How to Help Lower Back Pain?

April 30, 2020

3 Movement Related Causes with Self Tests for Each!

Chances are you or someone you know has experienced an episode of lower back pain. How to help lower back pain depends on a variety of factors, many of which are tied to how well you can control your movement. This back pain may be called sciatica, sacroiliac pain, herniated disc, or my favorite, “Lumbago”. This translates to, “You have low back pain”. Can’t get more specific than that!

Some Statistics:

It’s estimated that 80% of Americans will experience back pain at some point in their lives.
10% of the world’s population is suffering from significant back pain RIGHT NOW.
Despite tremendous advances in medical imaging, treatment, and surgical techniques, the number of people suffering from low back pain is INCREASING.
Fusion surgeries to the lumbar spine alone increased by 62.3% from 2003 to 2015 (1) despite no significant change in outcomes.

When you consider that low back pain is the leading cause of physical disability in our country, these statistics should be taken seriously! (2)

Low back pain is NOT a diagnosis, it’s a symptom!

One of the most commonly used diagnosis codes for conditions of the lumbar spine is M54.5 which means….Low Back Pain! That’s like taking your car to the mechanic because it’s making a rattling noise and they diagnose your problem with what they call “rattling turns”. You would never accept that as a diagnosis on your car because you know there’s more to it! Your lower back pain is no different but people routinely accept a vague diagnosis without a root cause.

When we help patients with their lower back pain in physical therapy, they are commonly present with a medical diagnosis of bulged, degenerative, or even herniated disc. Don’t forget that every tissue in our body was put there for a reason. The disc is unlikely to break down, disintegrate, or tear without some form of external force exerting itself on the tissue. Is the herniated disc the cause of the pain or is it simply a result of an underlying movement problem or movement inefficiency that is leading to unfavorable forces at the disc?

After almost 2 decades of helping people with lower back pain in orthopedic physical therapy practice, it’s clear that addressing the issue causing your disc to bulge or herniate not only produces results but leads to lasting changes! We see many movement patterns that can and do produce back pain and stress to the ligaments, muscles, joints, and discs in our lower back. Let's check out the 3 most common movement-related risk factors for low back pain. Check out my video on movement related low back pain risk factors.

Top 3 movement-related causes of LBP with a test for each

*There should be absolutely no pain with any of these tests. If you feel discomfort, reach out to your movement specialist (Physical therapist, Physician, or other professional trained to evaluate human movement).

3 Movement related risk factors for Lower Back Pain

1. Your spine segments are moving too much

Excess ligament looseness can be partly genetic but is often a result of certain muscles weakening or just shutting down completely.

Many times, this can be the result of other areas not moving enough. In these cases, the spine compensates by moving more than it should. The hips are a classic example. If they lose their ability to move backward (or extend as they do in a normal stride), your low back will need to hyperextend to achieve the normal walking stride. If you’re a runner, this is even more critical as the stride required to run is longer than that for walking. If the hips struggle to move forward (like bringing your knee to your chest), the spine will compensate by flexing more to accomplish any necessary bending to the floor which will lead to increased disc pressure and stress. The presence of inadequate movement or mobility in one area leading to compensation in another area is more common than you would imagine. This is why finding and connecting with a movement specialist is critical for your journey towards feeling, performing, and living your best!

You can do a simple test at home to see whether or not the muscles in your lower back are inhibited (sleepy) or working properly.

SELF TEST #1 – In standing, shift your weight back and forth from the right leg to the left leg. The muscles in your lower back should relax on the side where you are shifting your weight and the muscles on the other side should contract and tighten. If this is not happening, this is a sign that your nerve to muscle connection is not working properly!

2. Your spine segments aren’t moving enough

With jobs becoming increasingly sedentary, the adaptive stiffness that develops in the hips, lower back (lumbar), and mid-back (thoracic) is staggering. It’s not a matter of if but when the pain will set in.

Think about your diet and nutrition. When you fall out of your healthy ways for a few days, you might try to “right the ship” by focusing on healthier options for several days or even weeks to restore balance (hence the popularity of “the cleanse”). This same approach works wonders for our body but is rarely practiced. Many people spend 8-12 hours sitting and once they get home, jump on the couch and sit some more! 5 minutes of simple stretching or better yet, micro stretching throughout the day is like giving your joints and muscles those healthy foods they so desperately need for balance. We’ll dive into specific joint stretches in future posts.

Ironically, our body will frequently stiffen an area in an attempt to stabilize the unstable joint. This is often the cause of mild or severe muscle spasm. If you’ve experienced pain anywhere in your body and felt a sense of relief when you stretched only to have the pain return immediately or soon after, then the tightness is likely your body’s way of trying to protect this unstable region. This is entirely different from true joint stiffness and another reason why a careful examination and accurate diagnosis of your movement system is paramount.

SELF TEST #2 – With your heels, back, shoulder blades, and head against a wall, attempt to bring your arms forward and up as close to the wall as possible without bending your elbows. Be sure to keep your thumbs pointed upward toward the ceiling to avoid impingement of the shoulder. There should be no pain with this or any of these moves. Can’t reach? Measure and track your progress by using a ruler in your hand to measure your distance from the wall.

3. You’re out of control! Your ability to control your movement is out of balance.

This is usually due to weakness or poor activation of the posterior chain (also known as the muscles on the backside of your body) like your hamstrings, glutes, and spine extension muscles (basically your back muscles).

This can be an acquired weakness from disuse and/or driven by excess hip flexor and abdominal tightness. Excess tone and tightness on one side of a joint will typically result in weakness and decreased tone on the opposite side.

This lack of control is usually seen in someone’s sitting posture:

Poor joint awareness (proprioception) in a sitting position will result in an excessive posterior pelvic tilt (slumped), an inability to self-correct, and even a complete lack of joint position awareness. If you have no idea how you’re holding your body, there’s no way you can correct it!

How much we sit is a problem because it decreases circulation to your spinal muscles, ligaments, and discs. But how we sit is every bit as important!

This same lack of back, pelvis, and hip control can be seen when we watch someone with lower back pain attempt to bend.

Properly executing a hip hinge using the aforementioned posterior chain muscles is one of the most important exercises that we teach patients suffering from low back pain. In our video, you will see a way you can check and progress this at home.

SELF TEST #3 – Assess your ability to hip hinge at home by seeing how far you can move from the wall while still being able to gently touch your butt to the wall. Use a tape measure and/or painter’s tape on the floor to measure and track your progress.

There you have it, my top 3 causes and risks for developing low back pain.

Next time you have a muscle spasm, back stiffness, or lower back pain, realize that it may be related to how you control your movement. If you’re not back to feeling your best, it’s a must that you find a movement specialist to help get you back on track.

Whether you’re seeing a Physical Therapist, Physician, Nurse Practitioner, Physician Assistant, or Chiropractor for your pain, they must be a movement specialist, using that specialty to uncover the true driving force behind your problem. That being said, Physical Therapists are uniquely trained and positioned as experts on human movement. They know above all, how negative changes to the movement system can create dysfunction and how corrections can eliminate it.

If you want to feel, perform, and live your best, you’ve GOT to MOVE your best. Until next time…Keep it movin’!

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References:

Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in Lumbar Fusion Procedure Rates and Associated Hospital Costs for Degenerative Spinal Diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976). 2019 Mar 1;44(5):369-376.
https://www.cdc.gov/arthritis/data_statistics/disabilities-limitations.htm