Essential Exercises to Prevent Low Back Pain

By Joe Hanel, LAT

Back pain can be quite complex and a real hassle.

Whether you strained your back lifting something, sat for too long, or woke up with that all-too-familiar ache, back pain can really slow you down.

But here’s the good news—there are things you can do to help!

When back pain hits, it's important to take action.

Rest is a good starting point, but recovery requires more. You need to stay active and work on strengthening your back to help it heal and stay strong.

And remember, not all advice about back pain is accurate.

Let’s clear up some common myths:

• Myth 1: "If My Back Hurts, I Should Rest All Day."

  • Resting a little can indeed help when your back hurts. But too much rest can make your back worse. When you don’t move, your muscles can weaken, and stiff muscles can lead to more pain. Gentle exercises within pain limits can help reduce pain and keep your muscles strong.

• Myth 2: "Lifting Heavy Things Always Causes Back Pain."

  • Your back is strong and resilient. Lifting heavy objects can hurt your back if you do it the wrong way too many times in a row for an extended period, but learning the right technique can actually strengthen your back. The key is to lift with your legs, not your back. Keep your back flat, bend your knees, and use your leg muscles to lift. If you do find yourself out of position, it’s not the end of the world but you’ll want to focus on your form with each lift if your job requires repetitive lifting tasks.

• Myth 3: "Only Old People Get Back Pain."

  • Back pain can happen at any age. While it’s true that it becomes more common as we age, kids and teenagers can experience it, too, especially if they carry heavy backpacks, play sports, or spend too much time sitting. Everyone needs to care for their back, regardless of age.

  • It’s estimated that up to 80% of Americans will experience lower back pain at some point. Low back pain and disability impact up to 62% of our industrial workforce. Low back pain can also affect our police, firefighters, and emergency response at similar rates.

So, what can you do to prevent low back pain?

Over the years, I have treated LBP patients in many ways, trying lots of different approaches and hoping something provides them relief.

I have found that preventative exercise is the best way to prevent recurrence for many of those I have treated. Often, it may not be a lower back injury or tightness causing their discomfort, so it is important to address core strength and hip mobility while examining the lower back.

Check out this exercise progression, for example:

Start with a warm-up:

1. Single knee to chest stretch: Lay on your back with knees bent, draw in belly button to engage core. Birng one knee up to your chest and hold for up to 30 seconds; switch sides.

2. Rotation stretch/knee rock: Lay on your back with knees bent. Draw in belly button to engage core. Slowly rock knees to one side and hold for up to 30 seconds; switch sides.

3. Lumbar rotation stretch: Lie on your back, then bring one knee toward your face so that your hip is flexed to 90 degrees. With the opposite hand, pull it sideways toward the floor to feel a stretch in the lower back/buttock. Keep your shoulders flat on the ground during the stretch.

4. Back bridge: With head and shoulders relaxed tighten abs and glutes. Push through your heels to raise your hips, hold for 3 deep breaths and repeat.

Move to some strengthening Exercises:

5. Contralateral Extension: Activate your lower abdominals by bringing your belly button inward and by activating your pelvic floor muscles (inner thigh). Maintain steady abdominal breathing while you lift one arm and opposite leg up towards the ceiling keeping your chin tucked in. Return and repeat with the other arm and opposite leg.

6. Bird Dog (band optional): On all fours, draw in belly button then extend one arm then the other, then one leg then the other. Focus on keeping your back flat and staying balanced. Hold in extension for 1-3 sec. then switch sides.

If that’s too easy, try moving one arm up and the opposite leg up at the same time. Focus on keeping your back flat and staying balanced. Hold in extension for 1-3 sec. then switch sides. This movement should be slow and controlled.

By working up with core strength and hip and spine mobility, you'll keep ahead of lower back tightness and pain.

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Disclaimer: As a reminder, these exercises are for educational purposes only and should not be taken as medical advice. If you have a complex history of lower back pain, are unsure if these exercises are right for you or have pain while doing an exercise, it is recommended that you connect with one of our skilled clinicians to assess further. It may be recommended that these exercises or a different series are accompanied by manual therapy, trigger point dry needling, and therapeutic cupping to ensure that you achieve your goals and eliminate your lower back pain for good.

Dry Needling

Autumn Paul, PT, DPT

You may have heard about dry needling from one of your friends or family members and now you are thinking, “What is dry needling? Could I benefit from it?”

Dry needling involves the practitioner using a solid filiform needle or hollow-core hypodermic needle (similar to an acupuncture needle) to place it through the skin and enter the muscle. The goal is to place the needle specifically into a myofascial trigger point (hyperactive muscle fibers).

These trigger points can be located in a tense band of muscle. For example, many people have tightness or soreness in their shoulders or necks from the tension they carry throughout the day.

These hyperactive muscle fibers (tense bands of muscle) can send signals to other parts of your body which are considered “referred pain”.

The goal of dry needling is to pierce these trigger points in order to allow these muscle fibers to relax, which can help reduce your pain levels.

“So what conditions may dry needling help with?”

● Headaches

● Shoulder/neck pain/tightness

● Lower back pain/ tightness

● Tennis and golfer’s elbow

● Knee pain

● Shin splints

● TMJ/jaw pain

● Plantar fasciitis

● Hip Pain/ tightness

“Can any physical therapist perform dry needling?”

In order to be able to perform dry needling, the physical therapist is required to go through extensive training. This training includes studying human anatomy and hands-on practice. These training sessions are often a weekend course or even several weekend courses.

“Awesome, I want to see a physical therapist who can assess and see if I could potentially benefit from dry needling. How do I make an appointment?”

First, look online to see what location is closest to you. Then, you can request to schedule an appointment with a physical therapist who is certified to perform dry needling.

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References:

Firth C, Meon J, Price M, Taylor J, Grace S. Dry Needling: A literature Review. Journal of the Australian Traditional-Medicine Society . 2020;26(1):22-28. Accessed January 14, 2021.

http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=143040461&site=eds-live

http://www.kinfolkwellness.com.au/dry-needling-adelaide

Best Way To Get Rid Of Back And Neck Pain… Physical Therapy!

Written by: Dennis Kaster, PT-- Stevens Point North

Physical Therapy is one of the most effective and cheapest ways to treat back and neck pain, but few people know that. 

Most back and neck pain is caused by muscle weakness, tightness, poor posture, or poorly set-up workstations that put extra stress on the body. 

A Physical Therapist will assess which of these issues is causing the pain and help you get rid of it by doing specific stretches, strengthening, improving posture, performing treatment to decrease pain or swelling, using better lifting mechanics, or helping you set up your work or home workstations to put less stress on your body. 

The typical process in the past has been that when someone injures their back, they go to a medical doctor.  The doctor would decide what to do next, which many times included rest, medications, or expensive imaging. 

Several years ago a large medical organization, Virginia Mason, broke down the process of medical care for back injuries, looking for the quickest, most effective, and cheapest way to treat low back pain.  In the end, they found that people who saw a physical therapist first for lower back pain recovered much quicker, returned to work sooner, and experienced a much lower overall cost of care.  

This is because Physical Therapists specialize much more in the anatomy and mechanics of how the back works and how to stop and prevent pain.  Physical therapists also do not prescribe opioid pain medications.  Many times medical doctors prescribe opioid prescriptions, advise patients to rest until the pain goes away, or order expensive medical imaging, which many times is not necessary.  Many other research studies have found the same results.

As a result of the findings of multiple research studies, many insurance companies no longer require a physician referral to cover physical therapy, as they realize that people with mechanical low back pain respond much quicker and better if they see a Physical Therapist first.  Most people are not aware of this. 

Several studies have shown that as little as 7% of people with low back pain see a Physical Therapist.  This is crazy…..when Physical Therapy is one of the most effective ways to treat low back pain. 

Also, Physical Therapists have the expertise to recognize more serious medical issues that would require a referral to a medical doctor. 

So, if you see a Physical Therapist first and your pain is due to a medical issue, you can rest assured that the Physical Therapist will recognize it and direct you to the appropriate care. 

PLEASE HELP US TO GET THE WORD OUT!!  IF YOU HAVE BACK OR NECK PAIN, SEE A PHYSICAL THERAPIST FIRST.  IF YOU OR SOMEONE YOU KNOW HAS BACK OR ANY MUSCLE OR JOINT ISSUE, LET THEM KNOW THAT PHYSICAL THERAPY MAY BE THE BEST FORM OF TREATMENT FOR IT. 

If you have questions, please give us a call and we can answer them for you or check with your insurance to make sure our treatment is covered.

References

• Furhmans V. Withdrawal Treatment: a novel plan helps hospital wean itself off of pricey tests.  The Wall Street Journal. January 12, 2007

• Pendergast J, Kliethermes S, et al, A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy. Health Research and Educational Trust DOI:10:1111/j.1475-6773.01324.x, Oct. 2011

• Mitchell JM, de Lissovoy G. A comparison of resource use and cost in direct access versus physician referral episodes of physical therapy. Phys Ther. 1997;77: 10-18

• Moore JH, McMillian DJ, et al. Risk determination for patients with direct access to physical therapy in military health care facilities. J Orthop Sports Phys Ther. 2005;35:674-678

• Leemrijse CJ, Swinkles I, Veenoff C. Direct access to physical therapy in the Netherlands: Results from the first year in community based physical Therapy. Phys Ther 88;8:936-946

• Kenney. Transforming Healthcare, Virginial Mason Medical Center’s Pursuit of the Perfect Experience.  CRC Press, 2011

Back Pain during Pregnancy and Postpartum

Amanda Uting, PT, DPT

Back pain is common during pregnancy, with the prevalence of low back pain during pregnancy estimated to be between 50-75%. Back pain during pregnancy increases the risk of pain after delivery; more than one-third of women that have back pain during pregnancy still having back pain at 18 months postpartum. Back pain can decrease your ability to do normal activities at work and around the house, limit your exercise, and impair your sleep.

What may contribute to increase pain during pregnancy?

· Weight gain and postural changes: Women with a normal BMI are encouraged to gain 25-35 lbs during pregnancy. This weight gain, along with postural changes related to a growing uterus and baby, puts more stress on your joints.

· Joint laxity

· Fluid retention: results in increased pressure on soft tissues

How can physical therapy help you during pregnancy and after delivery?

As musculoskeletal experts, physical therapist have an important role in decreasing pain and improving function during pregnancy and during the postpartum period. Working with a physical therapist may include the following:

• Patient education

○ Exercise and safe return to exercise postpartum

○ Posture and breastfeeding positioning

○ Healthy bladder habits

○ Scar mobilization for Cesarean deliveries

• Safe manual therapy techniques.

• Home exercises.

Below are some exercises that may be beneficial for you to relieve back pain and increase strength for the physical demands of motherhood.  During pregnancy, please check with your healthcare provider before starting any home exercises.

○ Shoulder blade squeezes: Squeeze your shoulder blades down and back and hold for 2-3 seconds. Perform 10-20 reps. This is a great exercise during or after feeding your baby to counteract a forward shoulders posture.

○ Chest stretch: Stand in an open doorway and rest your palms on the doorframe with your elbows at shoulder height. Lean forward to feel a gentle stretch in the front of your shoulder and chest. Hold 30 seconds and repeat 1-2 times.

○ Cat/cow: On your hands and knees, gently relax your stomach towards the floor and then arch your back up towards the ceiling. Perform 10-20 reps in each direction.                                    

○ Bird dog: From a hands and knees position, attempt to push your abdominals towards the floor, and look forward; then contract your abdominals and arch your back, as if you are trying to hug baby in with your ab muscles. Keep your back flat as you extend one arm. If this feels easy, extend one arm with the opposite leg. Hold for 1 second. Perform 10-20 reps on each side.

○ Child’s pose: From a hands and knees position, bring your big toes to touch and sit your hips back. Let your stomach relax between your knees and feel a stretch in your back as your arms stay extended forward.

In addition, pelvic health physical therapists with specialized training can help patients that experience:

· pelvic pain

· urinary frequency or incontinence

· disastasis recti (abdominal separation)

If you are interested in the benefits of physical therapy during pregnancy or after giving birth, please get in touch with Advanced Physical Therapy & Sports Medicine at (920) 991-2561.

References:

Katonis P, A Kampouroglou, A Aggelopoulos, K Kakavelakis, S Lykoudis, A Makrigiannakis, K Alpantaki Pregnancy-related low back pain. Hippokratia. 2011 Jul-Sep; 15(3): 205–210.

Kanakaris Nikolas, Roberts Craig S, Giannoudis Peter V. Pregnancy-related pelvic girdle pain: an update  BMC Medicine 2011. 9(15)

Sabino J, Grauer JN. Pregnancy and low back pain. Curr Rev Musculoskelet Med. 2008;1(2):137–141.

Ostgaard H, et al. Back pain in relation to pregnancy: A 6 year follow-up. Spine. 1997; 22:2945-50.

Larsen EC, et al. Symptom-giving pelvic girdle relaxation in pregnancy. Prevalence and risk factors. Acta Obstet Gynecol Scand. 1999; 78: 105-110.

Kesikburun, S., Güzelküçük, Ü., Fidan, U., Demir, Y., Ergün, A., & Tan, A. K. (2018). Musculoskeletal pain and symptoms in pregnancy: a descriptive study. Therapeutic advances in musculoskeletal disease, 10(12), 229–234. doi:10.1177/1759720X18812449

“Exercise during Pregnancy” https://www.acog.org/Patients/FAQs/Exercise-During-Pregnancy

“Exercise during Pregnancy” http://americanpregnancy.org/pregnancy-health/exercise-during-pregnancy/

“ACOG Committee Opinion” https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care

“Pregnancy and Low Back Pain: Physical Therapy Can Reduce Back and Pelvic Pain During and After Pregnancy”J Orthop Sports Phys Ther 2014;44(7):474. doi:10.2519/jospt.2014.0505