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First Steps for Lower Back Pain

Lower back pain (LBP) is so common and pretty much every single human being on this planet will experience some degrees of back pain, some chronically and others rarely.In most cases, an overwhelming majority of cases of LBP  are benign and will go away through a natural course after 3 weeks. Only in a minority of cases, someone experience back pain which represent a medical emergency or more serious condition( cancer/ tumor, myelopathy, spinal infection…).
LBP is also the most common reason for missed work days in the United States and represents a major amount of $$$ spent in healthcare cost. Especially due to all too often over medicalized approach to its treatment with unnecessary expensive imaging (MRI, CT scans), recurrent physicians visits, medications ( especially the overuse of pain killers which has led to a major opioid dependency and addiction for millions of people…but that is another topic…)
LBP remains one of the most common condition to meet with your physician and your physical therapist. Recent studies showed that only 7% of patient with LBP are referred to a physical therapist…leaving the other 93%  being untreated or treated with aggressive surgery, medications or injections that can help the symptoms but rarely address the condition. This is what the most recent ( and not so recent) studies and my clinical experience over the past 15 years have taught me.

Still to these days, some patients are recommended bed rest…which is by far the worst thing you can do to improve your back pain.
See, the human body was designed to move. And even in the presence of injury, moving and movement are very important…which leads to my first tips.

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#1 Bed rest and inactivity will not help your back pain. You need to be moving! 

Although you cannot ignore your back pain and associated symptoms, you need to stay active and keep moving, trying to continue with your regular activities and if possible, exercise lightly. Just be sure to not experience sharp shooting pain and you’re not noticing an increase in your overall pain. 

If your daily routine includes walking, light exercises and stretching, keep on doing these as long as they do not increase your back pain. Walking is my favorite as it a daily essential human function that improves circulation and heart health. 

Daily back stretches are a great way to start taking care of your back but these can be challenging to perform  and scary as most of us are afraid of doing more damage ( but FEAR NOT…See tip #2).

Start with walking a short distance and built up daily from there. So no need to spend most of the day on your back, with ice or heat while crossing your fingers that you will wake up pain free the next day. Work you way up from wherever you are now to 30mn walk daily. Walking and exercises, besides decreasing your risk of heart disease and diabetes, also helps decrease your pain as it deliver the best medication for your body: endorphins.

Progressive stretching is very important, especially in your legs as increase flexibility and range of motion, in your hip for example, will help decrease stress and pressure placed on your lower back.  Yoga can also be an excellent way to help stretch your spine and legs.

Learning how to activate your core musculature can be helpful controlling your symptoms, especially in the acute stage of low back pain. Instructions are provided in free downloadable ebook below.
Taking an active role on the path to feeling better is one of the most underrated aspect of treatment after an injury.

Warning: if you also experience sharp shooting pain down your leg(s) , notice numbness in your groin or notice a change in your bowel and bladder function or experience genital pain, you need to see a physician as soon as possible as it this could be an emergency. 

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#2 The amount of pain you are experiencing is not related to the extent and severity of your injury 

This might sounds counterintuitive but it is something that all of us should remember when injured. Most people move and walk around daily with some level of spinal disc bulge, damage tissues and or arthritis in our spine, and most of us don’t experience pain currently. People that suffers full tendon tears very often do not experience pain beyond the time of injury.

And so it is very important to remember that pain does not that equal harm. Pain is just your brain at work and the amount of pain you experience is proportional to the perceived threat by your brain.
With chronic pain, pain becomes the new normal for your body and with increased time, we become more sensitized to it and it takes a much smaller stimulus and/or perceived threat to trigger pain. Nerves are always on high alert in that stage and so mundane activities like walking, turning/twisting, bending or lifting are perceived as threat and become very painful.

And so with chronic pain, injured structure are by that time healed and these movements and activities one might fear are likely not causing any actual harm.
Your best bet to prevent developing chronic pain from an injury is movement. The more movement early on after an injury, the better ( except for fracture of course). 


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#3 Don’t I need to get an MRI first and see a doctor before doing anything?
If you consult with
your general practitioner first because you’re experiencing pain, and unless you are in a medical emergency, such as severe lack of sensation, bowel and bladder incontinence, genital pain or a known fracture, it is likely you won’t see much improvement from that visit alone. You will either be prescribed pain meds, be referred for more imaging (x-ray, MRI…) or to a spinal surgeon. Recent studies shows that your zip code actually determine your chance of undergoing MRI testing and that you are more likely to undergo surgery if you have an MRI.

Too often, I see patients that have received MRI or imaging first and sent straight to surgery with no attempt to conservatively treat back pain ( with PT) or patient that have been begging for an MRI to be done because they have not received the right treatment and they want to find a culprit for their back pain. 
The problem is that an MRI is a test, not a treatment. An MRI will likely shows some degeneration, arthritis and likely some disc bulge(s) in more than 2/3 of the population. These findings are rarely helpful in treating low back pain. Even an acute disc bulge heals.

So unless a fracture, a tumor or some spinal cord injury or compression is present, an MRI is a very expensive and not so helpful commodity in helping treat your back pain.
Medicine and a physician consult have obviously their place for certain condition but for 95% of back pain cases with musculoskeletal origin, MRIs, injections and heavy duty narcotics are not necessary in treating low back pain.


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#7 Consult a Physical Therapist First

In this day and age, there are no other professional that is more apt to help you treat your back pain than a manual physical therapist who will take a close look at your back, should take the time to discuss, explain and identify the problem and give you the tools you need to address your back problems.
Remember that medications generally treats symptoms and not causes ( for musculoskeletal injuries at least), and can be addictive and not without side-effects. 

Latest studies show that surgery for chronic lower back pain are no more effective than physical therapy and also come with risk. Even with a surgical procedure, patient will require physical therapy to improve.
Physical therapy is a proven, safe, proactive  and more effective way to address your lower back pain problems.
A manual physical therapist will help you get faster results and teach you how to take care of your back for the long term so you can stay away from drugs, injections or surgeries. Physical therapy is the most cost effective way to address your back pain. 

In addition to applying the previous tips, a consult with a physical therapist is an easy process as it does not require a prescription from a physician (this is called Direct Access).

Your physical therapist is a movement specialist and will create a customized plan and home program for you to reach your goals and manage your back pain. A PT will help you stay mobile and active to prevent more injuries.
If you are interested in becoming more mobile, active, start addressing your back pain while staying away from surgery, pain medications or injections, download our free e-book “7 Easy steps to Relieve Your Back Pain” or call Butheau Physiotherapy at 425-281-4171 today to speak to a back pain specialist the Seattle, WA Area.


10 thoughts on “First Steps for Lower Back Pain”

  1. My back has been giving me some issues lately, and I’m not sure why. I thought it was interesting to learn that rest might not be the best solution for improving my back pain. I’ll look into doing some light activity like you suggest to see if I can improve my pain myself.

  2. Yes, the human body is made to move and changing position often, walking is extremely important to recover from lower back injury. Rest and lying down will only make your back stiffer and prevent it from healing.

  3. That’s interesting that surgery for lower back pain is no more effective than if you just received physical therapy treatments. This is good to know since my husband has been having problems with his lower back so I’m trying to figure out what we can do to help him out. We’ll have to find a physical therapist we can go to so he can be treated and hopefully have relief, and that way he won’t have to have surgery.

  4. Physical therapy should always take place before even considering surgery. There are a few rare cases where a medical emergency is present and surgery is inevitable, but for the majority of cases of back pain, physical therapy is the solution. the length of treatment of courses varies depending on the symptoms and how long it has been going on. Solving back problem should be a team work between patient, doctor and physical therapist where everybody is involved. Active participation of patient in treating and correcting problem with the advise and education from physical therapist is of the utmost importance… As no one is gonna “fix” your back passively. The patient must be involved.
    Let me know if you need help finding. a physical therapist. If you re in the Seattle Area, I would be happy to help.

  5. Thanks for the lower back pain tips. My brother has been complaining about low back pain for weeks now, so we’re a little worried about him. I’ll tell him that movement is a good way to help with chronic pain, like you said, and see if that helps him.

    • Chronic pain is very complex and can be difficult to treat. It takes a team of professionals( pain doctor, physical therapist, sometimes psychologist) to treat properly. Moving and avoiding being fearful of movement is indeed a good start. It might just not be enough

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  9. It’s good to know that you can get faster results with a physical therapist! My sister was at my house for dinner last night, and she was telling me about how her back pain has been really bad for the past couple of months and was wondering what treatment she should look into getting. I’ll make sure to pass this information along to her so that she can look into getting physical therapy.

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