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low back pain

Low Back Pain

How to Manage Low Back Pain

Have you ever had low back pain?  If you have, you are not alone.  It is estimated that approximately 80% of people will suffer from this disorder in their lifetime.  As a matter of fact, low back pain is currently the number one cause of disability globally.

What is Low Back Pain?

First of all its important to understand that low back pain is a symptom and not a disease.  Not only is it extremely common, it is experienced by people of all ages.  Surprisingly, back pain rarely occurs as a result of strenuous or intensive activity.  In fact, most people are doing something very simple when back pain strikes.  I commonly hear things like “I was just bending over to lift a laundry basket, an EMPTY laundry basket” or I” was leaning over the sink putting on my contact lenses”.  

It’s important to understand that low back pain is different than other injuries.  For example, when you twist your ankle you generally have intense pain that slowly decreases and goes away as the injury heals.  This is not what happens when you have low back pain.  Relief doesn’t seem to be related to healing because typically, there is no significant injury causing the low back pain.

Why Do I Have Low Back Pain

The short answer? We really don’t know.  Most of the time, a specific cause of low back pain cannot be identified.  In other words, we don’t know what the true source of the pain is.  That’s why most low back pain is called “Non Specific Low Back Pain” or “Mechanical Low Back Pain”.  Additionally, low back pain can be accompanied by pain in one or both legs. Some people experience associated numbness or tingling as well.

The common belief is that low back pain usually results from age related deterioration of the the spine – otherwise known as arthritis or degeneration.  But here is the conundrum, x-rays and MRIs of pain-free people show just as much degeneration in their lower spines as those with reported low back pain.  According to Brinjikji, et al., 2015, p. 813, it is estimated that 60% of people have a disc bulge at age 50 and 80% have disk degeneration. That is why the diagnostic importance of x-ray, CT scan or MRI findings are a topic of debate. There is no evidence that imaging improves outcomes. For these two reasons current clinical guidelines recommend against routine x-rays for people with low back pain unless there is a concern that the pain is resulting from something needing specific treatment such as cancer, fractures, infections or inflammatory disorders. 

Bad Genes?

It is estimated that lumbar disc bulges have approximately 75% heredity origin (Janeczko Ł, Janeczko M, Chrzanowski R, Zieliński G. The role of polymorphisms of genes encoding collagen IX and XI in lumbar disc disease. Neurol Neurochir Pol. 2014;48(1):60–62). 

The actual pain experienced may be tied to your genetics too.  The back pain symptoms are highly variable.  Pain can last from one day to three months.  Some people are prone to heightened pain, like in fibromyalgia and some people are less prone to experiencing pain.  We all know people with a low tolerance to pain and those with a very high tolerance to pain.  Turns out, it may be genetically determined. Research shows that low back pain runs in families.  This can be seen with identical twins who often have similar back pain even though they have totally different lifestyles. For example one twin has a desk job and the other has a physically demanding job. 

So Why The Pain?

Research is showing that pain is not usually related to the mechanics of the spine but with the way the nervous system is processing the information.  Typically, pain is an alarm bell telling us to stop or we will hurt ourselves but that alarm bell may in fact be a false signal.  It results from hypersensitive nerves that are interpreting normal sensations of touch or movement as a pain message.  This in turn leads to what is known as “fear avoidance” which leads us to avoid activities due to fear of increasing pain, which then leads to disability.  Just to clarify – the avoidance of activity causes the disability, not the increasing pain.  The best approach is advice and education, reassurance that low back pain is not a serious disease and that symptoms improve over time.  

How to Manage Low Back Pain

Here is the meat of your post. You’ll break down the problem into a list of easy to accomplish steps to help your reader.


  • This is the most important tip, in my opinion.  When we have really intense pain we become anxious that something is seriously wrong.  Understanding that hurt does not mean harm, with respect to low back pain, helps you to cope better.
  • Low back pain is a symptom and not a serious disease. The symptoms are typically due to simple mechanical dysfunction and will improve over time.

Avoid Rest and Stay Active

  • Our initial instinct may be to lay down and rest when we have back pain but that can make the pain worse over time. It can reduce flexibility and muscle tone, lead to an increase risk of depression and even increase the rick of developing blood clots in your legs.
  • Stand, walk and continue with your usual activities, including work.

Use hot or cold packs

  • Contrary to popular belief, there is not right or wrong answer.   You can read more about that here but just use whatever makes your back feel better.

Consult with a Chiropractor, Massage Therapist, Acupuncturist or Osteopath

  • Currently US clinical guidelines recommend non pharmacological care as the first treatment option and reserve pharmacological care for patients for whom non-pharmacological care has not worked. These guidelines endorse the use of exercise, massage therapy, acupuncture, spinal manipulation, TaiChi and yoga.

The Last Thing You Need to Know about Low Back Pain

The old advice to be careful and stop moving does not work. There is no evidence that being careful will slow down the aging process.  So live a full life and enjoy the activities that make you happy.

Please share any strategies that you have found helpful to manage your low back pain so I can create a new post to share them.

Ice or Heat?

We get that question every day.

The most frequently asked question we get is: “Should I use ice or heat?”  Since the late 1970s, therapists have often treated an injury with RICE (rest, ice, compression and elevation). It’s an easy formula to remember: RICE is nice. Its now common knowledge that nobody believes in rest anymore. You can have hip replacement surgery and be up and walking within hours.

As for ice, there seems to be a bit of debate going on. There’s not much research to show that ice does anything more than numb pain. Icing restricts blood flow to the area which helps numb the pain and keep the initial swelling from getting out of control. But does it work to actually heal the injury? As it turns out, there are no clinical studies of its effectiveness (British Journal of Sports Medicine, 2012). In fact, some studies suggest that icing actually seems to delay recovery from exercise-induced muscle damage (Journal of Strength and Conditioning Research, 2013).

Is it harmful to ice an injury?

When you damage tissue through trauma or develop muscle soreness by exercising very intensely, your body mobilizes your immune system to heal. It’s the same biological mechanism that you use to kill germs. This is called inflammation. When germs get into your body, your immune system sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immune system sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999). Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, published online Feb. 23, 2014). Anything that reduces your immune response will also delay muscle healing. Therefore, ice is counterproductive. Interestingly, Ibuprofen is worse because it actually stops the signal of the inflammatory response.

What about rest?

Blood flow brings inflammatory cells into the injured tissue to start the healing process and the lymphatic system then removes the waste products from the tissue. Muscle contraction is necessary to move lymph and eliminate these chemicals, not immobilization! Recognizing the importance of movement in the healing process is why nobody believes in rest anymore.

So what’s the current recommendation?

For minor injuries keep moving but always within a painless range of motion. If you can’t move the injured area, for example, if your ankle is in a cast, move your toes. Elevate to help the lymphatic system drain and as always, consult with your health care practitioner if you have any concerns.