Your Back Pain Guide Contents
Back pain sucks and we get it. We understand how discouraging it can be to want to stay active when you don’t know if what you are doing is helping or hurting.
Yes, we have been there and yes, we have helped many others like you (and ourselves) with back pain get through this process.
We are former athletes and both our physical and mental happiness is heavily dependent upon how active we can be throughout the week. So we get it.
Here’s the thing; you are stronger than you think and you can and WILL get through this.
What’s the key you ask?
First, is mindset. You need to be open to getting helped through this process by a professional who is trained to do so (we will tell you what to look for in your practitioner later).
Not only do you need to be open, you owe it to yourself to shift from thinking of yourself as broken to knowing that you can and will get through this.
This shift in mindset creates action and fosters consistency. Two absolute musts in your recovery process.
Second, is structure. To get the result you want FAST, you need a solid framework you can depend on.
This is where a solid practitioner who gets your needs and goals will be crucial. We will be diving into this a bit deeper so sit back and enjoy.
We Get You
Common Causes of Back Pain
Let’s clear the air a little here. You are NOT alone. Back pain is one of THE most common complaints we see (around 80% of people feel back pain at least once throughout their lifetime!)
BUT not to worry... when guided in the right direction, you can get out of pain and FAST.
Here are some common things we hear from our peeps:
“I was told to just avoid this activity and I will be good”
Which by the way happens to be what you truly enjoy for exercise (we’ve been there!). As you will find out later in this article, oftentimes avoiding activity completely is NOT helpful.
Also being told to avoid something without a plan of action doesn’t get you closer to where you want to go. Yes, being told what not to do is important, but having guidance throughout the process is a GAME CHANGER.
“I was given a list of exercises with no guidance and no one helped me”.
One of our biggest pet peeves! This is BS and you absolutely deserve better.
Your practitioner’s job is to guide you with feedback to make the recovery process as FAST as possible. If he or she is not there to give you direction, do you think you are getting the care you deserve?
“I was told I have sciatica or pinched nerve and to ice and stretch”
Yikes! This is an extreme over generalization that can be doing you more harm than good.
If this is the management plan you were given, you were likely not given a thorough exam. Stretching your hamstrings will actually cause a nerve to be MORE painful.
When you are stretching your hamstring you are also stretching the sciatic nerve (because the sciatic nerve lives right behind the hamstring).
So why can this be bad for the nerve?
When there is stretch or tension on the sciatic nerve, the blood flow decreases and that blood flow is super important for the healing process. Your nerve is giving you pain in the first place because of a decreased blood flow. See how that could be a problem?
Yes the hamstring may feel tight, but this is a protective mechanism to protect that sciatic nerve. Though stretching the hamstring may give temporary relief because of the muscular effect, it probably will not last long.
So if you have been told this please take it easy on that nerve of yours or trust us it will come back more pissed off than before.
Here is a safe exercise you can try in the meantime:
This works well for those who have back pain when sitting or back pain bendin forward.
This works well for those with back pain with walking, back pain with leaning back or back pain with reaching overhead.
“I just don’t understand why my back keeps hurting or what’s going on in there”
You deserve answers, but answers take time. It takes a thorough assessment and sometimes some trial and error to get to the bottom of what is causing your pain.
This is why we take time with you during our assessment so we know what YOUR goals are. And it doesn’t stop there. Throughout your management plan, we are constantly gathering data WITH you to get to the bottom of the cause and make any necessary adjustments on the fly that will be best for you.
This allows us to give you a plan that works for YOU.
"Is sitting causing my back pain?"
This all comes down to how your body responds and tolerates to sitting. You may have a certain posture that feels better to be in while sitting or maybe you can tolerate sitting for only a certain amount of time.
If this gives you a hard time, an easy way to avoid back pain while sitting is to take breaks by standing or taking a quick minute walk.
If you can't get up and walk around, try this one out and see if you can break that pain cycle (if it helps symptoms, do it often like every hour type of often).
When it comes to sitting, a posture that is bad for you may be good for someone else.
This all depends on how your body responds to certain positions. This makes the physical assessment extremely important as it dictates your treatment plan.
"My doctor told me I shouldn't squat"
This is definitely not the case (especially if he or she said forever. This is a severe over generalization.
You may not be going ass-to-grass, but there are many ways to modify squatting to make it tolerable. Even if the squat itself is not tolerable it can usually be re-introduced into activity pretty quick if done correctly.
Here are some great modifications that get the same benefits of training that are safer for the low back.
"I feel like I just need to stretch my hamstring!"
Often times low back pain that you are feeling accompanies a sensation of tightness in the back of the leg. That tightness is often a result of a protection mechanism to protect nerves in the leg that connect to the low back.
That being said, stretching the hamstring will also pull on those nerves. So if your tightness is related to your low back pain you are doing far more harm than good.
Yes, it may feel good on the muscle in the short term but it will often follow with increased low back symptoms that were even worse than before.
Long story short, avoid stretching your hamstrings until you have a thorough assessment by a doctor who can confidently tell you your hamstring tightness and low back pain are not related.
How You Move
The back is often not the true cause of the pain you are experiencing. Most likely it is a mobility or stability/control issue of neighboring areas.
It still remains important to find out what tissues are sensitive in the back so you can take some stress off and protect it for a bit. However, if you never address the cause of the problem it will probably come back.
I will put it this way, the back is just crying out for help and therefor is the victim. You don’t lock away the victim when a crime is committed do you?
To give you a better idea of what I am talking about, let’s take a look at how the human body functions in an ideal scenario. This is a very simplified version of a detailed picture, but is VERY useful. Take a look at this picture:
Simply put our body varies from mobile joint to stable joints stacked on top of each other. So starting at the big toe where the joint should be mobile (think propelling yourself forward, you need lots of big toe extension) then going up the chain the midfoot should be stable (this area is does the majority of the balancing when we are on one foot when walking, running, etc.).
This alternating pattern continues up the kinetic chain and if one joint is disturbed it usually affects the joint directly above or below, but can cause trouble all the way down the kinetic chain.
For example, if your ankle lacks the mobility to flex during bending movements like squatting, you will need to get that movement from somewhere else. That movement often will come from the knees, which increases mechanical stress on the structures of the knee. Enter higher chance of knee pain.
Your brain will figure out a way to get the job done, whether you have mobility in certain places or not. Typically the natural movement for you will be the path of least resistance, which makes sense as conserving energy was once pretty important to us back when we had to hunt and gather for our survival.
So if the mobility in one area in the body is not available, we will most likely ask more from the surrounding joints. This can lead to some unwanted results.
See how that works? What is great about this model is you can apply it to the entire body and learn where and how to implement movement drills for desired results.
So how does this apply to the back? Well, I am glad you asked.
There are two common scenarios that causes unwanted stress on that low back.
The mid back (thoracic spine) does not have the ability to freely extend or upright (you know the slouchy humpback look).
The hip joints do not have the mobility or coordination to flex before the low back so every time you bend or reach forward you get all of your motion through your low back (over time this can become a problem).
Like we said before your body will find that mobility somewhere in order to complete a task that your brain may have for you. This puts added stress on the back (lumbar spine).
A great way to decrease stress on that sensitive back is to make your mid back and hips more mobile. This allows your body to access more motion through the mid back and hips, giving that back of yours a much needed breather.
Now the next time your brain asks your body to bend forward, reach over head or get down to the ground the stress will be spread out since you have unlocked some motion that previously was not available in those areas. The human body is cool.
In this next section, let’s talk about pain and how it works.
Breaking the pain cycle
The key to getting out of pain is breaking the pain cycle early and often. But what does that even mean?
Let’s get into it.
Simply put pain is a warning system from the brain similar to an alarm. When reaching over a hot stove you didn’t know was on, pain tells you to take your hand off that hot stove, dummy. Or it tells you to limp if you have a thorn in your foot until you can take it out and heal from it.
However if pain has been present for quite some time or reoccurs often for you, your alarm system can be placed on high alert.
We compare this to an overly sensitive car alarm. You know, one that your shirt brushes up against and it starts yelling at you? This is what can happen to you when you have had persistent pain.
The car alarm should only go off when someone is trying to steal it or break into it, not walk by it. Just like you should only feel pain when true harm is done.
We need to recalibrate your alarm system to only go off when someone is trying to steal your car, not when someone walks next to it.
To do this it is important to find positions or movements that make your symptoms feel better, even if just for a few minutes. Once you find it, do it often.
This breaks the pain cycle and starts to recalibrate your alarm system out of high alert and back to normal.
Keep in mind this process takes time. If you have been feeling the pain for 5 plus years, give yourself some time. Measure things like how long the exercise breaks the pain cycle for. If it was 5 minutes one week and 10 minutes the next week, that is a huge win!
Here are a couple of things you can try and see how your body responds.
Finding What Hurts
Finding out the things that make your symptoms worse is a HUGE step to figuring out a solid game plan to get you out of pain. A lot of the times there are multiple movements that have overlapping common characteristics. Again, big time in creating a plan.
Like we said before, the key to getting out of pain and staying out of pain is breaking the pain cycle early and often. The earlier you start and the more persistent you are, the better off you will be.
This starts with finding out what hurts and removing it. After all if you are not in pain, you are inherently breaking the pain cycle.
Sometimes it is important to realize that simply removing whatever is giving you problems has a higher priority than getting more things to “fix” you.
This is why it is very important to be aware of what activities bring on your symptoms. You cannot change what you are not aware of.
As you are becoming more aware of what gives you pain and trying to remove things to see what helps, be aware that all information is good information. Even if something wasn’t successful in relieving pain, that is GREAT to know.
Now you can take that off the table and try something else. If something works, great! Now increase the dosage and implement more of that.
We already know how complex pain and the body can be so it is a continual game of trial and error and seeing what works best for you.
What DOESN’T Hurt
Now that we know what to stay away from, let’s talk about what we CAN do. The important thing here is you know that you should definitely remain active through your recovery (keep in mind this does not mean doing the same stuff that got you there, there will be modifications).
Now the question becomes “How do I know the movements are not causing harm?”.
That my friends is an EXCELLENT question so let’s answer it shall we?
First, you do not need to perform a bunch of movements that are focused at the back to get the health benefits you need. In fact, it can be doing more harm than good.
Think about it if an area is injured like in this case the back, why would we stress it even more? Doesn’t make sense right?
So I challenge you to stop stretching the crap out of your back and remember what we talked about before, how important that mid back and hip mobility/control is to take off some stress of that back.
In addition to mobility in the hips and mid-back, stability in the low back is a great way to train the core and take it easy on the spine. Now that’s efficiency right there!
Here are some good core exercises you can try:
So what next? Remember we have established the back to be the site of pain so we have to find ways to avoid picking the scab. Mobilizing that mid back as well as being coordinated in the hips will be crucial to this process.
Here is some solid mid back moves to try!
Next, find a movement of the back that feels good or actually rids the pain. Before we show you a video on how to explore this and how to dose it out, know this is not always possible and if there is a BUNCH of inflammation.
If this is the case for you take it easy and give it a couple of days to calm down, then try it again.
Anyways, here is a video that has some tips you can try out and see what works for you (again don’t be all sad if none work, just stay neutral for now until it calms down).
Finally, general movements that you would see in a normal gym routine can be greatly beneficial for numerous reasons (endorphin and hormone release that cause pain relief and antidepressive effects are just a couple good reasons).
Keep it simple here. Pick two lower body movements and two upper body movements that do not cause your back any pain then put them together for a workout.
To sum it up the following is a great guide to finding movements that will not further injure your neck.
Stop cranking on our back
Mobilize your mid back and hips
Stabilize your core/torso (stabilizing you low back)
Find a back movement that feels good
Keep working the rest of your body in a pain free zone
Creating a Game Plan
You’re management plan is essentially the template or roadmap to getting you out of pain, becoming more mobile and ultimately getting back to where you want to be: active and pain free.
We like to think as your management plan as a continuous assessment. This way we are getting constant feedback from you and we are able to be fluid and make changes that fit your needs and concerns as they come up.
Your management plan should include prescribed movements or modifications that either provide pain relief (think of this as your natural aleve) or make the body more resilient.
You should also be given advice on how to perform daily activities in the safest manner as to not pick the proverbial scab. This part is crucial as it often overlooked/undervalued that addresses the habits that got you into this situation in the first place.
It is also important that you walk out with advice on how to modify any exercise routine or sporting activities that you do. Let’s use the gym as an example here.
Maybe you have a pull-up goal you have been wanting to achieve. Often times those with back pain will perform those pull-ups while arching their back. This puts unnecessary stress on the low back.
A simple fix for this person could be bringing your knees up during the pull-up. This will take stress off the sensitive area for that person.
You see how important that could be for your recovery?
If you leave the doctors feeling great but go back to doing the same shit that got you there, your results won’t last. This is why it is very important that your practitioner provides you with advice and safe modifications in your routine. Seriously, it is an absolute must!
Finally your management plan should include hands on manual therapy techniques that provide relief and can oftentimes be self administered (i.e. foam rolling, joint mobilizing, etc)
So here is what you should take home with a solid structured management plan:
Pain relieving exercises or body positions
Exercises that build resilience
Advice on safe alternatives to daily activities
Advice on safe modifications on workout routines or sporting activities
Manual therapies that can be self administered
What to Expect From us for Your First Visit
Let me just start by saying this; if your doctor does not spend at least 30 minutes with you to figure out a solution to your pain, walk out of the door and find someone else to help you.
Here is what to expect when you visit us for the first time.
A thorough history where we ask you from top to bottom about the experience you are having related to your back. This is very important to us and should not take any less than 20 minutes.
The information in the history points us in the direction we want to start going with you during the physical exam. The history provides us with your goals and personal concerns which is vital for us to know in order to help guide you to where you want to be.
After we know and understand your experience with your back pain or tightness, it is time to figure out what tissues are sensitive.
This process is the structural exam where we put your body in different positions that places stress on specific structures. This tells us roughly what part of the body is hurting you.
Keep in mind these tests may be painful and we are only doing so to know what hurts. Knowing this will give you a better long term management plan and treatment. This process is paired with a more functional exam.
After we find out what body part is sensitive, we then assess how you move your body during common movements that are needed for everyday activities (i.e. squatting, reaching overhead, bending forward, etc).
This information tells us what may be causing your pain and how we can make some small adjustments that will go a very long way in your recovery process.
Now that we know your goals, your experience in relation to your pain, what body part hurts you and why, we can begin the treatment.
Your treatment will be individualized for you and YOUR specific goals. Often times this looks like trying many movements/exercises and seeing which one gives you the best result.
Other times it will look like manual therapy/body work in order to calm down the pain response. This depends on the your wants, needs and at what part of the recovery process you are in.
Your management plan is a sum of all of the information we have gotten to this point. It’s essentially taking all of the information and summing it up into bullet points. This acts as your game plan or script to take your health into your OWN hands.
This my friends is where the power lies and where YOU put in the work to get better.
As you can begin to see, this process takes time to find the cause of your pain and provide a solution. You absolutely deserve this time!
This is why we spend anywhere from 30 min to 90 min with our patients on the first visit.
Here is a list of what you should expect when coming for your first visit.
Structural Exam (Assessment of what tissues are painful)
Functional Exam (Assessment of how you move and how it may relate to your pain)
What We expect From You
Simply put we need the prioritization of your health. At this point you will need to prioritize getting healthy as high as possible on your list of to-do’s.
This is a process and you WILL get better. However you will be with us for 30 minutes to an hour 1-3x per week. You need to be accountable to the rest of the week when we are not with you.
The true value is not just what we can do to decrease your symptoms in office. You will almost always feel some immediate relief. However it takes time for long term changes in movement and motor patterns to set in. The great thing is you will be continually getting better during the whole process.
In order for this process to work we need your help and commitment to follow the game plan. If you have had pain for years we probably don’t have a magic bullet to fix it with 1 visit.
We always aim to decrease your symptoms as fast as possible.
However, in more chronic cases we need to identify a pattern and habit that could trigger symptoms. This is the what not to do portion.
Second we need to find movements that help you get better (the what to do portion). Think of your exercises as a prescription.
If you were sick and were prescribed an antibiotic that worked on a dose response IE: take every 4 hours and you and didn’t the antibiotics may not reach the desired effect.
Think of what we give you as a movement prescription but instead of an antibiotic every 4 hours you mobilize your t-spine. It’s important that you do your homework and ask us questions and express any concerns that come to mind during this process.
When do I need to get an X-ray/MRI?
Imaging should be done only when things do not add up in an exam. An image just gives us better insight on what your anatomy looks like.
What it is does NOT tell us is what areas are giving your sensation of pain.
Just like every other aspect of the exam, these images are just a piece of data that needs to be correlated to everything else that is gathered in the history and exam.
Though this information can be very useful in certain scenarios, it can also be harmful in others.
For example, if someone is told they have degenerative changes in their knee (which is extremely common and often does not cause pain) they can then become fixated on this and be fearful of movement.
Degenerative changes is just a medical term for aging or response to stress. This doesn’t always have a significance on the recovery process.
So here is when we think it is a good idea to get imaging:
ANY of the red flags mentioned in the next section
There has been a solid trial of a thorough management plan like we mentioned in the management plan section with no change and we just need more information.
Things do not add up in your first visit and we need more data to give the best management plan for you
Keep in mind when we say exam we mean a complete exam, not the 10 minutes where the doctor scans the area asks you 2-3 questions and performs a minimal structural assessment.
This happens ALL OF THE TIME and it breaks our hearts when our patients come in and tell us this was their experience.
But in a nutshell, imaging is often not necessary to get you out of pain and back to an active lifestyle.
Red Flags are symptoms that can be related to very sinister diagnoses that require immediate attention and urgent intervention.
Please take these seriously and seek attention by a medical provider if you have the following:
Fever or night sweats
Unexpected weight loss
History of inflammatory arthritis, cancer or infection
Pain that is not dependent upon body position/cannot be reproduced by body position
Intractable night pain
Progressively worsening numbness, tingling or muscle weakness into the arms/hands
Gross balance issues (i.e. you noticed yourself tripping or falling more recently)
Clumsy hands (i.e. difficulty with texting/typing, buttoning shirts, etc)
Cold sensation down the legs
Numbness in the saddle area (genital region)
Bowel or bladder dysfunction (pain when urinating, inability to hold back urine, increase urge or inability to fully void bladder)
Menstrual cycle disturbances
Drop attacks, double vision, nausea
How to Find a Good Doc
We are going to keep it short and sweet in a list format for you.
Someone who gives you the time you deserve to find a solution (remember if you are seeing a doctor who is supposed to find a solution to your pain and you are there for less than 30 min… find a new doctor)
Someone who is concerned about YOUR goals
Someone who can give you a game plan that fits your needs and goals
Someone who addresses the activities that may be causing your pain (if necessary)