Low back pain affects most of us at some point in our life. It is one of the most common causes of disability and the 2nd most common reason one sees their primary care physician, second only to the common cold. Despite this, it usually does get better on it’s own. However, research is pretty clear about the methods that can help you improve quicker and with less risk for developing chronic low back pain or sciatica. Check out this video for everything you need to know about low back pain and sciatica. If you already know you also want to schedule an appointment in addition to getting started treating yourself, schedule here.

As mentioned in the video, most low back pain, while it can be extremely painful, is not something that you would intervene with further than conservative care. So long as the following is true, trying to self treat your low back or getting in with your Physical Therapist is the appropriate course of action.

Make Sure that Your Pain is “Mechanical” and Musculoskeletal (muscles, joints)

Your low back pain seems “mechanical”, meaning that movement and positions are what hurt it. This signifies that your pain is in your muscles and joints rather than referred pain from your organs. If your pain changes based on time of day, with meals, etc, regardless of what position your body is in or movement it is doing, then you should schedule a visit with your Primary Care Physician for further assessment. If it’s obvious that movement hurts it, self treatment or a visit with your Physical Therapist is appropriate.

3 Red Flags: if present, seek immediate care at Emergency Room

Sudden weakness in legs or anywhere else.
- This would be obvious weakness making walking difficult. The key is weakness, not just pain.
Sudden change in bowel and bladder control.
- If you are unable to sense or control when you have to go to the bathroom, seek immediate care.
Numbness where you sit on a bike seat.
- Numbness in this region should also cause you to seek immediate care.

Assuming all the above checks out, first follow these 2 rules, then figure out which Low Back Pain treatment category best fits you:

Primary Rules for Improving with Low Back Pain

Stay as active as you can following these 2 rules related to any pain you have:

Acceptable level of pain
The pain doesn’t feel like it will be worse the next day

3 Categories of Low Back Pain Treatment

Manipulation
- Feels like “cracking” your back would feel good
Directional Preference
- Extension Bias: back bending, standing, walking feels good
- Flexion Bias: sitting, bending forward feels good
Motor Control and Strength
- Usually this person is otherwise pretty flexible, maybe some tight muscles, but pretty flexible joints
- Even if you’re not overly flexible, if the other 2 categories above don’t fit you, then start in this category

1. Spinal Manipulation

You can attempt to self manipulate or “crack” your back. Research is pretty clear that if this feels to you like it would help, then it probably will. If you are apprehensive about it, then probably don’t seek it out! Physical Therapists, in addition to Chiropractors and DOs are skilled at performing joint manipulations. If you feel like “cracking” your back will help your pain, you can try on your own, but you can also schedule an appointment. We can help!

2. Directional Preference

2a. Extension Bias Treatment

If bending back, standing, and walking feels good for your pain, then these are the treatment strategies for you!

If Extension Bias Treatment seems best for you then go ahead and work through our extension progression:

As your back or sciatic pain is improving, start to first integrate the hip stretches in the flexion bias treatment below as you also work on our core and hip strength exercises below and finally finish with the flexion bias strength work to restore your function to tolerate all low back movements with good mobility and strength.

2b. Flexion Bias Treatment

If sitting and bending forward feels good for your pain, then these are the treatment strategies for you!

As your back or sciatic pain is improving, start to first integrate the hip stretches in the extension bias treatment above as you also work on our core and hip strength exercises below and finally finish with the extension bias strength work to restore your function to tolerate all low back movements with good mobility and strength.

3. Motor Control and Strength

If you tend to be more flexible, the other categories don’t fit, or you’re improving and ready to work on strength, these are the treatment strategies for you!

Just as important as the core strength is hip and lower body strength to help decrease low back pain and reduce the risk of having it in the future. Make sure you work these hip strengtheners into your routine as well!

To fully “rehab” your back, you should be able to tolerate and work to continue to improve on all of our foundational strength patterns and directions linked in our 7 Foundational Movement Patterns Strength Progressions Charts.

That’s it! In summary, low back pain is normal, usually not as serious as the intensity of pain makes you think it is, and the people that do the best are the ones that apply the strategies above. While the intent of the above strategies is for you to be able to self treat your pain, if you want to be efficient with your time and efforts and double down on improving quicker and decreasing your risk for future low back pain, schedule an appointment with us and we’ll get you there!

An example of how we can help is, in addition to hands on manual therapy of any necessary massage, cupping, or joint manipulation, we can help you progress your exercises more specific. For example, some of the hip exercises above, we would give some of the “flexion” hip stretches to you when you are in the “extension bias” category to help you improve your hip flexion and not have to flex as much through your low back. If this is over your head, maybe you should just come in for an appointment and we’ll be able to explain it in a way that makes sense and gets you better faster!

We are truly stronger together!

Dr. Dane Happeny, PT, DPT, OCS
Doctor of Physical Therapy
Board Certified Orthopedic Specialist

References

1. Honeyman PT, Jacobs EA. Effects of culture on backpain in Australian. Spine. 1996; 21(7):841-3. doi: 10.1097/00007632-199604010-00013. https://pubmed.ncbi.nlm.nih.gov/8779015/

2. Lin IB, et al. Disabling chronic low back pain as an iatrogenic disorder: a qualitative study in Aboriginal Australians. Br Med J. 2013; 3(4):e002654. doi: 10.1136/bmjopen-2013-002654. Print 2013. https://pubmed.ncbi.nlm.nih.gov/23575999/

3. Brinjikji W, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol. 2015;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. https://pubmed.ncbi.nlm.nih.gov/25430861/

4. Chang DG, Shymon S, Powell AJ. Natural resolution of a herniated lumbar disc. Br Med J. 2013; bcr2013201037. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794266/

5. Pickar JG. Neurophysiological effects of spinal manipulation. Spine J. 2002; 2(50): 357-371. https://doi.org/10.1016/S1529-9430(02)00400-X. https://www.sciencedirect.com/science/article/abs/pii/S152994300200400X