Written by Marissa Hoen | October 19 2020
Unchain your Back Pain
Right from the very beginning, our bodies have been responding to the inherent stresses of everyday life. Over the years we experience so much through our bodies, but sometimes these bodies can’t keep up with the physical demands of our experiences. Low back pain is one of the most common issues that I have seen as an RMT, and one that I personally deal with the more time I spend at a desk studying. Just as the causes of low back pain vary, so do the methods of relieving that pain. In this post, I’ll talk about about acute and chronic pain, as well as some steps you can take to lessen that pain*.
Acute or Chronic pain?
Acute pain is new pain. It is usually caused by something identifiable and lasts less than 6 months1. If mistreated, this pain has the potential of becoming chronic. Chronic pain can persist even after the originally damaged tissue is fully healed, but can also arise without injury1.
Ways to Reduce Pain:
Heat
Heat applications help to reduce pain, increase blood flow, increase cellular metabolism, and improve elasticity of tissues2. I use heat when I want to warm up for work, or to reduce dull aching pain and muscle spasms. Take caution if you decide to put heat on an acute injury, as you could increase swelling and raise the temperature of an already heated area, which may not be ideal for the healing process.
Cold
Applying cold packs to the low back helps to reduce pain, decreases local blood flow and lymph circulation, and may reduce muscle spasm2. I usually use cold in acute pain situations, if I have just had an injury and I want to reduce pain and swelling. Each person has a different reaction to cold however, so you may need to test this yourself!
Positional changes
Sitting or standing for long periods can provoke low back pain, so it is ideal to keep your spine gently moving throughout the day.
If you need to be in the same position for an extended period of time, find ergonomic solutions that reduce excess force through the lumbar spine.
Those with specific issues such as lumbar disc herniations may find lying flat painful, side lying with a pillow between the knees is a great position to reduce pressure on discs and spinal cord3.
Rest
If you’ve just had an acute injury, treat it appropriately and then let it be. The healing process takes some time, and you don’t want to cause further damage to the tissue! Try not to stay completely still however, as some movement is essential for recovery.
Move what doesn’t hurt!
A safe method in pain reduction is to exercise around the pain. Learn which movements cause discomfort, and exercise within your comfort zone. Exercise induced hypoalgesia, or the reduction of pain levels after exercise, is greater in individuals who performed more physical activity4.
Stabilization exercises
Exercises that target the trunk muscles, or muscles surrounding the spine and abdomen, were shown to be more effective in reducing pain than general exercises5.
Examples of these exercises include planks, lumbar flexion and extension while on hands and knees (like a cat-cow in yoga), and simply contracting the abdominal wall6.
Manual Therapies
Massage therapy has been shown to decrease many different types of pain while helping to improve other aspects of your health and wellbeing7.
Manual Physiotherapy techniques may be more effective in decreasing low back pain than stabilization exercises5, however a combination could be beneficial.
Both the Feldenkrais method and movement education programs known as ‘back school’ are effective in reducing chronic low back pain8.
Specific Strengthening and Stabilization Exercises9:
If you feel low back pain during any of these exercises, stop the exercise and try again later. If it still causes pain, ask your physio or kinesiologist if they have any tips on your form!
Resisted Hip Abductions
The Gluteus medius muscle acts to abduct the hip (move the thigh away from the body, picture jumping-jacks) and assists in stability when walking. It has been shown that those with low back pain may have weaker gluteus medius muscles10.
Try this to reduce pain in the moment: put a belt or strap just above your knees and gently push into the resistance. Keep your back in a neutral position, breathe, and try to hold the contraction for 30s-1 min.
Quadruped Hip Extensions
On hands and knees, engage your core to keep your back in a neutral position, then squeeze your glutes and hamstrings to slowly bring your foot towards the ceiling. Try 10-15 reps per side!
Glute Bridge
Lying on your back with your feet flat on the floor and knees bent, engage the glutes to slowly raise your hips off the ground.
Side Plank
Begin on your side with knees stacked on top of each other and your forearm or hand making contact with the ground. Slowly lift your hips towards the ceiling and hold your side plank, breathing throughout.
*Note: If you are experiencing unexplained acute back pain or pain that is persistent or getting worse, talk to a medical professional before doing specific exercises that could cause further injury.
References
Acute vs chronic pain. (2017, January 26). Cleveland Clinic. Retrieved October 18, 2020, from https://my.clevelandclinic.org/health/articles/12051-acute-vs-chronic-pain#:~:text=Acute %20pain%20usually%20comes%20on,underlying%20cause%20for%20the%20pain.
Malanga, G. A., Yan, N., & Stark, J. (2015). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine, 127(1), 57-65. doi:10.1080/00325481.2015.992719
Sleeping with a herniated disc. Tristate Pain Institute. Retrieved October 18, 2020, from https://www.tspain.com/blog/sleeping-herniated-disc
Ohlman, T., Miller, L., Naugle, K. E., & Naugle, K. M. (2018). Physical activity levels predict exercise-induced hypoalgesia in older adults. Medicine and Science in Sports and Exercise, 50(10), 2101-2109. doi:10.1249/MSS.0000000000001661
5Neto, M. G., Lopes, J. M., Conceição, C. S., Araujo, A., Brasileiro, A., Sousa, C., Carvalho, V., & Arcanjo, F. L. (2017). Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: A systematic review and meta-analysis. Physical Therapy in Sport, 23, 136-142. doi:10.1016/j.ptsp.2016.08.004
Smith, B. E., Littlewood, C., & May, S. (2014). An update of stabilisation exercises for low back pain: A systematic review with meta-analysis. BMC Musculoskeletal Disorders, 15(1), 416. doi:10.1186/1471-2474-15-416
Crawford, C., Boyd, C., Paat, C. F., Price, A., Xenakis, L., Yang, E., & Zhang, W., (2016). The impact of massage therapy on function in pain populations—A systematic review and meta-analysis of randomized controlled trials: Part I, patients experiencing pain in the general population. Pain Medicine, 17(7), 1353-1375. doi:10.1093/pm/pnw099
Paolucci, T., Zangrando, F., Iosa, M., De Angelis, S., Marzoli, C., Piccinini, G., & Saraceni, V. M. (2017). Improved interoceptive awareness in chronic low back pain: A comparison of back school versus feldenkrais method. Disability and Rehabilitation, 39(10), 994-1001. doi:10.1080/09638288.2016.1175035
Bade, M., Cobo-Estevez, M., Neeley, D., Pandya, J., Gunderson, T, & Cook, C. (2017). Effects of manual therapy and exercise targeting the hips in patients with low-back pain- A randomized controlled trial. Journal of Evaluation in Clinical Practice, 23(4), 734-740. doi:10.1111/jep.12705
Cooper, N., Scavo, K., Strickland, K., Typayamongkol, N., Nicholson, J., Bewyer, D., & Sluka, K. (2016). Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. Eur Spine J 25, 1258–1265. https://doi-org.ezproxy.library.uvic.ca/10.1007/s00586-015-4027-6
Image Credit can be found here: https://www.vectorstock.com/royalty-free-vectors/back-ache-cartoon-vectors