The Ultimate Cheat Sheet For Back Pain (Part 1).

Updated: Jul 19, 2019

Understanding back pain is complex, difficult, and one of the most frustrating pathologies with regards to appropriate management. Here at Vital Six we find that most of our clients have already tried everything and anything with minimal results.


It should be noted that our philosophy centers around holding YOU accountable. After all teaching someone to be an active participant in eliminating their pain is much more rewarding than relying on others or medication. The irony is that some of the simplest things for reducing back pain are often overlooked. Without further adieu here is what you need to know.


1. Change your Activity Levels


This is probably the most important item on our list and yet it is probably the hardest to do. We are telling you to make it a priority to significantly modify your activity levels. Even If only for a little bit. Managing kids, employer expectations, hobbies, and having social life is not easy and even harder with pain.


However when mitigating back issues, especially during a flare up or an fresh injury, it is probably best to let your symptoms resolve. Studies show that within the first six weeks of an acute episode of back pain is when the biggest reduction in pain and improvements in function occur (1). Understandably, many people have a hard time giving up or modifying certain activities even if only for a short amount of time.


Try telling a runner to run less or a mom to refrain from carrying their child. Ironically, the activities that we perform the most are usually the biggest contributor to one's symptoms.


Dr. McGill, a prominent researcher in spine bio-mechanics advocates a "pretend surgery approach" for those contemplating surgery or who continue work with pain. His belief, in conjunction with ours, is that the forced limitation of activity and change in lifestyle following surgery can be more beneficial than the actual surgery.




Recovery times can vary after low back surgery, however a rough estimate is anywhere from 4 weeks to 6 months. Back surgery, while a last resort for many people, can be seductive. The idea of surgery offers hope for those who have found limited success with other forms of treatment.


While in certain cases surgery may be required, more often than not surgery is over-utilized and not warranted. Here is a good article discussing the gross rise in surgery over the past decade despite worsening client outcomes in pain or function. In short make recovery a priority when recovering from back pain, contemplating surgery, or having reoccurring episodes of pain. We promise your body with thank you.


2. STOP STRETCHING


For some reason the idea that we need to stretch more when we have back pain continues to precede the idea that we need to stretch less. One of the biggest misconceptions when it comes to reducing back pain is increasing flexibility of the low back.


Many times we have patients who seek out yoga, Pilates, or have been stretching the heck out of their back/hips no avail. These are the same people that find temporary relief only to find their symptoms much worse hours later.


Let’s be clear we are not anti-stretching, yoga, or Pilates. These activities can be beneficial but only when given context. Take three people and ask them to perform a downward dog pose; it is almost guaranteed we will end up with three different versions of the same pose based on injury history and anatomical differences.This example is amplified when dealing with individuals in pain.


Having someone with a lumbar spine that dislikes rotation and then having them excessively rotate their spine isn’t really a service that someone should be paying for. This is seen throughout all levels of “fitness professionals” however it is more apparent in the group setting. The point being, unless you have been individually assessed by someone you trust, general stretching of the lumbar spine or the surrounding structures is probably unadvised.


The lumbar spine generally prefers stiffness. If we take a quick look the typical diagnoses of low back injuries: Spondylolisthesis (slippage or excessive motion of the spinal vertebrae), herniated disk (usually associated with repetitive or excessive flexion and/or rotation of the lumbar spine), and spinal stenosis (narrowing of the vertebrae that results in developed stiffness) just to name a few.




Also you'll be hard pressed to find any studies that show increased lumbar spine motion is correlated with a healthy back. More so the opposite is true.


We also know for those people who are "tight" or constantly stretch until the cows come home, creating stiffness in the spine helps tremendously. We can look to studies like this one that show significant hip range of motion differences in between individuals with unstable and stable lumbar spines.


Anecdotally we see instant gains in hip range of motion and reduction of pain after gaining stiffness in the lumbar spine. Think about this, maybe our hip flexors always feel tight because they are working overtime. The hip flexors, more specifically the iliopsoas (Psoas Major and Iliacus), attach at the hip and lumbar spine.


The iliopsoas primary role is to flex the hip however when the spine is unstable the hip flexors can pick up the slack. This is the classic case of someone who feels better immediately after stretching but then inherently feels worse hours later. Give this person some stiffness in their lumbar spine and magically their hip flexors feel relaxed.

So for anyone out there who is convinced they need to stretch more we challenge you to do the opposite. You may be surprised at what you find.


Stay tuned for part two where we cover three more simple things you can do to get rid of your back pain!


Want more information?


If you are in back pain click here to learn more about how we can help you. Also feel free to call us at 913 - 303 -0032 to speak to a therapist today!


References


1. Menezes Costa L da C, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LOP. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ : Canadian Medical Association Journal. 2012;184(11):E613-E624. doi:10.1503/cmaj.111271.

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