Low Back Pain: to do or not to do…

When it comes to low back pain, treatment strategies are all over the map. There is a lot of conflicting information out there. It’s hard to know what TO do, and what NOT TO do.

Usually, low back pain starts with something you did, an unusual activity or an unusual amount of a usual activity. More rarely, it seems to appear out of nowhere. In either case, some tissue (e.g., muscle, ligament, disk, joint) is injured, there is pain and inflammation, and then a healing cycle begins. 90% of the time that healing cycle is enough and you get better in 2 to 4 weeks.

So, what should you do when you have a sudden “attack” of low back pain? Research and science have answered this question for us quite definitively. Unfortunately, many providers “follow their intuition” rather than proven best practices. In fact, 80% of the time, providers recommend exactly the opposite of what they should. Here is what they SHOULD be doing:

1. Classify low back pain into 1 of 3 treatment categories based on signs and symptoms.

2. Do no IMAGING for at least 6 weeks, unless red flags are present

3. Stay active; avoid bed rest

4. Take NSAIDs not opioids

5. Refer to physical therapy as soon as possible

Here is what typically happens: 50% of the time patients are sent for imaging and prescribed opioid pain relievers or muscle relaxants; and 80% of the time, patients are told to rest in bed. Physical therapy is recommended less than 18% of the time, even though early PT is documented to get better results much faster, saving everyone time and money now and in the future.

Why does early PT for your current injury impact the future? Because the greatest risk for chronic low back pain is a previous history of low back pain! When your provider does not follow clinical guidelines, you are 5 to 6x more likely to have the problem again and again. Early PT ensures that proper mobility, stability, and strength is restored to all tissues involved, significantly reducing the risk of recurrence.

First, mobility. Learning a few simple active exercises that you can do in pain-free ranges of motion goes a long way to reducing inflammation, restoring proper nutrition to stiff joints, and increasing blood flow to tight muscles.

Next up, stability. Stability is not about strong abdominals, but rather, is focused on relearning how to access the correct deep postural muscles that are responsible for anticipatory contractions, motor control, proprioception in the trunk. Interesting fact: these deep postural muscles get “turned off” by pain, and they do not turn back on without training. In other words,

the light switch to these muscles will not turn back on once you have recovered. You must actively train to turn the light switch back on.

The final progression is functional strength training to coordinate complex body and extremity movements and incorporate activate stabilization into daily life. Functional strength training also builds endurance, power and resilience.

There you have it…the best “to do’s” for treating low back pain, and the best possible insurance against repeat episodes. By all means, ice and take an over-the-counter analgesic, but then come into PT as soon as possible. The earlier you start, the faster you will recover. And, if you are in the minority of the population that is not recovering, we will quarterback you to the right provider for the right care at the right time.