Updated: Sep 22, 2020
Back pain in incredibly common, but that doesn't mean it's not frustrating or even scary.
How do you know what is causing your pain, what you should/shouldn't do for it, and who do you turn to to find meaningful relief?
First be reassured that most episodes of back pain resolve with conservative care.
MRI's - for most - are a waste of time and money.
We've learned from countless research that a picture on a scan does not necessarily equate to the cause of symptoms.
Conservative treatment such as ice, heat, rest, and ibuprofen usually does the trick for an episode of back pain, but sometimes, especially in recurrent cases, more intense pain management is indicated.
This is when you seek out specialists.
As a Doctor of Physical Therapy, I am trained to perform a clinical exam that can give me a lot of information on what may be driving your pain.
So let's look at the most common findings and therefore most common treatments I prescribe.
A Physical Therapist's Treatment Plan for Low Back Pain
1. Studies point to a correlation of lost hip rotation mobility and low back pain.
Almost all of my clients present with some hip rotation tightness.
This makes sense when you step back and observe how we move.
If there is a tightness in the hip joint we have to make up for that loss of movement somewhere else, and usually we rob that mobility from the spine.
By watching someone squat, walk, weight shift, side bend, and rotate I can get a clear picture of what structures are restricted, weak, or just not working.
Watching someone move will give me far more information than an MRI scan.
Check out my instagram video to see a sample of a hip mobility assessment:
The correlation between lack of hip internal rotation and extension range of motion with incidence of low back pain is well documented. 🤔👩🏻🏫 Here’s one quick and easy screening tool to check your range of motion. 🧐 Standing in neutral spine flex the hip and rotate the lower leg inward and outward, slowly so that nothing else moves. This is isolating of your hip internal vs external range of motion. The two should be equal, internal = external and R= L. ⚖️ You can see I’m not perfectly symmetrical! 🤷🏻♀️🤫 Now let’s check hip extension. Again stand tall in neutral spine and let’s see 👀 how far the leg can extend behind the body arching the low back. 🚫 Ideally you’d be able to demo 10-20 degrees of motion here. 💯 Studies tell us that a lot of people have difficulty reaching neutral hip extension, let alone 10-degrees past neutral! 😟🙈 So let’s find neutral in our kneeling hip flexor stretch. 👍 🔑keys: ✔️Stack the hip over the knee ✔️Rock the pelvis into a slight posterior tilt. ✔️Don’t worry about lunging forward, we are just trying to get neutral extension here without jamming the hip. 💡 ✔️raise the same side arm and side bend in the opposite direction to From here you can release into a longer line runner’s lunge. Try rocking forward and back, up and down until you find the sweet spot 👌 Hang for a handful of deep breaths in each position, then follow up with some simple strength support on all 4’s. 🧘🏻♀️💪 Now re-check your motion and see if you made some gains! 🤞 enjoy your new mobility! 🧘🏻♀️👏🙏 #yogaforlowbackpain #hipstretches #stretchesforlowerbackpain #hipopener #hipflexorstretch #alignment #posture #mobility #hipmobility #physicaltherapist #physicaltherapy #yogaismytherapy #yogateacher #balancedbodyyoga #theyogasuites #spinecare #spinehealth #mobilehipshappyspine#mobilehipshappyspine
Bilateral (both leg) limitations correlate with low back pain whereas one-sided deficits tie in more with sacroiliac joint dysfunction.
2. As a society we sit for the majority of the day, which results in tight hip flexors.
So should we just stretch our hip flexors?
It's a good place to start, but but may not be the complete solution in and of itself. The hip muscles overlap with the diaphragm, back, pelvic floor, and leg muscles.
The best stretch for you is the one that addresses your unique deficits. It should also be one you can do without pain, with full breath, and with no compensation strategies.
This might take some 1:1 work with a physical therapist (ahem) who can help release soft tissues and
mobilize your joints with skilled hands-on treatment in addition to prescribed exercises.
3. Remember the flip side of stretching is strength. A system is not balanced without strength.
Strong muscles help you move better, lift and carry efficiently, and they protect your joints - including the joints in your spine - from breakdown.
Where do you need strength?
The majority of my clients are working on balanced glute (butt/hip muscle) strength and deep core strength, which includes the pelvic floor, diaphragm, and abdominals.
But we don't train brut strength for the sake of strength. PT's focus on strengthening healthy movement patterns.
4. Stress Relief
I'm going to add a bonus category here and suggest that you look at what is going on in your personal life that may be aggravating your nervous system and therefore creating inflammation.
Stress is very real and it manifests itself in the physical body. Based on my empirical evidence of treating patients for over 15 years, I can tell you nearly 90% of them admit to personal stressor coinciding with the onset of symptoms.
This may seem like fluff, but it's real.
And this is the icing on the cake when it comes to working with a PT.
With the highly personalized model of care that my business is set up to provide, we can really listen to our clients, which sometimes is all they need. Some yoga stretches and deep breathing exercises help too 😉
If you are curious about where you may be lacking mobility, strength, or are wondering where your back pain is coming from, please please seek out a Physical Therapy evaluation.
Gone are the days where you need a referral to go to PT (in most states, including WI!) PT's are trained to spot red flags and will tell you if you need to go to a doctor.
Most back pain is mechanical. Most resolves conservatively. Most recurrences can be prevented.
Get PT. It works!