Low back pain is an extremely common complaint that millions of people suffer from every day. In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.
It may be merely bothersome for some, but it can be debilitating and unbearable for many. When receiving a diagnosis of a disc herniation, disc bulge, degenerative disc disease, sciatica, or any other back pain-related issue, it is easy to feel as though there is no relief in sight, or worried that you may need surgery or have to take painkillers for the rest of your life. Sometimes surgery is the right answer, as when there is a progressive loss of muscle strength or other serious neurological issue. But if major red flags have been ruled out, there are quite a few non-surgical options to consider for treatment and management. One of the most important things to consider is how to help yourself and develop a daily routine to improve health and alleviate back pain.
Following are some of the most frequently asked questions about back pain that I encounter in my practice:
If I have an issue with my discs, how do I know if the problem is getting better or worse?
Location, location, location! One of the first questions to check in with yourself about is: where is the pain? There are two ways to think about the relationship between pain and movement: peripheralization and centralization. Peripheralization means that pain is moving further away from the damaged tissue. In the case of a disc injury, we are referring to the back or spine. Centralization means that the pain is becoming more focal, and moving closer to the damaged tissue (again – the spine). The further away from your spine the pain is – the worse that specific movement is going to be for the disc.
Take the most common scenario: if bending forward to towards touching your toes relieves your back pain, but makes the pain in your calf worse – this is bad! If standing up straight or extending backwards makes the pain in your leg go away, but does not relieve your back pain – this is good! Even if it makes your back pain worse, as long as the symptoms further away from your spine decrease, research supports that this is a good movement to help your back. So – avoid movements that generate pain in places further away from your spine.
I have heard that strengthening my core will help with my low back pain. Does that mean I should do sit-ups?
NO! There is a distinct difference between strengthening your core and doing sit-ups. Dr. Stu McGill has done quite a bit of research on this topic. Certain positions of the spine significantly increase pressure on the discs. Repetitive forward bending (flexion) combined with twisting (rotation) has been shown to have the most detrimental effects on the discs. If you have back pain, it is important to maintain a NEUTRAL spine during movements throughout your day.
If sit-ups may be bad for my low back and discs, what can I do instead to improve core stability?
Take a breath. Seriously. Proper breathing (referred to as diaphragmatic breathing) will expand the belly, not puff out the chest. Breathing into your stomach and back is one of the body’s best built-in stabilizing systems for the core and back muscles. A lot of people don’t allow their bodies to breathe naturally. By keeping their abdomens braced tight and overusing their low back muscles, they end up keeping their breath shallow and in their chest. So, embrace that dad-bod and take some deep belly breaths for lower back health.
What can I do during the day to prevent aggravation of my pain and help support the healing process?
Find the movement that can centralize your pain. Most commonly, extending such as a back bend will achieve this, but not always.
A simple exercise you can try is a back bend posture, similar to a Cobra Pose in the practice of Yoga for those familiar. Lying face down on the ground, press up through your hands to lift your chest and abdomen off the ground while your legs are completely relaxed. Try this for 3 sets of 10-15. Even if it gets a little worse in your spine, as long as the furthest point of pain away from your spine is alleviated, this is the right movement for you.
If this does not work, you can try side bends. A simple way to do a standing side bend is to stand with your feet shoulder-width apart. Touch your left hand to the left side of your head and slowly bend towards the right until you feel a stretch through the left side of your body. Repeat the same movement with your right hand on the right side of your head and bending towards the left. This exercise may be effective if you are experiencing one-sided pain.
If bending forward towards your toes causes pain down your legs, the most important thing to do is avoid flexion during your day until the pain is relieved. This includes simple things like tying your shoes, picking something up from the ground, and sitting. If you have to pick something up from the ground, try going into a lunge so that you are moving from your hips instead of your spine. If you have to sit all day, try sitting at the edge of your seat with your feet flat on the ground. This should help you relax into a neutral spine.
There are plenty of different causes of low back pain, and not everyone is the same. These are things that commonly help, but they are not solutions for everyone. It is important to get assessed for treatment and get the right advice on how to modify your exercise routines to best suit your case.