Ask the Doc: I Have Lower Back Pain!

by MISSY ALBRECHT, DPT, CSCS, FMS| Physical Therapist/Coach

Remember that you should be lifting your children and that heavy box of books just as you would a heavy barbell at the gym…Posture and movement are key in treating low back pain.

There is rarely a quick answer to this question: “My lower back hurts — how can I fix it?” Or for any other body part that hurts, really. In order to help someone the most, it’s essential to know his/her medical background, injury history, and all the other details of when you have pain, for how long, what helps it feel better, etc. Which is why a doctor, physical therapist or chiropractor has to meet with someone in person in order to get a clear(er) picture of what’s going on.

However, (and this “however” is why I’m writing this) there are situations where you start to see the same patterns over and over again and can assume what’s going on based on what the person is feeling. For example, if athletes are experiencing lower back pain afterdeadlifting, teach them how to use their hips instead of the lower back and their pain may magically go away (as long as there isn’t shooting pain into their leg from a newly ruptured disc). Most of the time there are a few additional areas besides correcting position that need to be targeted (after the person is evaluated and all info is gathered) such as getting rid of muscle spasms, stretching muscles, mobilizing joints, and retraining muscles to work properly.

A Basic Lower Back Pain Evaluation

This post is not meant to treat everyone’s low back pain, but I’d like to share my general guidelines (based on research, clinical doctorate training and experience) for what I go through with my patients/athletes who come to me with low back pain/tightness/stiffness:

1) Medical/Injury background, as well as current injury information

• This is the information I mentioned earlier that cannot be collected in a quick “hello” at the gym, e-mail or text message. It’s a back and forth question/answer situation where I get to know you and what’s going on. The information obtained helps me see if you need to get diagnostic testing done by a doctor (to rule out things like a disc bulge or fracture or nerve compression), or to make sure the low back pain isn’t coming from a more serious source (such as the kidneys or ovaries).

2) Watching you move

• [T]he goal with all of my patients/athletes is eventually for them to be able to treat little nagging injuries on their own as well as maintain good mobility in their tissues to stay healthy.
  This usually includes watching you walk, squat, pick up something from the floor. and perform other basic movements depending on the conversation above and after learning what bothers you. This helps me to see how you are using your body to help determine the initial cause of the injury. There can be a lot of good treatment that goes on with just educating a person on how to move better. Remember that you should be lifting your children and that heavy box of books just as you would a heavy barbell at the gym.
  And your posture for the start of a deadlift should be similar to the way you stand or sit throughout the day. These are things that can be lost in translation and end up slowing the healing process if someone goes home after their session with me and continues to aggravate their body without knowing it. Posture and movement are key in treating low back pain.

3) Specific testing to look at strength, flexibility, joint mobility and other special tests to help me determine my treatment path

• There is ample research on the common areas to treat with low back pain [see references below], but again — it all depends on what is going on in your body. If it’s something more serious, it’s very important that you seek medical advice. However, the goal with all of my patients/athletes is eventually for them to be able to treat little nagging injuries on their own as well as maintain good mobility in their tissues to stay healthy. Below are a few examples of things that I commonly work on with people who have low back pain (click on links for ways to work on relieving these areas on your own, although again not a replacement for medical advice):

Working on these muscles can provide major relief for the lower back because of their attachment to the spine.

• Tight hamstrings/adductors
• Tight glutes (looking at rotation at the hip joint in different positions)
• Tight lower back muscles
• Tight hip flexors (quads, psoas, iliacus, TFL)
• Tight lower back muscles (lacrosse ball on wall or on floor, or foam roll….along with heat/ice)
• Stiff hip joint
• Stiff thoracic spine
• Weak abdominal strength and control during movements (i.e. squat)
• Weak glutes or poor activation
• Poor breathing patterns (not using diaphragm well or not expanding ribcage, along with over using neck muscles)
• Additional problems that I address after the pain has reduced: ankle flexibility, shoulder flexibility, shoulder position (external rotation for active shoulders).

What About Muscle Spasms?

• Check out this video by Theresa Larson DPT.
• Seek medical advice if a few days’ rest does not relieve the spasms.
• Talk with your coaches to make sure your form is excellent so this doesn’t happen again.
• Try some of the postures in these pictures for relief:

What Does All This Mean to You? How Can It Help?

If you have lower back pain and feel like you’ve tried all that you can try to address it, make sure you’ve hit all of those spots above. Use this as your reference checklist. And perhaps most importantly, make sure you are lifting things at home just as if you were lifting heavy weight as often as possible! Nothing is perfect every time, but we need to be perfect as often as possible. As K-Starr says, “If you’ve been injured already, you’ve lost that privilege to be in a bad position ever.” In other words, you have to be extra careful. You only get one body,  so treat it nicely.