By now I know you’ve all read our previous articles in this lower back series. Wait, you haven’t? Come on guys and girls you really need to head over there! Okay, here is a link to those pieces, and when you’re done you can pick up where you left because we’re discussing something pretty cool in this article- How to treat common lower back pain in the comfort of your own home!
Common lower back pain is exactly that- common. Meaning that it tends to happen quite often, or at least affect a large percentage of people at least once in their lifetime. This can result in the entire process becoming a very time consuming and in some instances slightly annoying situation. I mean first you need to go see the doctor, he or she then refers you for some form of diagnostic tool, x-rays or scans etc. After which they usually give you a prescription for the pain and depending on the extent or the injury and ultimately the source of the pain the doctor should refer you to either an orthopedic specialist or a physical therapist. Okay, but what happens when you go through all of this and STILL have recurring back pain? What if you’re not a fan of going to the doctor, which we highly frown upon as you really should see your primary care physician on a regular basis, but each to their own I guess. Or maybe going through this entire process isn’t financially feasible for you and you need some help or a cost effective way to help you. This is where we come in, this article is going to take a do it yourself approach to treating common lower back pain.
Disclaimer: This article is aimed at the people who suffer from low to moderate lower back pain. If you have even the slightest suspicion that you have suffered a severe injury or aggravated a moderate injury in some way, please consult a primary health provider. This article isn’t a diagnostic tool and is set out based on the opinion of a seasoned rehabilitation specialist.
Anyway, as we were saying, this article will cover a group of common lower back injuries that follow similar pathophysiologies and can benefit from a similar template for recovery and rehabilitation. We will take a look at primary and or acute treatment, pain and symptom management as well as diagnostic and special tests that can assist you in identifying the cause or possible cause of your pain. And finally, we will dive into a detailed rehabilitation program that can be used as a template. Here we will focus on quality over quantity and give a brief reason for the selected exercise and how they fit into the bigger picture of your recovery process.
The following list of injuries may not be super extensive but do fall under the most common category. These injuries are annoying and can develop into chronic debilitating issues. However, they tend to not inhibit daily activities or physical functioning significantly too much.
These injuries, painful conditions or risk factors include:
Muscle strains and ligament or tendon sprains pretty much follow the same pathological sequences. These injuries are usually caused by an excessive force placed on the lower back musculature as a result of lifting a really heavy object or using poor form during flexion or extension movements. The lower back region can hold its own, as this area is usually quite stable unless you have an underlying condition or previous history of injury in that area.
Which brings us to the next risk factor and probably one of the most significant- muscular weakness and imbalances. The human body is a weird thing, it loves homeostasis. Maintaining some sense of balance is what it strives for as anything in excess or anything that lacks results in some form of a problem. Usually these problems are injuries caused by the lack of balance within our musculature. Our body then compensates for such imbalances in an effort to restore homeostasis. A good example is when a recreational marathon runner develops iliotibial band friction syndrome or suffers from chronic or recurring hamstring injuries. If you took a good look at his or her biomechanics testing their load patterns during a running analysis, I am willing to bet money that 9 times out of 10, their condition or conditions are caused by gluteal muscular weakness. Essentially, their glutes don’t fire and produce sufficient horizontal force to aid in running. So the body adjusts by placing much more emphasis on thigh muscles, in the case of hamstring injuries, to exert more force to compensate for the lack of glute involvement.
However, in the case of iliotibial band friction syndrome this is usually caused by the lack of postural involvement by the gluteus medius muscles. These muscles assist in keeping the pelvis aligned during a single limb stance, which essentially means during every step you take while running. When these muscles are weak or fail to fire properly (please note we are using the term fire very informally here) the pelvis proceeds to drop during forward motion. If this continues significant damage to the pelvic joints can occur, therefore to combat this our bodies use the IT band to compensate for this issue.
In both these examples muscular weakness and imbalances are quite evident, giving you a clear idea of why these conditions can cause you to develop injuries and or chronic pain. This is very much applicable to the lower back.
In this case, it is more often than not a weakness in the antagonistic muscle group- the abdomen muscles and deeper core muscles. Our core group of muscles play such a significant role in postural control, stability and balance as well as stability during motion. With compromised core strength, the body's most natural response to combat this imbalance or muscular weakness is to alter the loading patterns of the area. It does this by placing far more load on the lumbar region in order to maintain the balance. Unfortunately, just like the basic concept of force and leverage, when the force exceeds what the lower back can tolerate the area will buckle under the pressure. This is how lower back injuries occur due to imbalances and weakness.
Acute refers to immediate and this is ultimately a make or break step in treating your injuries diy style. The main thing here is managing your pain, if you can manage and ultimately treat your pain you have essentially won half of the battle. This is because as long as you have pain, you’re going to be stuck fixating on the pain instead of your recovery. It sounds stupid, but it is actually such a common problem with most people. Pain is a disruption of your body’s homeostasis, any disruption will get most of your attention, particularly during the acute phase. When your body adapts and gets used to the disruption this when pain becomes chronic and this is what we want to avoid by any means necessary.
But that being said, the gold standard approach to managing acute pain is the RICE method. Now this is something we hammer on repeatedly in our pieces regarding injuries. And for good reason, I mean it’s the gold standard for a reason. In short RICE is an acronym for REST, ICE, COMPRESS AND ELEVATE. We’re not going to go in depth in the definitions of each of these terms, however there are a few previous articles in which we cover the concept of RICE in a lot more detail.
So what do you need to do when you hurt your back? First things first you need to take a break and rest your back, seriously taking a step back and toning it down by taking it easy will significantly help manage your pain. After that you will need to ice the injury (cryotherapy), this will help with the swelling and subsequent inflammation that will be occurring over the next 48 hours. Compression and elevation might be a little tricky with lower back injuries. This is because of the lack of joints within the lower back. You could potentially look into getting the injured area stabilized with something like kinesiology taping as this has anecdotal evidence to support acute injuries but that’s only an option and not really a “compression” technique per say. Therefore I’d say resting and icing should be your priorities during this phase to ensure minimum long term detrimental effects of injury.
Here comes another disclaimer…
If you’ve hurt your back and suspect that it could be potentially serious, please please please go get it checked out. Yes, I know we said we’re discussing injury management at home, but this goes without saying any lower back injury cannot and should not be taken lightly. And it is for that reason that we want you guys to rather be informed than to make any assumptions about your health. No one has x-ray vision, not even the best of the best surgeons in the world. So that’s why we encourage getting some form of diagnostic scan done in order to rule out any serious injuries.
I know that the NSAIDS are the most commonly prescribed medication class for injuries of this nature. That’s because they’re effective and don’t completely obliterate your immune system like steroids would do. But they do come with a significant downside, NSAIDS are very strong acids by nature, yes this is a little organic chemistry throwback for you, and they cause significant damage to your body’s naturally pH levels resulting in potential strain on your gut and stomach lining. So sustained use of NSAIDS can cause more harm in the long term than good.
That’s where the legend and OG comes into play- Ibuprofen. Ibuprofen doesn’t get enough respect in my opinion. Not only does it possess significant analgesic properties to treat most types of painful symptoms, it also has anti-inflammatory properties that can significantly reduce your swelling and inflammation related symptoms after your back injury. That being said, it might be slightly less effective than traditional NSAIDs. So you might need to take a higher dosage in order to yield the same results as NSAIDs would get you on a lower dosage.
Both options are great for pain management, the choice ultimately lies with you. If you have any history of gut related issues such as re-flux or heartburn we would suggest Ibuprofen and if you’re not big on taking medications or pills I’d say stick with NSAIDs. Again, these are just generalized suggestions, please note these are not guidelines meant to be used for diagnosing or distribution of any kind.
Before we jump into the rehab and recovery phase, there is a second step we need to cover first- secondary care. This is not a commonly discussed phase as it is usually associated with acute care, however it is in its own right a step by itself. After you get injured your body’s first reaction is to protect itself from any further injury or damage. In terms of the lower back it is usually inflammation and if it’s musculoskeletal inflammation is accompanied by muscle guarding.
In both instances the body’s response isn’t ideal, as it usually impedes your normal day to day activities. That's why you need secondary care to help manage the impending tightness, muscle stiffness and in some cases the muscular spasm-like symptoms.
Secondary care includes mobility like stretching or self myofascial release, this will significantly help with reducing your body’s natural response to the injury. Additionally, heat therapy such as bean bags can help loosen up severely tight spasms in the lower back without causing significant pain. All in all, using secondary care techniques can seriously help you reduce injuring induce responses within your body.
The common issues that affect our lower backs are muscle strains, connective tissue sprains, myofascial pain, muscular spasms, weaknesses and imbalances. If you suffer from one or more of these conditions at a low to moderate level of severity you do have the option of treating yourself. Therefore, each of these conditions require some acute management to alleviate the immediate painful symptoms, followed by a well thought out secondary care protocol to build towards the rehabilitation and ultimately recovery of your condition. And these two latter topics we will be covering in quite some detail in Part 2 of this article.