Having lower back pain can be an excruciatingly painful experience, and often a debilitating situation for millions of Americans. A UNC study has estimated that 80% of Americans will experience lower back pain at some point in their lives. Unfortunately, Americans sit more than ever, contributing to the rising prevalence of lower back pain. Aside from what people read online, most Americans are more confused than ever when it comes to self management of their sore lower back, and how to prevent the debilitating pain from recurring. After your first bout of lower back pain, you will never want to experience it again. This article is designed to explain in detail the 6 tried and true methods that will help you resolve a painful lower back. The article also discusses a practical approach to prevent future painful recurrences of back pain.
Step One – First identify your type of lower back pain.
It is important that you first define your medical history, if you want to resolve your particular type of back pain.
- Is this specific back pain something that has gradually built up over the years, and now seems to be getting progressively worse?
- Or, is the back pain acute or sudden lower back pain which presents like a sharp needle stab or electric shock, and this is the first time you have experienced this?
- Is your pain localized and does it present itself as chronic lower back pain and respond well to moving your body at different angles?.
- Was the pain triggered by an acute trauma like a fall or a motor vehicle accident and now everything you do hurts it? If this is case, then seeing your Physician should be your first course of action.
- Understanding the differences between sudden lower back pain versus chronic lower back pain is important for you to understand so you can properly implement the proper treatment course. Simply applying any random treatment can exacerbate an acute condition, or at best provides no pain relief.
- If you have been experiencing sudden severe lower back pain for the first time, chances are any body movement will be painful. You will not want to move your body at all. The best treatment course is to schedule an emergency appointment to a local Chiropractor who will take images of your lower back to make sure there are no visible fractures, and get you moving again. Once you have made progress with the Chiropractic treatment plan, then you can apply the methods listed below to prevent a future recurrence of sudden severe lower back pain.
Step Two – Determine if any of these medical diagnoses pertain to you.
If you have been diagnosed with any of the below listed six medical causes of sudden severe lower back pain, then please consult with your physician before engaging in any mobilization or rehabilitation program. The Methods that I will be discussing work for the majority of chronic lower back pain problems, however, the six medical causes of lower back pain often require medical management. If you have any of the six listed diagnoses then I urge you to get your physicians approval before engaging in any rehabilitative or exercise program. Here are six medical diagnoses that may not respond well to movement therapy.
- Disc Tear
- Disc Rupture
- Facet’ Syndrome
- Vertebral Fractures
- Spinal Stenosis
These six common diagnoses are bone and intervertebral disc problems which often cause severe back pain. They are difficult to manage with movement therapy alone. Often medical management is indicated to reduce severe back pain. These six problems are often human created by poor lifestyle choices, such as living a sedentary lifestyle, obesity, nutritional deficiencies, poor posture, prolonged sitting, smoking and lack of conditioning of the core intrinsic stabilization system of the human body. These poor lifestyle choices affect your global health including musculoskeletal health of the spine. The end result is dysfunction. Although it could be argued that a disc tear is a direct result of trauma, it has also been shown to be the end result of degenerative disc disease, which has been coined a result of aging. But what exactly is aging? Why do some people experience severe lower back pain and others don’t? Although we all will age, we are responsible for keeping our bodies youthful, strong, functional and properly tuned. If we allow ourselves to slow down, put proper exercise, nutrition, sleep and stress management on the back burner, then accelerated aging with associated health problems are to be expected. How we deal with inevitable aging and body pains often predicts quality of life. According to Harvard University Psychologists, your chronic back pain is “connected to your head”
Step Three – What can you do to alleviate sudden lower back pain?
These seven very important steps are medically proven home remedies for back pain.
- The Fetal Stretch – If you experience sudden back pain, carefully move to the floor, bed or any flat surface. Lay flat on your back with both legs bent to reduce further lumbar spine spasms. Once the spasm subsides, carefully draw your bent knees towards your chest and assume the fetal position. Being in this position will induce a gradual and comfortable stretch to your back muscles, while realignment of your pelvis and lumbar spine begins. Hold this position for at least one minute or until the pain subsides to at least seventy five percent.
- The Child’s Pose -Carefully log roll over on your tummy. Get to your knees and slowly transition into the Child’s Pose Position. Hold this position for several minutes, and you should notice an elongation of your spine and an improvement in lower back comfort. The Child’s Pose Position, gently tucks the pelvis into the opposite position that often triggers episodes of sudden lower back pain. The Child’s Pose Position is regarded by chiropractors and physical therapists as a fantastic home remedy for lower back pain, that can greatly improve spine function. Do your best to drive your hips all the way back so they come in contact with the heels of your feet. Simultaneously extend your arms forward to add extra decompression to the spine. Hold this position for thirty seconds to two minutes for the best result. Once the back pain has subsided by at least 75% then move on to the next step.
- The Hip/Knee Pendulum -Carefully roll over on to your back. Make sure your knees are bent at a right angle as illustrated. Remember not to fully extend your legs quite yet. Flat lying legs can engage tight hip flexor muscles and induce lumbar spine extension which could trigger a lower back spasm. With knees bent, slowly begin rocking your legs side to side in a pendulum fashion. Continue this movement for thirty seconds to two minutes to get the best benefit. The purpose of this movement is to re-establish a normal lumbar pelvic rhythm. This natural lumbar pelvic rhythm is required if you want to begin walking naturally without inducing a recurrence of sudden lower back pain.
- The Pelvic Bridge – It’s time to assess your lower back strength with this next movement called the pelvic bridge. It is important to know that your lumbar spine needs to have the strength and stamina to lift your torso off the floor. If you cannot, then you will not have the endurance to stand for any length of time without back problems. Begin the movement with both legs bent, back flat on the floor, and attempt to slowly raise your hips off the floor. Your goal is to be able to raise your hips approximately four to six inches off the floor and hold for 15 seconds or longer. If you can successfully perform the pelvic bridge without too much pain and effort, then this is a excellent sign that your painful lower back is resolving. You are now ready to progress.
- Try to stand and move cautiously – Once you’re finally able to stand upright, be aware than any sudden twisting or rotational movements to your spine, can induce another attack of sudden lower back pain. Refrain from sitting down in a chair as this can induce an anterior pelvic tilt which can aggravate the lumbar spine, and result in severe lower back pain.
- Beware the chair -If you must sit in a chair, limit your sitting time. Strategically place a large ice pack on your lower back. If you maintain a neutral spine posture and sit upright in your office chair, you should be able to hold the ice pack firmly in place against the backrest of your chair. Consider this good biofeedback for maintenance of good posture and spinal dynamics. It is also very important that get out of your chair every 15 -30 minutes to decompress your spine. Once your back begins to feel normal again, do not stop with the ice therapy and intermittent standing. In fact, it’s time to move more and implement some more mobilizations.
- The McKenzie press up – This is a pelvis and lower back integrator. When the lower back is subjected to severe lower back pain, both the lumbar spine and pelvic girdle tend to lock up. It’s this phenomena which keeps the body bent over like the Leaning Tower of Pisa. The Mckenzie press up is designed to synchronize the pelvis and lower back so that you can stand up straight again. To do the McKenzie press up, get yourself into a push up position. Extend your arms beneath your chest, while keeping your pelvis flat on the floor. It is important to note that you won’t be able to fully straighten your arms until your back flexibility returns. As you press your torso off the floor, be careful not to perform this exercise too fast. Do not allow your hips to rise off the floor. If the hips begin to rise from the floor, then this is your end point and simply hold the position for a few seconds, retract both arms, and return back to the floor. Perform the up down movement twelve times. You should notice improved flexibility and comfort in your lower back. If you have been diagnosed with a history of facet syndrome or spondylolisthesis, then refrain from doing this particular mobilization. See the illustration below.
Step Four – How to relieve chronic lower back pain associated with sitting and poor posture.
Chronic lower back pain, sometimes has very different symptoms than sudden lower back pain. Chronic lower back pain and lower back stiffness go hand in hand due to faulty sitting postures; when driving a vehicle, when sitting for endless hours at work, or when reclining or laying down in a sunken, soft bed, or couch. If this sounds familiar, and chronic lower back pain is affecting your life, then a muscle specific rehabilitation course of action will definitely help.
A small investment in your back health. I highly recommend that you invest in a 55cm Swiss ball and a 5″ diameter foam roller. These two tools, are necessary for the self management of chronic lower back stiffness and pain. Both of these tools can be purchased on Amazon at a very reasonable price. I have no affiliation with Amazon, but like their competitive pricing! The links I have provided are what I consider the best quality you can buy at a competitive price. I don’t recommend purchasing poor quality imitation Swiss-balls. Why? Because they are too squishy, are not puncture resistant, and don’t support the spine well. The Swiss ball I recommend is made by the German company Sissel, and is puncture resistant. Sissel is the only ball I will use on my clients. I own three Sissel Balls, which have never failed me over the twenty years that I have owned them! To purchase a Foam Roller and Swiss ball, refer to the links below.
- Swiss Ball Back On Ball Extension – This is a highly therapeutic mobilization for both the thoracic and lumbar spine. This is a popular mobilization prescribed by many physical therapists. It’s simple and relatively easy to do. As you can see in the image, you must carefully drape yourself over top of the ball, and gradually stretch your stiff spine into extension. Be sure you are properly balanced and begin by dropping your hips towards the floor and then progress by extending both arms backwards.
- Swiss Ball Side Lying Extension – This is another fantastic therapeutic spine mobilizer which is designed to elongate the spine in the frontal plane. Often chronically severe lower back pain will cause tightening of the muscles on the sides of the body known as internal and external obliques. These muscle have a tendency to lock up and contort the spine sideways. This sideways lean can lead to a lateral disc rupture, which can further force the torso to lean towards the side of the injury, otherwise known as Antalgia. By side lying over a Swiss Ball you can safely straighten out this spinal contortion and greatly reduce episodes of severe lower back pain.
- Foam Roller Thoracic Spine Mobilization – Foam rollers were designed and implemented by Israeli scientist Dr. Moishe FeldenKrais in the mid 1970s. Foam roller therapy has become a mainstay in physical therapy practices. When using the foam roller it is very important that you roll slowly and systematically. Its important that you apply pressure to the proper place when mobilizing the thoracic spine. Begin rolling at the top of your shoulder blades and travel no further than the middle of your back. Mobilizing the lower back can greatly reduce severe lower back pain related to misalignment of the lumbar vertebrae. Misalignment of vertebral bodies can lead to a condition known as Spondylolisthesis. When first mobilizing your thoracic spine segments you may feel some benign popping sensations as the vertebrae fall into proper alignment. Don’t worry the popping is normal. Avid users of foam rollers swear by them, and claim it’s benefits are on par with chiropractic treatment.
- Kneeling Hip Flexor stretch – After you have done your joint mobilizing with the Swiss ball and Foam Roller, then it is imperative that you improve the flexibility to the primary muscles responsible for most chronic lower back pain issues. These muscles are also known as hip flexors. Hip flexor muscles are also known as the Psoas. They have an origin point on the lumbar vertebrae (the five spine segments of your lower back) and insert on the femur (also known as your long leg bone). When you sit too long with legs bent and butt muscles squished, the hip flexor muscle reciprocally shortens. When you attempt to stand up, this overly tightened muscle compresses the lumbar vertebrae and causes chronic back pain and stiffness. In some cases, this muscle can induce severe lower back pain with sciatica.
- Swiss Ball Rectus Femoris Stretch – The Rectus Femoris muscle is the nasty cousin of the Psoa hip flexor muscle, and its origin and insertion points are very similar to the Psoa hip flexor muscle and should be stretched accordingly. A tight rectus femuris muscle can cause you to hunch over when standing or walking. This postural misalignment often deactivates lower back anchor muscles known as the gluteal muscles, and can trigger an episode of severe lower back pain.There are many other ways to stretch the Rectus Femoris, however, I have found the Swiss Ball stretching method to be highly effective and long lasting. To see how to apply this stretch see the picture below.
- Supine Piriformis Stretch – This highly effective stretch is best done laying flat on your back. Bring one knee towards your chest and place the opposite knee which is to be bent at a right angle over the top of the other knee. Your leg position should look like the figure four. Draw the bottom knee toward your chest and lay back with your head on the floor. What you should feel is a deep stretch, deep within the gluteal muscle when the top leg is bent at a right angle and drawn in. The piriformis muscle is an active participant in causing severe lower back pain, due to the fact that it has a tendency to compress the fragile sciatic nerve when too tight. To see how to apply a piriformis stretch, see photo below.
Step Five – Safe and effective low impact exercises for lower back pain relief.
If you search the internet you will see many medical and exercise experts who advocate doing various forms of low impact exercises for lower back relief. My suggestion to you is not based on theory, but real life application, and my experiences working with many clients who suffered with lower back pain. Most importantly, be careful when choosing your low impact exercises. There are many exercises which aggravate and inflame your spine. Your choice of low impact exercise should be what works best for your lower back condition. With that said, there are only three low impact exercises that I would recommend to help eliminate lower back pain.
- Swimming – If I had to recommend one exercise to help rehabilitate someone dealing with sudden lower back pain it would be swimming. A published research article about The efficacy of aquatic exercises for patients with low-back pain has confirmed why I believe swimming is the best way to heal a painful lower back. Swimming floats the spine and gently decompresses the intervertebral joints. When swimming, there is no vertical axial load on the intervertebral discs. Also, the cooling and soothing effect of the water is very therapeutic to the spine. Swimming has also shown to re-hydrate compressed intervertebral discs, which are often related to lower back pain. When swimming for lower back rehabilitation, be mindful not to crane the neck, as this can place the spine’s posture into hyperextension. My recommendation is to gently float in various positions, or use a flutter board to help with buoyancy. Keep in mind that you are swimming for rehabilitation and not competition. So, no ballistic flailing of the arms.
- Stationary Cycling– This is the classic cycling style where the body is positioned as if you are riding a road bike (not the recumbent bike where you are sitting in a chair and peddling). I have personally used stationary cycling with great success to remedy my chronic lower back pain. Conversely, I have recommended stationary cycling to many of my clients who found that the awkward position of the stationary cycle only aggravated their lumbar spine condition. Here are the reasons why. Your success while riding a stationary cycle is contingent on proper seat height adjustment and handlebar reach length. If these adjustments are improper, then the hips will be forced to laterally rock when peddling. If your arm reach is too far from the handlebars, then this awkward position can compromise the lower back even further. This awkward position also causes the pelvis to tilt forward, which can further impinge your intervertebral discs, ligaments or facets. It is interesting to note that lower back pain and cycling go hand in hand. So be mindful on setting up your stationary bike properly.
- Walking – When done on a flat, comfortable, predictable surface, walking can be beneficial for lower back pain relief. Avoid sandy beaches and undulating trails. These surfaces are often unpredictable. Moreover, these surfaces can cause excessive stress on ankles and knees which can potentially trigger lower back spasms. Wearing comfortable walking shoes is also vital to your lower back comfort success. Inappropriate shoes with stiff soles can create an intense ground reactive force reverberation, which can trigger another bout of lower back spasms. Being mindful about your posture when walking is very important. Being bent forward with your head down, adds extra stress on an already stressed lower back trying to find comfort. So think perfect posture, eyes forward and take smaller strides.
Step six – What can you do prevent your lower back pain from reoccurring?
The American Obesity Association has reported that obesity related lower back pain is prevalent in approximately one third of Americans. Carrying extra body weight, especially around your belly, and back, compresses intervertebral discs, anteriorly tilts the pelvis, pronates the hips and knees, and can lead to a facet syndrome, degenerative disc disease or disc rupture. Conversely, losing weight has profound benefits in replenishing intervertebral disc height, thereby reducing the risk of nerve root impingement and ligament strain. Research by Nachemson AL. has shown that for every pound an overweight person loses, the disc pressure drops respectively. If you are unsure on how to approach weight loss through diet, exercise and without hurting your back again, then consult a CHEK Practitioner and Lifestyle Coach who is expertly skilled at assessing and correcting spine problems, and can prescribe a sensible exercise and weight loss program for you. I do not recommend the use of a general personal fitness trainer as they simply do not have the adequate medical background or technical skills to assess and correct your spine dysfunctions and orthopedic issues. Moreover, there is a high probability that a general personal trainer will cause more harm than good to your fragile painful spine. Here is a good article regarding this: Personal Trainers are Failing to improve Clients Health
- Educate yourself about the root of your problem – Having a spine condition which triggers sudden lower back pain, is an alarming and serious issue not to be taken lightly. The more flare ups you experience, the greater the risk for spine arthritis. Arthritis of the spine can lead to a debilitating and painful condition known as spinal stenosis. Most painful lower backs are easily managed with corrective exercise or physical therapy. This requires your time commitment, and your ability to see a therapist twice weekly on top of doing your own home exercises. If you have to take medicine to treat your painful lower back then your first line of defense should be non steroidal anti-inflammatories (NSAIDs) such as Aleve or Motrin. Unfortunately, chronic use of NSAIDs can be dangerous to your kidneys and GI tract, and non steroidal anti-inflammatories (NSAIDs) do not always effectively manage a lower back pain. The other choice of drugs are muscle relaxants and opioids. These work well, but not without extreme side effects. Drowsiness, sedation, constipation and risk of dependency are common side effects to be concerned with. People who take these drugs report difficulty concentrating at work and a decrease in motor skills and reaction time when driving.
- Implement the appropriate treatment plan for your problem- There is nothing worse than having back pain problems interfering with the quality of your life. You can continue to self manage the periodic episodes of lower back pain at will, but this will only cause frustration. I strongly advise that you implement a long term strategy to investigate and correct the underlying problem which is triggering your painful lower back. I would hope that you want resolution. My experience in working with numerous back pain clients has been enlightening. When people struggle with severe lower back pain, they become very proactive at finding out the cure. However, once they find the cure which effectively cures the lower back pain, then it becomes the “out of sight, out of mind” approach to furthur back care maintenance. To put this in perspective, proper management of lower back pain issues, means that you will need to stick to the treatment plan for the remainder of your life, or the pain will come back and bite you!
- If you can’t manage your painful lower back alone, then seek professional help – There is no shame in seeking out professional help. We all have our strengths and expertise. Getting an accurate biometric assessment and corrective exercise prescription will give you greater insight on how to better manage your painful lower back. There are Physical Therapists, Chiropractors, CHEK Practitioners, and Corrective Exercise Specialists at your disposal to help you heal. It is well documented in several NIH studies that there is a very high prevalence rate in lower back pain. This is due to the fact that we sit more and move less. Another interesting research paper titled What low back pain is and why we need to pay attention mentions, “Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling”. In other words there is a high likelihood that your lower back pain will come back if left untreated, and the pain in your lower back can become disabling. After reading all this wonderful information and solid research, I can only hope you will take the appropriate course of action to ensure a happy, pain-free lifestyle.
About the Author
Rivak Hoffman, President of Every Bit Fit Arizona is a devout health wellness and exercise professional living in Scottsdale Arizona. He is a licensed CHEK Professional / Practitioner, Holistic Lifestyle Coach, Corrective Exercise Specialist and a NASM Nationally Certified Personal Fitness Trainer. His passion and niche’ in the industry is spine related medical issues, orthopedic rehabilitation and medical exercise training. He has successfully healed hundreds of distressed and now happy clients who have been plagued with lower back pain and neck issues over the past twenty years. Should you require a comprehensive, long lasting exercise therapy program to heal your medical issues, then contact Rivak for a complimentary consultation at EveryBitFitAz.com.
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