CONNOR HAMILTON BSc. MSc. MCSP

At some point, whether you’ve been training hard in the gym, or stuck in the office, you’ve probably experienced lower back pain. Maybe it’s happened to you multiple times! So how did you manage it? Did you seek medical care? Who from? And did it help?

The truth is, that experiencing back pain is very common and unfortunately the advice you receive on “how to fix” your back can vary widely depending on the healthcare professional you speak too. One person might press on your spine and tell you that your back is “out of place” and that you need “manipulated” to “put it back in”. While another will convincingly tell you that your pelvis is “out of alignment” or that you have “fascial restrictions that need manually broken up”. The truth is that much of this terminology is based on outdated evidence which instead of providing reassurance, it feeds fear that somehow you are broken and need “fixing”, and the only way to achieve this is through creating a dependence on that individual practitioner. The whole concept behind Connor The Physio is, and will always be, to equip you with the knowledge and understanding needed to reduce your reliance on physio, giving you the right tools in the tool box to keep you healthy, strong and above all injury free. With that in mind, let’s cut through the noise and show you some of the common themes and tips on how to manage back pain once its already happened!

You don't need "fixing"

I have to be careful how this is said, but in line with the evidence base, for the most part, unless you have a spinal pathology, spinal bones don’t just “go out of place”, your pelvis doesn’t just “slip out”, and the strongest hands on therapy in the world can’t “release fascial adhesions” this isn’t my opinion, it’s the opinion of the evidence base. Terminology like this can be very unhelpful and creates the idea that your body is inherently weak and unstable and that you need the help of a “highly skilled practitioner” to be “fixed”. This creates dependence... dependence on the healthcare system and dependence on the practitioner. So how do we manage this?

Education

Occasional back pain from time to time is completely normal and it will usually resolve itself without treatment. Sometimes this reassurance alone can be enough to decrease pain, as your belief about pain will directly influence how your body interprets pain.

Your spine is designed to move and it’s designed to be inherently strong and stable. While hands on therapy can help to relieve symptoms temporarily, the key is to encourage moving through the pain free range of movement, modifying your activities to “work around the pain” and implement a management strategy to find tolerable movements and gradually increase your tolerance to these movements. That’s where physiotherapy comes in. 

Respect the flare up... identify the tolerable movements

After the dreaded lower back “tweak”, most of us will have a movement that the spine doesn’t tolerate well. Something I see almost every week are powerlifters and bodybuilders experiencing lower back pain from deadlifting or the recent trend of stiff leg deadlifting. Generally describing pain when bending forward but no pain when extending backwards. In this scenario, we don’t panic! we identify the aggravating movement, understand that at the moment our body is highly sensitised to this movement pattern so we temporarily avoid it. Instead we work into the non-aggravating movement (extension) to help give our brain a threat free movement which will desensitise and decrease pain. As symptoms start to decrease we can slowly re-integrate and increase our tolerance to bending forward. The mistake we make when we panic is to repeatedly work into the aggravating movement “to see if anything has changed” which usually makes things worse!

People run into trouble when they panic because they can’t bend forward…and do one of two things, repeatedly, and frequently bend forward and stretch into a highly sensitized movement, or avoid any and all movement all together, which usually makes it worse!

Train in non-threatening positions

In almost all cases, after red flags have been ruled out by your healthcare practitioner, there is absolutely no reason why you can’t keep training with modified activities. Find the movements that don’t hurt… integrate them into your sessions or daily routine, and load them up.

Cant bend forward? Try lunging, split squatting, step ups, hip hitches and bridging. Give your brain some non-threatening movements to help de-sensitise pain and promote recovery. 

Reintegrate the painful movement pattern

I like to use the acronym "Rail"

• Release
• Activate
• Integrate
• Load

In the early stages, there's nothing wrong with hands on therapy to decrease symptoms so long as it is with the main effort of giving you space to move. As you work through non-threatening movements, de-sensitise pain and reduce the irritability of your symptoms we can look to reintegrate the painful movement pattern. How do we do this? well if your pain was caused by bending forward you could look to integrate box squats, thoracic breathing, cat/cows to gradually re-expose you to spinal flexion. It won't be comfortable, but it shouldn't be painful. So long as symptoms don't persist for hours after activity then you're working within your means.

Load mangement

Avoid the temptation to jump straight back into your working weights the second you start feeling better. Remember, there was a reason that mechanically "Things broke down". Quite often we are strong enough to tolerate a movement, getting the bar from A to B until we find ourselves in a range where we can't tolerate the load, I simply like to call that spot "The deficit". The load has to go somewhere and quite often it ends up on the spinal erectors putting us out of action. So with that in mind a simple trick to work your way back up to full strength is to load up to 60% of your 1RM and increase by 10% per week until you're back to your pre injury weight.

Final words

Seems pretty logical right? Identify the movement, de-load and work around the movement until symptoms start to settle, reintegrate the movement and then load. Easier said than done. This advice is of course just general advice for the everyday back pain, however if you are experiencing ongoing and persistent back pain that won't seem to budge, touch base with your local lifting physio whoever that might be.

A word of caution

Although very rare, It would be irresponsible for me to not touch base on the signs and symptoms of Cauda Equina.

Cauda Equina Syndrome is a very rare but serious condition, where the bundle of nerves called the Cauda Equina at the bottom of the spine become compressed. The Cauda Equina controls the function of the bladder and bowel, and the sensation to the skin of the genitals and bottom area.

The most common cause of compression to the Cauda Equina is a central disc prolapse although other causes are possible.

Cauda Equina Syndrome warning signs

• Loss of feeling / pins and needles between your inner thighs or genitals
• Numbness in and around your back passage or buttocks
• Altered feeling when using toilet paper to wipe yourself
• Increasing difficulty when you try to urinate
• Increasing difficulty when your try to stop or control your flow of urine
• Loss of sensation when you pass urine
• Leaking urine, or a recent need to use pads
• Not knowing when your bladder is either full or empty
• Inability to stop bowel movement or leaking
• Loss of sensation when you pass a bowel motion
• Change in ability to achieve and erection or ejaculate
• Loss of sensation in genitals during sexual intercourse

If you experience any of these symptoms, please contact your Emergency Department straight away. Without early interventions, the possible consequences can be devastating, including irreversible damage to bladder and bowel function, and sexual dysfunction. 

About the author

These articles are,  as always, here to give you a nod in the right direction and to help you gain a further understanding of key parts of the body and how they function to keep you moving, and keep you strong. If you are experiencing back pain, recovering from surgery or need a point in the right direction, my diary is open at Arch 33 South College Street Aberdeen and I would be more than happy to hear from you. 

Remember that these articles are not a "one stop shop" and provide general advice only, always seek guidance from your healthcare provider before engaging in physical activity. With that in mind I understand that your rehabilitation needs are individual and your journey unique. Whether you're recovering from an injury, aiming for athletic excellence, or seeking overall well-being, Connor The Physio is well placed to meet your needs. 

Find me at Arch 33 on South College Street, part of the soon-to-open Results Gym hub and training hall. This not only makes us easily accessible but also fosters a collaborative environment.

Ready to take the next step on your rehabilitation journey? Book your session today!