ribcage and spinal mobility
Seated glute stretches
Gradual hinging or press ups to tolerance
Glute bridges and hip muscle exercises for symptom management
Trunk and spinal mobility (to not move like a block)

Strength

Adding weight to the squats and hinge position
Progressing to single leg positions
Trunk and spine strengthening
Posterior chain strengthening

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References:
Cholewicki, J., Breen, A., Popovich Jr, J. M., Reeves, N. P., Sahrmann, S. A., Van Dillen, L. R., … & Hodges, P. W. (2019). Can biomechanics research lead to more effective treatment of low back pain? A point-counterpoint debate. journal of orthopaedic & sports physical therapy, 49(6), 425-436.
Cholewicki, J., Popovich Jr, J. M., Aminpour, P., Gray, S. A., Lee, A. S., & Hodges, P. W. (2019). Development of a collaborative model of low back pain: report from the 2017 NASS consensus meeting. The Spine Journal, 19(6), 1029-1040.