How to help lower back pain 

Low back pain is defined as pain, muscle tension or stiffness localized at the back and glute area with or without associated leg pain. It can be described as non-specific low back pain, a serious condition or as a radicular syndrome. For the sake of this post, we’ll be focussing on non-specific lower back pain.

Please note – this post is meant to be informative. If you are suffering from lower back pain do not seek to resolve it yourself, please seek medical attention. This is a list of ‘red flags’ according to the NHS, if any of these symptoms are present please seek urgent medical attention here.

Types of lower back pain

If your pain has been present for less than 6 weeks, we call this acute low back pain, 6-12 weeks sub-acute and chronic for anything longer than 12 weeks. 

What causes low back pain?

Acute non-specific back pain can happen at any time. It could be when trying out a new movement, or it could be on the thousandth rep of a lift you’ve done many, many times before. This is because there can be a few things that lead to pain at this particular time. You may have bitten off more than you can chew with the annual gardening and a combination of tiredness and a stubborn weed has caused your pain, or you’ve pushed yourself too hard in the gym week on week and your back hasn’t had time to recover between sessions. 

The takeaway from this is, rather than a specific movement that could be perceived as the cause of your back pain, it can in fact be as a result of loading the tissue (muscle, ligament etc) too quickly and suddenly, or doing too much too soon, causing the tissue to break down (strain or sprain). This pain can occur in a very specific area, be more general and it may even have some associated leg pain. 

But that’s not the only cause…

Without going into too much detail (I’ll leave that for a follow up blog), back pain can be as a result of a combination of reasons and stressors in your life. Mental stressors have a very real physical effect on our bodies. You may have had poor sleep, stress from work, heightened anxiety and even your fears and beliefs around movement can contribute to causing lower back pain. 

So, when treating and managing your back pain, we have to look at all these aspects and either look to reduce the stressors in life, whether physical or psychological, or create a better way of coping with these them.

How to help lower back pain?

If you get an episode of acute back pain, what can we do to alleviate the pain and get back to pain free activity and movement?

Usually there will be specific movements that will aggravate your symptoms. For example, bending forwards. Rather than complete rest and movement avoidance, we need to look at maintaining the mobility we have, either by working movements that are pain free, and also introducing de loaded versions of back flexion. Then we look to increase our pain free movement toward a return to full range of motion. 

For instance, depending on how bad your pain is, you may want to progress from:

• Lying on your back, holding knees toward your chest – de-loaded back flexion

• Seated back flexions, de-loaded and supported back flexion 

• Standing flexions within manageable range*

• Increase range and holds at bottom of movement

• Introduce loading and variations of movement i.e. bands and twist, especially if your pain is more on one side or you feel more tension on rotation

*Manageable pain = 0-4/10 pain during exercise and 24hr post 

What helps lower back pain?

This is what I’ve found to be the best way of helping lower back pain: to initially increase movement tolerance at the back and then load tolerance through bodyweight and then external load. 

This approach not only looks to reduce pain with function but can also prepare the back for loaded tasks that we do every day such as carrying the washing, gardening, lifting our kids and grandkids. 

Rehab in general needs to meet the demands that you put on yourself day to day, this is still true when managing back pain. You may even find “rehab” looks like a graded progression of the initial aggravating activity. You can start with some “easy gardening” or limiting the time that you’re out pulling weeds and slowly increasing over time. 

Acute nonspecific back pain can be very frustrating and even debilitating. The key strategies should centre around manageable movement and ranges of motion. As your pain allows, increase movement and loading, allowing the movement and load tolerances to improve and confidence to return.