Learn the cause of your back pain and how to get rid of it for good. Discover what you need to know to get yourself back to better than normal.
What you will learn:
Inside this guide are the key components to understanding and effectively attacking your low back pain. Getting rid of it for good involves first finding the cause, then putting together a clear plan to eliminate it.
This guide discusses:
- Top 3 Causes of Low Back pain
- Self Test for Low Back Pain
- Movement Challenge
- Top 3 Exercises for Low Back Pain
- Top 3 Behavior Modifications for Low Back Pain
- Low Back Pain Quiz
Top 3 Causes of Low Back Pain
Low back pain is caused by one or a combination of these three main causes…
This can be a disc herniation, rupture, bulge or a simple irritation. If you have had an MRI, you might be familiar with these terms. All of these diagnoses cause inflammation in the lower back that can put pressure on other structures that lead to pain. The most common of these areas are the spinal nerve roots or the spinal cord. Most people get nervous or upset when they learn that they have some kind of disc injury but as it turns out, most disc injuries are asymptomatic. This means that many people are walking around with one of the above versions of a disc injury and they don’t have any symptoms (pain).
Did you know?
Most people that have a disc injury don’t have any pain at all? A study published in the New England Journal of Medicine showed that 64% of people with diagnostic testing showing a disc injury had absolutely no low back pain.
People who have disc injuries…
Are typically age 40 and under
There are of course always exceptions but most people with disc injuries tend to be on the younger side. This is because as you age, you start to lose the water content of the disc and it becomes less likely for you to have a disc injury like a bulge or herniation.
Have pain that gets worse with bending or sitting
Most people with a disc problem have an increase in pain in the lower back or even down the back of the leg when they sit in a chair (often even worse when sitting in their car) or when bending forward at the waist, like when brushing your teeth at the sink or bending down to tie your shoe. When you do these activities, pressure is put on the front of the disc and the material inside the disc pushes toward the back of that spinal segment which puts pressure on the nerves right behind the discs.
Typically have these signs and symptoms…
- Low back pain that can go down to the hip, knee or even all the way down to the ankle.
- Pain that is worse in the morning when getting out of bed.
- Pain that gets worse at the end of the day.
- Complaint of numbness and or tingling in the low back or the leg.
- Get relief of pain with standing or walking.
- Feel nervous to move in certain directions (usually twisting motions of the spine) for fear of increasing the pain.
Stenosis in the spine is defined by a narrowing of the holes created by the vertebra (segments of the spine stacking on top of one another) that the nerves travel through. These holes are called the vertebral foramen (the big hole that the spinal canal travels through) and the intervertebral foramen (the smaller holes that the spinal nerves travel through on each side of the spinal cord). As these holes get smaller, there is less room for the nerve to move through. This is an issue because it can restrict the motion of the nerves or even put pressure on the nerves causing pain, numbness tingling and or burning anywhere from the low back down to the feet. As we age, this is a natural process that most people know as being called arthritis.
People who have spinal stenosis injuries…
Are usually over the age of 40
There are always exceptions to this rule, but most people with spinal stenosis are over the age of 40. As the spine ages, the water content of the disc lessens and the space between each vertebrae gets smaller. This is one of the reasons most people get a little shorter as they age. As the space gets smaller, there is less room for the nerves to travel through and thus there is an increase in the incidence of pain caused by this smaller space.
Have pain that gets worse with standing and walking and is relieved with sitting
If you are over the age of 65 and you have low back pain that gets worse as you stand and walk and gets better if you sit, there is a 95% chance you have spinal stenosis. This is the tell tale sign that your back pain is coming from a narrowing of the canals the nerves travel through them.
Typically have these signs and symptoms…
General pain/ soreness in the low back, usually stronger on one side.
Morning stiffness that feels better after you get up and moving.
A forward bending/ hunched over posture makes the pain better (like leaning forward on your grocery cart).
Pain that extends down from the back into the hip, knee or even all the way down to the foot.
Numbness/tingling or even just pain and stiffness in the legs.
A feeling of general weakness or even a cramping sensation in the legs.
Sacroiliac Joint Injury
A sacroiliac joint (or SI joint) issue is the most commonly missed problem during examination of someone with low back pain. This problem can’t be seen on x-ray or MRI and is difficult to diagnose. It’s a shift in the position of the pelvis that typically causes very specific pain on one side of the tailbone. This pain is caused by the inflammation and irritation associated with the pelvis not being in alignment. It can also cause the appearance that one leg is slightly longer than the other which causes a structural imbalance in the pelvis and spine. SI joint injuries usually come in combination with a disc injury or stenosis, but SI joint problems can happen on their own.
People who have an SI joint injury….
Can be anywhere from age 9-90
This is one of the factors that make diagnosis so tricky. Although it is more common to have SI joint issues when you are young (birth to age 50) we see these issues in the aging population as well. It is also much more common in female patients due to their chemical differences to males and is even more prevalent in females who have had a pregnancy.
Pain that increases with change of position
Getting in and out of the car, rolling in bed and changing positions from bending and squatting to moving upright, or vice versa, usually irritates SI joint injuries.
Typically have these signs and symptoms…
Pain in a small area on one side of the low back/tailbone area that is easy to point to… “I have the pain right here!”
Sharp stabbing pain with normal movement.
Feeling of being ‘uneven” like one leg is longer than the other.
Pain that can go down the back of the hip to the knee, but not past the knee.
Feeling of “being stuck” on one side of the pelvis.
Self Tests for Low Back Pain
During a physical therapy examination, your therapist will perform tests to rule in or rule out causes of your pain, no matter what body part is bothering you. There are dozens of low back pain special tests, but here are a few that you can perform on yourself at home.
Watch this video showing the 3 self tests you can do at home to discover the cause of your low back pain. Simply focus the camera of your smartphone on this image…
The forward bend test
Stand up straight with your hands at your side. Bend forward and reach to your toes as far as you can go.
Negative test: Your lower back pain does not get worse when you bend over at the waist.
Positive test: If your pain gets worse when bending over the test is positive
What does a positive test mean?
When performing the test, if the pain goes down the back of the leg, your pain might be caused by a disc irritation, a nerve root irritation or a facet joint irritation.
Sit at the edge of a table or chair. Slouch over and tuck your chin down to your chest. Bring one of your ankles into dorsiflexion (bring your toes up towards your nose). Straighten your knee until you feel a pull anywhere from your low back to the bottom of your foot. Most people will feel a pull behind the knee. Once you feel a pull, look up towards the ceiling.
Negative test: This test is negative when lifting your head does not decrease the stretch/ pull/ pain in the back of the leg.
Positive test: This test is positive when lifting your head up relieves the stretch or pain in the back of the leg by at least 50%.
What does a positive test mean?
A positive slump test means that the nerves running from your back down to your foot have some kind of pressure on them and/or are not moving smoothly in the path that they travel. A positive test does not indicate nerve damage, only that movement of the nervous system is restricted.
Stand up straight with your hands on your waist. Bend your spine backwards (extension) then side bend and rotate to the side of your spine that you have pain Repeat this on the opposite side as well.
Negative Test: This test is negative if the position does not reproduce your pain.
Positive Test: If you get into the testing position and the test reproduces your low back pain or if pain goes down the leg.
What does a positive test mean?
If the pain stays in your low back, it means that your back pain is likely being caused by some kind of facet joint irritation. These are the small joints on either side of your spine.
If the pain occurs in the top of the hip or down the leg, it means that there is likely pressure being put on the nerve roots that are coming out of your spinal cord.
When your back is healthy, what can you do to test it out to make sure it’s working the way it should be? A physical challenge is a great way to test out your back. Think of it as an oil change. Every 5000 miles, you should bring your car in to have your mechanic make sure that everything is in good running condition. The same concept holds for your low back.
The test will be different based on your age. Select the test below in your age range and see how you measure up!
The Test: Bear Position
- Get down on your hands and knees on the floor with your shoulders directly above your wrists with your arms straight.
- Position your hips directly above your knees.
- Tuck your toes underneath your ankles.
- Lift your knees off the floor 1-2 inches
- Attempt to hold this position for as long as you can while maintaining your shoulders over your wrists, your hips over your knees and your spine in neutral.
Can you hold the bear position for 3 minutes?
Can you hold the bear position for 90 seconds?
60 and above
Can you hold the bear position for 45 seconds?
If you are able to maintain the position for the amount of time above based on your age, great job! It is likely that you have developed the muscles of your core well enough to prevent low back pain. If you were unable to maintain bear position for that amount of time, your core could use some strengthening and you are at a higher risk of developing low back pain.
How do I get better at this test?
Improving your score on this test is simple. Practice the bear position and try to improve your time. Even if you can only hold the position for a few seconds, that’s OK! Nowhere to go but up! Keep working on this along with the top 3 exercises for getting rid of low back pain and your core strength will continue to improve. Check out our blog post for more information on this test including video instruction.
- Seated Hamstring Stretch
- Seated Piriformis Stretch
- Deep Squat Stretch
- Bird Dog
- Slump Slider
- Side Plank
- Neutral Spine
- Stop Sitting
- Move More
Top 3 Exercises for Low Back Pain
There are hundreds of exercises we could have put in this section. Depending on what is causing your low back pain, some of these exercises might help and some might not. It is important to realize that if any of these exercises are increasing your pain, you should not do them. Also, prescribing exercise is much like prescribing medication. The type of exercise and amount of exercise is very important. Without a full examination by one of our physical therapists, it’s difficult to prescribe exercises that will take away your pain. The exercises below were selected to help decrease low back pain, no matter what the cause is, but it is only a “best guess” and not an actual prescription based on an examination.
Watch the video below showing the top 3 exercises you can do at home to get rid of your low back pain.
Get down on the floor on all fours. Balance your weight equally between your hands and your knees. In one smooth motion, reach out with your right hand and reach back with your left foot while balancing on your left hand and right knee. Keep your back flat. Hold this position steady and return to the starting position. Repeat this with the left hand and right foot extended.
Suggested program: Hold each position for 5-10 seconds and complete 10 repetitions on each side. Do this once per day.
Sit at the edge of a chair or your bed. Tuck your chin down to your chest and put your arms behind your back. Slouch over by leaning forward as far as you can go without causing an increase in your back pain. Crank your toe back towards your nose as far as you can go. Slowly straighten your knee until you feel a pull in the back of your leg. Pause in the position you feel the stretch and then return to the starting position.
Suggested program: Repeat this 15 times on each side holding for 3 seconds and do this one time per day.
Lay on your side on the floor with your elbow supporting your upper body and the outside of your hip supporting your lower body with your knees bent at a 90 degree angle. Simply lift your hip off the ground so that your lower body is now supported by your knees and your elbow continues to support your upper body. Suggested program: Hold this position then return to the starting position. Hold the position for 5-10 seconds and complete 10 repetitions on each side. Do this exercise one time per day.
Top 3 Stretches for Low Back Pain
A word on stretches…
A stretch is designed to lengthen muscle tissue to allow for greater range of motion. In order to do this, the holds for a stretch need to be a minimum of 2 minutes. Holding for only 20-30 seconds will not get the job done.
Watch the video below showing the top 3 stretches you can do at home to get rid of your low back pain.
Seated Hamstring Stretch
Sit at the very edge of a chair with the leg you are going to stretch straight and the other leg bent. Sit up straight and lean forward from your hip joint, not your low back until you feel a stretch going down the back of the leg that is straight. After the stretch is done, return to the starting position.
Suggested program: Hold for a 2 minute stretch, complete 1 time per day on each side
Seated Piriformis stretch
Sit in a chair with the leg you are going to stretch crossed over the other leg. Sit up straight and lean forward from your hip joint, not your low back until you feel a stretch in the back of the hip that is crossed over the other leg. After the stretch is done, return to the starting position.
Suggested program: Hold for a 2 minute stretch, complete 1 time per day on each side
Deep Squat Stretch
Assume as deep of a squat as you can tolerate while supporting your weight in a door frame or by holding something that is secure (banister of stairs, heavy piece of furniture, you get the idea). Shift weight from side to side to work on the mobility of the ankles, knees and hips in all planes of movement.
Suggested program: The goal of the program is to be able to assume a full squat position for 10 minutes with little to no discomfort. This usually takes months to achieve with consistent daily practice so don’t get discouraged if this takes a while. For now, try to hold the deep squat position for as long as you can tolerate with frequent breaks. For example, set a timer for 2 minutes and get into the position for maybe 10, 15, 30 seconds at at time with breaks of standing in between the reps of deep squatting. Eventually you will work up to a full 10 minutes unsupported if you stick with it.
Top 3 Behavior Modifications for Low Back Pain
Here are some quick tips to help you get rid of your back pain fast no matter what the cause. These concepts are simple, but not easy. It will take some adjustment on your part, but it’s worth the investment.
Spend More Time in Neutral Spine
Neutral spine is another term for “good posture.” The big difference is you can measure a neutral spine using a simple pole. You are in neutral spine if you can put a pole on your back (we use PVC poles in the office, but you can use a broomstick or anything that is straight) and have that pole touch the back of your head, the spot right between your shoulder blades (your mid back) and your tailbone while the space between the pole and your low back (right where your belt line would be) is the width of your hand. You should be in neutral spine when standing and walking, while sitting, and even with bending and lifting. The more time you spend in neutral spine, the less low back pain you will have… it’s that simple.
Watch this video showing you how to maintain a neutral spine at home so you can get rid of your low back pain for good.
Stop sitting so much
Did you know that sitting for more than 23 hours per week increases the risk of getting a heart attack by 125 percent! There are a ton more scary statistics that I can throw at you regarding sitting, but let’s just agree that prolonged sitting is really bad for you. Google it. Look into standing desks at work and home when spending long hours doing paperwork or hanging out on your computer. You don’t have to have expensive solutions to this problem… A properly sized cardboard box placed on a counter top is just fine.
Just move more
The modern lifestyle has most of us moving less and less. As our economy has moved into knowledge work meaning many jobs that require movement (physical labor) have gone away. So, we have to add movement into our daily routine to counteract our sedentary lives. This doesn’t have to be running 10 miles or going to the gym for hours on end. Simple solutions like a walk with your dog or other loved one, taking the stairs instead of the elevator or even parking as far away from the grocery store as you can are little changes you can make to add more movement into your day.
Low Back Pain Quiz
Take this quick 5 question quiz to get an idea of what your next steps should be to eliminate your low back pain.
So you have read the guide, checked out the exercises and stretches, learned some quick tips you can apply right now and even taken our quiz on low back pain… What are your options to get rid of this back pain once and for all?
- If you scored a 3 or less on the quiz above, you most likely have mild low back pain. You can follow the advice in this guide and it’s possible that you can get rid of your back pain for good.
- If you scored a 4 or higher on the quiz above, it’s likely that you have a more serious low back pain problem. The advice in this guide can help, but we advise that you take the next step in getting rid of your pain by coming into one of our offices for a free screen.
What is a free screen? We are glad you asked…
- A free screen is a 30 minute 1-on-1 appointment with one of our physical therapists where you get a complete examination and are given….
- A diagnosis: What is the true cause of your pain
- A prognosis: How long will it take to get rid of the pain
- A plan: The next steps to get rid of your pain once and for all.
To set up your free screen, simply call 610-955-3718 and we will get you in the schedule ASAP.
How much does this screen cost? This is the best part. It’s absolutely free! We don’t even take your insurance information. All we ask is 30 minutes of your time to prove to you that we can get rid of your back pain without the need for medications, injections or surgery.
Frequently Asked Questions
Should I get an MRI for my back?
An MRI is an incredibly useful tool to rule out major injuries that may be causing your back pain. However, MRI results rarely factor into the decision making process when putting together a plan to fix your low back pain in physical therapy. In fact, they can often be misleading. The MOST important tests to find out what is causing your back pain and putting together a plan to fix it happen during the evaluation in physical therapy. Depending upon your age, chances are better than 50-50 that if you go for a magnetic resonance imaging (MRI), some abnormality will be revealed. I have 2 herniated/bulging discs in my lower lumbar spine and I almost never have low back pain…. Because I know what to do to make sure these structural defects don’t slow me down.
I have pain in my back that goes down my leg… what does that mean?
This means that you likely have pressure on your sciatic nerve. Even light pressure from inflammation, disc bulging or herniation, tight muscles, poor posture and other reasons. Pain down your leg does not mean you have nerve damage. It just means you need to find out what is putting pressure on that nerve as fast as possible so you can remove that pressure.
What exercises should I do to get rid of my back pain?
That all depends on the cause of your low back pain. This is discovered during a free screen or an initial evaluation at Robbins Rehabilitation West. Some exercises might help and some might make it worse. Most low back pain sufferers either have a disc problem, an SI joint problem, or spinal stenosis. Sometimes you can have a combination of these…The point is that it is difficult to give exercises to help unless we know exactly what is causing the pain. A complete exam is required so that the exercises actually help with the pain.
What will happen if I don’t do something to get rid of my back pain?
The problem will likely get worse. Depending on what is causing your low back pain, it may come and go. Sometimes you might be fine for a few weeks or even months, but if you don’t fix the movement faults that are causing your low back pain, you will have a hard time getting rid of it for good and it could one day turn into a more serious problem.
Should I take medication or get surgery for my back pain?
These are common treatments for low back pain unfortunately. By now you probably know about the opioid crisis in our country. About 130 Americans die every day from drug overdoses related to prescription pain medication. That means that in a year’s time, almost as many people in this country will die from opioid addiction as soldiers killed in the entire Vietnam war. Surgery is an amazing tool in the right situation but it should be used as a last resort when it comes to most low back pain. You should consider surgery only after consertive care has failed.
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