Back Pain: 6 Tips For Treating Back Pain & The Biggest Misconceptions?
Updated: Jul 20
The biggest misconceptions in effective treatment of actue back pain, a Doctor of Physical Therapists Perspective
As a Doctor of Physical Therapy who has treated thousands of patients suffering from back pain, I have noticed a trend. When we feel pain, especially back pain, we freeze! We pop some advil, we lay in bed, scroll google to try and self diagnose and pray that it will just be gone by morning. What if I told you doing exactly that likely makes your back pain worse?
I know it probably goes against everything you have ever heard about treating back pain and probably against your instincts, but trust me when I say, there is another way and all the research clearly proves it is much more effective.
Tip #1 - MOVE PURPOSEFULLY
One of the most important things to keep doing when you start having back pain is to keep moving. Laying or sitting in one position is almost always likely to make your pain worse in both the short term and definitely in the long term. In the short term it will stiffen your back and reduce blood flow to the area, often making the inflammation worse. In the long term, the stiffer the joints, weaker your muscles and more deconditioned you become, the harder it will be to rehabilitate your back pain back to preinjury status. The spine likes movement and so does the rest of your mind and body.
Now, that is not to say if you are experiencing back pain, you could or should go on a run. When I say movement, it could look as simple as changing your position every 15 minutes. What I am saying is that targeted and purposeful movement is a key factor on your road to recovery. So, you may ask, what movements should I do? Well, unfortunatly you will never catch me saying "cure your back pain with X exercise". In fact that is one of my biggest pet peeves about social media and the internet. I believe in an individualized approach and what may work for one person likely will need tweaking for the next person. This is where you will get huge value from seeing a concierge physical therapist who can spend 60 minutes 1:1 with you to do a deep dive into your body and help you come up with an effective plan specific to you.
Tip #2 - Don't waste your time with heat & ice
Heat and Ice may feel good but they don't actually penetrate deeply enough to have the effect that you wish. The old school of thought was ice reduces blood flow improving inflammation and swelling and heat increases blood flow and relaxes the muscles. However, more recently we are finding that in reality the ice and heat can't penetrate deeply enough to affect the temperature of deep muscles and the spine to really make any difference. So while heat and ice may feel nice and is probably not doing any harm, it is not actually doing anything to help you recover from back pain. If you want to keep doing it then go for it but don't let it replace your purposeful movement.
Tip #3 - Don't Avoid Pain
It is human nature to do everything we can to avoid pain and in some instances this is the right approach. But what tends to happen when we are injured is we become so pain averse and fearful of doing something that makes our injury or the pain worse that we stop moving entirely or move in an awkward fashion - both of which will actually make your road to recovery longer. Some pain is actually okay and expected when we are recovering from a back injury. Here is another place where it is essential to work with a concierge physical therapist that can monitor your symptoms and help guide you on pain that is okay to push through and pain that you need to avoid.
Tip #4 - I feel you, I herniated a disc
I have treated thousands of patients with back pain but I still believe that there is nothing that replaces being able to personally relate to what a patient is going through.
About 12 months ago I had my own episode of back pain to deal with - after a c-section and not being as active as I would like, it was no surprise. My daughter fell and I went to catch her and felt a "pop" followed by pain down my leg. Gosh darn it, I knew exactly what it was - I herniated a disc. I had every classic symptom you read about in a text book. Every bone in my body was saying grab the advil and lay down in bed but I knew that I had to practice what I preached. Don't get me wrong, I did reach for that advil - actually for Aleve, I personally think that works better - but I didn't hold up in bed for the evening - but I know that with a herniated disc, the spine typically likes extension. I also know that herniated discs do not like flexion. So I knew reducing sitting and bending activities were important, but also introducing standing and laying on my belly were even more important.
With in 24 hours, my pain went from an 8/10 to a 2/10 and within 48 hours my pain was completely gone from my leg and just a 2/10 stiffness sort of symptom in my low back. Why did this happen so quickly? Partly because I was able to intervene immediately and also because the spine likes movement and I introduced the correct movement into the spine. By increasing extension in the spine it helps to move the bulging disc off of the nerve thereby reducing the pain. Now that is not to say my job was done - it wasn't, I spent weeks continuing to introduce extension into my spine and working on my flexibility and hip, pelvic floor & core strength to recover from this but if you take anything from my experience it is 1) move early and 2) get help early to make sure that you are introducing the right movement for your particular back pain.
Tip #5 - Get Help Early
As with all injuries, but especially with back pain it is important to intervene early. These days with direct access laws, you do not need a prescription from an MD to see a physical therapist and honestly the findings from an MRI are not necesary to begin treatment either. As physical therapists we are trained to treat the patient, not the MRI. The quicker you can get to a physical therapist the quicker you will get better. Having to wait to see a physician and then an MRI is only going to leave you in pain longer and make the rehab more of a challenge. A strong physical therapist will not hesitate to refer you to a spine specialist or an MRI if it is needed.
Tip #6 - Don't Rely on Google
Lastly, don't rely on Google! I have done it myself and it never ends well. The internet is not a replacement for your personalized medical care. It often sends you sprialing down a rabbit hole and can even send you down the wrong rabbit hole making your back pain worse. To echo my thoughts above, there is no one size fits all approach to treating back pain making it extremely important to see a skilled physical therapist to find out what you need.
If you don't remember anything from this post, please just promise me that you won't just grab the advil and post up in bed. At least grab the advil, change your position and make an appointment with a skilled, preferably a 1:1 physical therapist as soon as possible. Feel free to email us at firstname.lastname@example.org if you have questions or would like to make an appointment for a comprehensive evaluation.