Low Back Pain: Part 1 - Flexion Based Pain

Did you ‘throw your back out’? Does it hurt to try to bend over, or has sitting become your worst enemy due to pain? Have you been plagued by chronic low back pain with no long-term results coming from medications and rest?

This guide will help you become educated and empowered to deal with your back pain today and for years to come. Low back pain effects over 80% of people at some point of their life and last year, we spent $62 billion on back pain care alone.

Simply the BEST guide to getting out of back pain every...thank you!!!
— Michelle Edwards

The typical medical model has led many people to believe that they have a ‘bad back’ or that they are sentenced to a life of pain and fragility because of a ‘herniated or bulged disc’.

Well that’s just not the case.

The idea that humans are these fragile and easily broken creatures flies in the face of thousands if not millions of years of evolution. Humans are resilient and supremely adaptable organisms, albeit extraordinarily complex. When it comes to back pain, it is really no different than any other injury, we just happen to have adapted to a cultural standpoint where our environment can wreak havoc on a low back as well as the rest of the human body. A culture based around sitting, days devoid of movement and nutrition that is typically subpar has left many, many…many people in pain and looking for answers.

So whether you hurt your back deadlifting or your ‘back went out’ picking up a sock, we hope you find some relief with the following suggestions.

SHOULD I REST?

In short…NO. It has been shown time and time again that movement is a game changer with low back pain, especially when it is incorporated early & often in the injury cycle. The most common question we receive as clinicians in regards to low back complaints as well as many other injuries is, ‘will I damage something more by moving/exercising?’. When we are talking about discogenic or pain coming from a disc, even though your pain may be an 8 or 9 out of 10 movement is still your best friend.

Damage is typically not being exacerbated by movement, instead the opposite is most often true with directional or preferential movement decreasing symptoms better than pain killers or muscle relaxers (which tend to be the most common treatment utilized by primary or urgent care centers).

SHOULD I ICE/HEAT?

Ice and heat can make us ‘feel’ better, but that doesn’t mean that they are actually doing anything for the components of chemical or mechanical low back pain. Again, it is far more beneficial to again turn to movement, and when we look to movement we need to talk about graded exposure. This simply means that we want to introduce small amounts of movements, stress and load in order to get our nervous system to respond positively.

RX

Try the following exercises for the a few days and see what kind of changes occur. As with any online suggestion it may be necessary to seek the advice of a medical professional, we know of a few right here in Birmingham! (click here to schedule now)


  • Lumbar Extension - 3 sets of 10

  • Diaphragmatic Breathing - 10 breaths feet resting/10 breaths feet elevated

  • Hip Hinge - 10 reps no weight/10 reps light weight (if no pain with first set)

When dealing with flexion based low back pain the prone press-up or lumbar extension is a great place to start.

Diaphragmatic breathing or primary respiration can help reestablish proper stabilization patterns thereby reducing pain and improving function. This position allows the thoracic diaphragm and the pelvic floor to be parallel to one another which creates a better Zone of Apposition (ZOA), which allows improved Intra Abdominal Pressure (IAP).

The hip hinge is crucial for proper deadlift, squat and everyday loading of the spine and hips.

Ankle Sprain: Acute Phase Care

You’re out on the trail or playing a pick-up game of basketball, when the dreaded ‘ankle turn’ occurs. Sometimes we hear a pop, sometimes we just hit the deck with searing pain, sometimes it swell immediately, sometimes it doesn’t…what you need to know is what to do!

An inversion or lateral ankle sprain usually takes a toll on the ATFL (anterior talofibular ligament), but it can wreak havoc on other ligaments on the outside and inside of the ankle as well as musculature and soft tissue further up the leg. You can also suffer an eversion sprain which stresses the deltoid ligament of the ankle greatly, acute phase care is similar if not identical for this injury.

Do i need an x-ray?

The Ottawa Ankle Rules are a good standard to know whether your should seek imaging right away, but a good rule of thumb is if you can’t bear weight or walk (even with a limp) within 12-24 hours you should probably seek a medical consult and possible imaging.

Should you ice?

You can use ice for the first 24 hours to control severe swelling and to reduce pain. Swelling and inflammation are normal healing processes so we don’t want to quell them too quick or too much. The same goes for NSAID (non-steroidal anti-inflammatory drugs) use (ibuprofen/naproxen) these have been shown to reduce healing of tendon/ligament injuries as well as slow down muscle recovery, so use only as need for pain mitigation. Devices such as Compex, MarcPro and Normatec can greatly aid in recovery and swelling reduction in the acute phase. It can also help to get your feet elevated above the level of your heart when you are off your feet, this helps increase blood flow return out of your ankle back to your heart. Also kinesio tape or stretch tape can be used to reduce swelling and bruising.

 
 

Should i use a brace/air cast?

As we mentioned movement early and often is key, so if you don’t fall into the criteria of seeking medical help and you can bear weight a brace provides little help to stabilize, and an air cast should only be used if a medical deems it necessary. Walking boots may be prescribed if acute or avulsion fractures have occurred. Compressive sleeves can help reduce swelling and increase feedback to the ankle in the acute and sub-acute phase as well as return to play, this is our top choice for compressive sleeve by CEP.

What does early phase rehab look like?

In the olden days (maybe 5 years ago) we used to rest everything until we would be left with a swollen, nicely bruised and stiff ankle. Now we know movement, early and often is the key to quicker recovery and better long-term outcomes. Try to get barefoot as much as possible when both surface and environment allow, this will help keep your feet ‘awake’ as your nervous system is trying to subdue stimulus to the injured ankle.

Try these exercises below for the first week post ankle sprain.

Perform 3-4 times throughout the day.


Demonstrating ankle Controlled Articular Rotations (CARs) via Functional Range Conditions (FRC). Great drill for increased ankle mobility and stability.

Triplanar ankle mobilizations are a great drill to work on multi-planar mobility and propioception of the ankle-mortisse joint. Ankle dorsiflexion is a crucial movement and this drill can help reintegrate it into the kinematic chain.

Sinlge-leg deadlifts are great progression or scale from our typical bilateral or standard deadlift.