4 steps to diagnose and get rid of your lower back pain now

Part 1 – Back Pain Red Flags

First things first. Let’s clear some red flags. Red flags are signs and symptoms that, if present, need to be reviewed immediately and is a medical emergency. If you have any of the following signs and symptoms, it would be highly recommended that you go to the emergency room of your local hospital, or contact your local general practitioner.

• Pain in your lower back that may travel down the back of the thigh, the calf and to your feet.
• Frequent pins and needles, or numbness in both legs
• Severe weakness in both legs
• Faecal incontinence (i.e. sudden loss of the control of your poo)
• Urinary retention (i.e. trouble urinating)
• Gait / walking abnormalities
• Numbness around the saddle region (i.e. the rectal and genital areas and the inner thighs)

These symptoms are synonymous with Cauda Equina Syndrome. If you already have a pre-existing history of these symptoms and have been cleared by a medical professional, then monitor for any changes to your normal signs and symptoms. Generally, if there are no red flags, then the individual is recommended to move as much as tolerated. It should be noted, that if pain does continue to worsen, or if the individual notices that their function is deteriorating quickly, then they should go to the emergency room to eliminate any sinister pathology.

Part 2 – What causes back pain?

My scan says I have a bulging disc and degeneration of my spine. My back is “out.”

Unfortunately, there is still a large disconnect between the current body of research and some health practitioners. As we now know, most investigation results from MRI, X-Ray or CT scan for your lower back doesn’t really tell you much. In fact, one study by Herzog et al. (2017) showed an individual who had 10 MRI’s within three weeks, and had results reported by 10 different radiologists! So what was the consensus? There was none. 49 different issues were reported, but 0 were reported in all 10 scans. Which shows that there is high variability in reported findings, even within the same patient.

Ultimately, scans can help exclude serious medical emergencies, but does not isolate your source of pain, and doesn’t really change your treatment strategy. An MRI of your lower back may be able to tell you what changes have happened to your back, but may not necessarily mean that it is the source of your pain/

This is important, because lower back pain – or even any musculoskeletal pain – is multifaceted, and there are several other variables that can affect your ability to recover from injury / pain and your pain levels. This includes your general health, factors such as sleep and nutrition, as well as previous injuries and fitness level.

Belief Systems

Perhaps understated, is your belief systems about your back pain and what back pain means to you. Unfortunately, it is not well addressed at times, and many patients and clients are always left thinking – My back will never be better and I have to be extremely careful about everything I do otherwise I’ll throw my back out and never be able to walk again. This couldn’t be further than the truth, and these negative thoughts and connotations are much more detrimental to your overall health and well being.

Timeline for Recovery Generally, the first 0 – 72 hours (3 days) will be the worst after the initial injury or flare-up. This is due to a normal acute inflammatory process that occurs with most injuries. Resolution of the majority of pain usually occurs in the first 4 – 6 weeks following injuries.

Following this time period, most individuals will be relatively pain-free. However, some will still have a lingering sensation, which they explain as “I can feel it’s there, but it doesn’t bother me.” Usually we can describe this sensation as the “last 5%”, and full recovery can sometimes still take weeks to months following injury and is dependent on a large plethora of other factors.

So in the meantime, what should you do?

Part 3 – General recommendations

With your newfound understanding of lower back pain, here are some quick tips to facilitate your recovery from any acute back pain, or flare-ups that you may experience.

• Keep moving as much as possible. Motion is lotion.
• Use pain relief strategies as needed. Whether that includes over the counter pain relief medication, heat packs or getting a massage.
• Change your posture OFTEN.
• Go for a walk.
• Don’t worry!!! Your back will get better. Unfortunately, it does take time and a bit of effort, but eventually the pain will settle and your function will begin to return.

It really is that simple! Unfortunately, after experiencing your first bout of lower back pain, many individuals still look for that “magical cure” and “instant pain relief” strategies. Some individuals get suckered into paying for magical TENS (transcutaneous electrical nerve stimulation) and Ultrasound treatments (sounds extremely fancy, but really doesn’t have much scientific evidence to promote its use) or get round after round of massages, which provide fantastic short term relief, but very little for long-term changes.

With that being said, there are some certain movements and exercises that I do encourage doing as these can promote healthy movement through the spine and get you going just a little bit quicker!

Part 4 – 4 Simple Exercises to Relieve Your Back Pain

Here are four simple exercises, that may provide some pain relief and will encourage movement in the lower back. If these exercises are painful, then stop. Back pain is very individual to each person, so a blanket recommendation of exercises will not necessarily target YOUR back pain.

1. Knee rocks

• Holding your knees, gently rock your knees backwards and forwards.
• Continue this motion for 20 – 30 seconds while taking some deep breaths.

• The same as knee rocks, but gentle rocking side to side.

2. Sitting side stretch

• This stretches the quadratus lumborum (QL)
• In a sitting position, reach one hand over your body.
• When you feel the stretch in your side, take a deep breath through your chest.
• You should feel your ribcage rise, and a large stretch through your side / back.
• Take two to three deep breaths, then repeat on the other side.

3. McKenzie Extensions (Lumbar extension)

• Lying on your stomach, prop yourself onto your forearms.
• Slowly push your arms away. This should extend your lumbar spine.
• Then, slowly lower yourself back into the starting position.
• Repeat this motion 10 – 15 times or as needed.
• STOP if it is painful. Do not push into the pain, instead stop just before the painful point.

4. Sitting Forward Stretch

• Sitting in a chair, tuck your chin and bring your body down to the ground.
• Slowly feeling each vertebrae move one at a time.
• At the bottom position, take two to three deep breaths, and then slowly raise yourself back up.
• STOP if it is painful. Do not push into the pain, instead stop just before the painful point.

Part 5 – Conclusion

Remember that your lower back pain will get better.

It does take some time and it becomes frustrating, as it really takes away your ability to do anything. However, you should keep moving as much as your pain allows you to, and don’t worry! If you’re worried about your lower back, or it hasn’t been getting better weeks after your initial injury, please contact a local health practitioner. Preferably a physiotherapist, as they can perform a detailed assessment and treatment plan that should be individualised to your case.

So what will a pain-free lower back let you do?

References

• Herzog, R., Elgort, D. R., Flanders, A. E., & Moley, P. J. (2017). Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period. Spine, J, 17(4), 554 – 561.