Have you been scared recently by a new - or recurrent - bout of back pain?
It can take your breath away, and it can be so scary because there are multiple kinds of tissue we are dealing with when it comes to the spine.
There's muscle, your verterbral joints themselves, tendons, ligaments, and nerves!
So how do you know what is causing your pain, and who do you turn to to find meaningful relief? Your doctor? A chiropractor? The emergency room??
It's probably no surprise that - unless you are in 10/10 pain - I'm going to say get to a PT first.
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.
There have been studies done where they scan a cross section of the population and find perfectly happy, pain-free people living with bulging discs and degenerative joints. I know it seems weird, but a disc bulge on a scan does not necessarily equate to the cause of your pain.
A good clinical exam can provide a lot more data on what may be driving your pain than a scan of your still spine while you're lying down at one moment in time.
One of the benefits of my concierge practice is that I get a lot of time with my clients. I have time to listen and really hear them.
Think about it - how much time do you spend in a doctor's office? And how much of that time is your doctor on the computer?
Do they look at your posture? Watch how you move? Do they touch you?
PT's do all of these things to help you find the root cause of - and therefore solution to - your pain.
My emperical evidence suggests that factors like stress play a HUGE role in back pain.
So let's look at the most common treatment plan a PT is likely to advise.
A Physical Therapist's Treatment Plan for Low Back Pain
1. Studies point to a correlation of lost hip mobility and low back pain.
It makes sense, the femurs and the spine all connect into the pelvis, what one does or does not do intimately effects the other.
I'll save you from reading several research papers - hip rotation imbalances are present in a statistically significant number of cases of low back pain.
Therefore we conclude restoring hip mobility is a good idea in terms of treatment.
This makes sense when you step back and observe function, which is where a solid clinical exam comes into play. If someone lacks hip mobility they'll have to make up for it somewhere else, and often times that is through 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.
Statistically we know that the imbalance looks like this: external rotation is typically greater than internal rotation, and extension is limited by about 10 degrees.
Check out my instagram video to see what this looks like:
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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
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.
Tight hip flexors means loss of hip extension mobility, and because the body is brilliant at knowing how to adapt, it knows to just move up the chain and take the mobility from somewhere else.
Your lumbar spine.
Results of these studies show average hip extension in people with low back pain in the negatives, meaning meaning they can’t even extend to neutral!
So what happens when they simply try to stand up, let alone walk?
The lumbar spine compensates.
This pattern can only go on for so long before the body says enough, I can't do it anymore, this is not what my spine is meant to do, break down!
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 body on a more energetic level.
Stress is very real and it manifests itself in the physical body. Based on my emperical 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 😉
So whether you sense you are lacking mobility, strength, or are afraid to move thinking you're going to do more damage to your back, 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!
For more info on how we can work together on your back pain please complete the interest form below to start a conversation.