Lower Back Pain
By Dr. Jesse Riley, MS DC
Lower back pain isn’t just annoying – it’s confusing.
You don’t know how long the excruciating pain will linger: days, weeks, or months? Since we use our lower backs every day, our normal activities become exhausting obstacles. What’s worse, in the greater Denver area everyone has activities they would love to get back to – whether it’s climbing, running, or just throwing the ball in the backyard with your child (human or furry).
Not knowing how long your daily activities are limited is devastating.
And that’s the main problem with lower back pain: when it limits your activities, it interferes with your identity.
Many of us proudly occupy roles such as parent, partner, or caretaker. We choose to take care of others, and ourselves, every day because it’s what we love to do. When our everyday activities become challenging or even impossible, our limitations affect our psyche. Without the ability to perform even mundane tasks like bending over to put on your shoes comfortably or getting a good night’s sleep pain-free, we’re not fully participating in life the way we want to.
As isolating as lower back pain can be, you should know you’re not alone.
In fact, many people experience this everyday:
The good news is you don’t have to silently suffer anymore.
At Modern Movement Clinic, we know what it feels like to suffer from lower back pain frustration. In fact, we see clients every day for this. To save you crucially important time in your recovery, here are the first five questions clients ask us that will spare you the confusion that comes with lower back pain.
This page covers the first four questions every client with lower back pain asks us:
• How can I take immediate steps NOW for my lower back pain?
• What are red flags in lower back pain?
• How can I form a long-term plan for conquering chronic lower back pain?
• What can I expect from my first Chiropractic visit?
Plus, BONUS miscellaneous Q & A’s to set you straight on your journey to living pain-free!
How Can I Take Immediate Steps NOW For My Lower Back Pain?
Feeling pain is an overwhelming experience.
Acute pain can be anxiety-inducing. When we’re in this anxious state, it can feel like time is sped up. Anxiety can turn to hopelessness, and inevitably you want to tune your pain out. However, drowning out your pain will only leave you feeling more confused, more burned-out, and more frustrated.
How do you escape this cycle?
Start by slowing down first.
Pain can be outsmarted. When experiencing pain, your body wants to communicate with you. If you slow down and listen to your body and mind, you can understand what your pain is telling you.
Listening to your body may not be easy in the beginning.
But through trial and error, you will slowly discover how to interpret your body’s unique signs.
At Modern Movement Clinic, we begin this process with these three simple steps.
- What Hurts My Lower Back? Identifying Painful Movement
- What Feels Okay? Identifying Pain-Free Movements
- Making Sense of Everything
What Hurts My Lower Back? Identifying Painful Movements
Your clinician needs to know what movements are painful so that they can help chart the route to your recovery.
The first step any good clinician or therapist will take you through is a movement assessment. The movement assessment helps us identify where we feel pain, and when.
A movement assessment consists of the client replicating different scenarios that involve movement in different ways. The actions are comprised of simple movements and directions. All joints to some degree work in three planes of motion, sagittal, frontal, and transverse plans where we might see movements like flexion, extension, rotation, and side-bending. This would look like flexing forward, extending backward, rotating side-to-side, or bending side-to-side at the low back.
When we test these movements, we can pinpoint which motions are causing problems for your lower back.
Sometimes you know that “when I do this, it hurts.” Other times, there are many motions that elicit pain.
Differentiating painful movements are what gives us a larger picture of the overall situation.
A great example of a painful movement might look like when you tell your clinician, “When I bend over to pick up my kid from the ground, my back hurts. I try to keep my back as straight as I can but the lower I go, the more I notice it”.
The more information we have, the faster we can put together the story of what movements might be limited or modified for the time being to allow the body to calm down and flush out the irritation in the area.
Taking a holistic view of your specific circumstances is what typically separates traditional clinicians or therapists from modern practitioners. For modern practitioners, we know anatomy rarely ever dictates pain. There is often acute trauma (such as broken bones, lacerations, etc.) or a mechanical overuse/underuse that underlies pain.
Understanding painful movements is an important step to learning about how we will chart your path to recovery together.
What Feels Okay? Identifying Pain-Free Movements
Focusing on what movements feel okay with your lower back is JUST as important as identifying what feels painful.
We use clues from your movement assessment to get an idea of what movements do not cause a threat right now. Know that as time moves on, your movement portfolio will get bigger and you’ll be able to do more activities with far less pain.
With the information of what motions feel okay, we’ll make a plan to get you back moving.
Starting with movements that feel okay, you’ll slowly regain your ability to do your everyday tasks. We’ll add special modifications customized to you to increase your activities even more.
With the ability to move more, you’ll rebuild your confidence, step-by-step.
Confidence is key!
Making Sense of Everything
Now that we have a clearer picture of the source of your pain, what movements are limited, and what movements feel okay, it’s time to put the puzzle pieces together.
Through extensive continuing education and current research (something else your practitioner should be keen on), pain has been found to be much more like an alarm system for your body, NOT A DAMAGE INDICATOR. Think of your pain as a smoke alarm. A smoke alarm is incredibly helpful for alerting you to a potential fire, but if you’ve ever cooked in an apartment, you know the alarm can also be touchy.
When we repeatedly force our body into movements that feel painful, the alarm bells may be ringing all the time. This is not only annoying, but also confusing.
Therefore, we want to modify or avoid irritating movements right now.
For now, limit motions that hurt and do more of what feels good. No, it’s not rocket science, but it will make a huge impact on your recovery. When we talk about movement that feels “good,” this doesn’t mean that exercise makes you feel like you’re on a tropical vacation. But, if the motion feels doable then do more of it.
Moving more in a supported way will get you back on track in no time.
Movement assessments are so important because this information can’t be gleaned from an X-ray or just touch. Movement tells us which direction to go in. You’ll also read on later why X-rays or MRIs doesn’t always need to be something we need initially.
Instead, take the first steps by assessing your movement with a professional.
What Are Red Flags When It Comes To Lower Back Pain? Signs To See Medical Specialists That Aren’t Physical Therapists or Chiropractors
Lower back pain isn’t ALWAYS caused by a mechanical event and can stem from an something cause.
It can stem from an underlying cause. However, this scenario is very unlikely. As in, only 1% of cases. The other 99% of cases fall under the non-emergent category and are very treatable with low back pain rehab. This is when you would see a functional movement therapist like at Modern Movement Clinic.
However, for the 1% of those with an atypical case, we want to make sure you don’t ignore the signs to get the help you need.
If you are experiencing any of the symptoms below, you should seek out further medical advice, such as the Emergency Room, a medical specialist, or your General Practitioner depending on the situation.
- History of Cancer
- History of Vascular Disease
- Unexplained Weight Loss
- Consistent and Ongoing Infection or Fever
- Prolonged Use of Steroids or Any Drugs That Inhibit the Immune System
- Significant Trauma (Accident or Trauma Recently)
- Prone to Fractures (Osteoporosis or Osteopenia)
- Loss of Bladder or Bowel
- Numbness and Tingling In the Groin Area (Saddle-Like Paresthesia)
- Numbness and Tingling In Your Arms (Especially If Upper And Lower Body)
- Major And Noticeable Motor Weakness In Lower Extremities (Hard Picking Up Legs or Drop Foot)
- Limited Spinal Range of Motion (All/Majority Directions Supremely Limited)
- Neurologic Findings Persist Beyond One Month
- Severe Tenderness
- Visual & Auditory Disturbances
- Severe or Unexplained Headaches
- Trouble With Balance & Coordination
- Chest Pain, Unusual Swelling, or Shortness of Breath
How Can I Form A Long-Term Plan For Conquering Chronic Lower Back Pain?
We’re glad you asked!
Having a long-term plan will be your biggest asset in lower back pain recovery.
Consider the following questions to make a personalized plan that will work for your lifestyle.
What Are Your Goals?
Your goals must align with you personally. We often make goals that don’t relate to who we are or what we care about. Instead, create goals that are realistic and have personal meaning to you.
For example, instead of the blanket goal of “I want to get rid of my lower back pain,” think along the lines of “I want to play with my kids comfortably” or “I want to work out with my buddies with confidence.” It’s simple, it’s got meaning, and it’s personalized to you and your needs and wants.
Where Are You At Now? – Current Fitness
Your activity level should be on par with where you are fitness-wise. That way, the pace of progress you see is a level you feel comfortable with. If you have never been active before, that’s okay! You may just need more consideration to think through what reasonable expectations look like.
Modern Movement Clinic always keeps your needs and abilities in mind while pushing you towards progress.
Where Are You At In Life? – Personal Situation
Life gets crazy, doesn’t it? Maybe you’re a new parent. Maybe you have a new job that is a bit more demanding. Maybe you’re taking care of your partner or a loved one. Everyone has their own specific situation that we consider.
This doesn’t mean that you’re not prioritizing your own health. We just need to find out when that should be and what it looks like.
Consistency – Can’t Water Your Lawn With a Bucket
The biggest myth in any rehabilitation program?
That progress requires 120% effort, all the time. On the other hand, you can’t put in 0% effort and expect results. However, consistency is the single most important factor in reaching pain-free progress.
Lighter and less aggressive exercises more frequently are much better than heavy and aggressive exercises a couple of times a week. Good consistent input yields good consistent output.
Remember the pain alarm? Remember how doing good movement makes the alarm calm down? Imagine doing it consistently during the days and weeks. (Cue mind-blowing gifs)
Like the heading says, and like people of Denver and the mountain west know, you can’t expect a green lawn by slinging water out of a bucket into the backyard. Consistency is key.
Control – What We All Want Out of This
When experiencing lower back pain, or any pain, we can feel like we’ve lost control.
Feeling like you’ve lost control in your life makes you feel like your efforts don’t matter. Apathy towards your pain is the OPPOSITE of what we want. Instead, buckle in. You’re in the driver’s seat here and you get to control the acceleration and ETA most of the time.
Being aware of your recovery and progress gives you a higher success rate. Seeing progress encourages you to continue forward and maintain consistency.
Outcomes – Don’t Expect Easy Street
Any good plan has pitfalls. Some pitfalls we anticipate and others we may not see coming at all. We often expect because we follow the program that a positive response will result 100 times out of 100. Have you ever studied for a test and STILL did bad? Just me? Okay.
No, I’m not saying you must be physically active 24/7 for the rest of your life. But keeping a mindset of setting goals, moving, self-efficacy, and consistency does make the work more sustainable. You may even start to notice other positive benefits in your life as a result.
Sometimes people believe that rehab from an injury should be a progressive upward slope. Injuries and pain are tough. Everybody responds differently and at different rates. We all come from different backgrounds and experiences with pain and injury which can manifest in recovery. However, by having a plan in place, we create more control in the face of the uncontrollable.
What I Do Need To Do Now?
If you’ve gone this far, don’t quit now! (that’s a joke and motivation at the same time!) But it obviously means you care. I care too. The first thing is making sure you stay active. Whether you are an athlete or not, you don’t need to be sidelined. Whether this is with lower back pain, we can do alternative exercises that can have these areas work in different ways.
You would get this from an assessment at Modern Movement Clinic and any other good functional movement therapist who practices with an evidence-based approach in the greater Denver area. You may be a runner, skier, hiker, or just a weekend warrior but that doesn’t mean you need to put your activity to a halt. Movement is medicine.
What can I expect from my first Chiropractic visit?
Whether you work with the Modern Movement Clinic in-person, online (oh yeah, we can do that, too), or with another therapist, make sure the first part of your recovery comes from working with a licensed healthcare professional.
Not your gym buddy, Jim, not your athletic sibling that you still resent but won’t admit it, and not your parents…unless any of them are licensed healthcare professionals who have trained and passed examinations to do so.
Many other professionals in the health and wellness industry are great additions to helping some areas of your lower back pain, but they are not trained to make clinical assessments and diagnoses since that’s outside of their scope of practice.
Let’s see what else your examination and experience look like with a practitioner from Modern Movement Clinic.
Don’t Wear Your Sunday’s Best (Unless It’s Athleisure)
If you’re coming to Modern Movement Clinic, whether an online consultation or a live visit in our Denver-based clinic, you’re going to move.
We get that sometimes you might be coming from work or going to work, but to get the answers you seek, we need to see how you move. Bring a change of clothes if you’re coming from another activity. Dress in comfortable clothing that allows for freedom of movement.
Are You A “Fashionably Late” Person? Read This Then
We’ve all been there, right? Traffic hits, weather turns, kids are screaming bloody murder, and inevitably time speeds up. It happens!
However, we recommend that you leave 10 minutes earlier than what the navigation says on your phone if it is your first visit. This ensures you find our location without being rushed when we sit down to chat.
This can take away from the emotional component of your pain and limit our ability to get the entire picture of what is causing your pain.
The first visit lasts around 90 minutes unless indicated by the practitioner. Corresponding visits will be based on the time you and the practitioner agree upon.
We’re Pretty Modern – Doing Things Digitally
We want to remove as many complications as possible for you.
We have an online booking option that allows you to take control of your recovery from the comfort of your home. Your payment is taken care of online through our scheduling app, your exercises are all digital, and a recap of your session is emailed to us after you finish.
After all, it is the 21st century and your rehab and performance should reflect your needs today.
We’re Here For You. Not Our Egos.
Finding the right healthcare provider can be hard as it sets the tone for your recovery process. Some things to look for are listed below:
- Does Physical Testing – clinical and physical examination is paramount as it relates to what your goals are. It takes time and analysis to do this. You shouldn’t be rushed in and out of the space. We don’t use special gadgets and gizmos to do the analysis unless it is needed and even then, they shouldn’t be regarded as cure-alls but as an adjunct. All that glitters is not gold quite often.
- Focuses On You – at Modern Movement Clinic in the Denver, Colorado area, you’re not a number. You’re not even a deductible. If you come here, you are a priority. What matters to you in your recovery? That’s our priority, too! Did we just become best friends?! Now let’s get you better so we can go do karate in the garage.
- Lets You Have Independence- we like you moving and being your best self. We realize some people have an easier time with that than others do and that’s okay! We aren’t pushy at Modern Movement Clinic. You have options. Sometimes options can be confusing, so we always make time to talk with you about your options so you’re well informed about what option fits best for you.
- Grows With Your Goals – things can change in a recovery plan, and you want someone who can change with you. When you improve, you don’t want to be doing the same things right? BOOOORRRRIIIINNNGGG. At Modern Movement Clinic, we are constantly tweaking, progressing, and altering movements to fit your needs and goals.
What Kind of Questions Should Be Asked During the Exam For Your Lower Back Pain?
During a history, we are creating the story that surrounds your challenges, getting more background information, and asking you things you may have not considered yet. Together, these help you inform your own goals.
Here are some types of questions that should be asked in your history:
- Where is your pain located?
- When did this start?
- Is this something that is constantly present, or comes and goes?
- What does the pain feel like?
- Does this change with activity?
- What does your pain scale look like?
- Are there any medications or interventions you do now that make it better? What about things that make it worse?
- Do you have any numbness, tingling, or weakness of the area or other areas corresponding with your lower back?
- What’s been your experience with this pain thus far? Have you already seen anyone for this?
- How is this lower back pain inhibiting your day?
- What is this pain taking away from you right now?
- If you had no pain at all right now, what would you be doing differently?
- Do you have any short and long-term goals after reading those last two questions?
BONUS: Miscellaneous Q & A’s!
Do I Need An MRI For My Lower Back Pain?
Turning to imaging, through X-ray or MRI’s, is often our first instinct.
The inclination to go straight to imaging is common, but more often than not you don’t need to spend the time and money. In fact, getting an image scan first can often INHIBIT your progress as the report offers little explanation to understand what’s important. Reports with too much information and too little explanation can lead us down the WebMd rabbit hole and to further confusion.
Valid reasons for getting image scanning would be if you’re experiencing any red flags previously mentioned or if we do not see any improvements in your treatment. In this case, you will likely take an X-ray before an MRI.
Okay, So What Can I Do About My Lower Back Pain?
Summed up in two words: keep moving.
People commonly want to stop and rest when experiencing pain. Although rest is relaxing, new research says rest is less beneficial than if we just kept moving on with life. After all, this is just a speed bump. We’re slowed down but it doesn’t mean we won’t get to where we want to be, a pain-free lower back area. Massage therapy, dry needling, soft tissue, and adjustments or mobilizations are a nice addition to the therapeutic experience but the most reliable therapy is activity and exercise.
To act in your lower back recovery now, start by moving and making a plan.
Active vs. Passive Therapy – Did I Say We Had to Move?
I like massages, vibration guns, heat, mobilizations, adjustments, and dry needling just as much as the next person. We call this type of treatment passive care.
When you do prescribed activities to yourself, we call this active care. A lot of research actually shows you recover faster when this is part of the plan. The adage “If you give a man a fish, you feed him for a day. If you teach a man to fish, you feed him for a lifetime” takes full shape here.
When working at Modern Movement Clinic, you have options. Sometimes we need to manage the acute pain while also knowing that movement is medicine, so why not have both? Exercise and movement yield the best long-term results and gives you control over the process.
Should I Be Stretching My Lower Back Pain Away? – What If I Said No?
We’ve carried a lot of ideas with us through the decades. As more research comes to light, we have found that stretching out the lower back can potentially inhibit progress.
It all comes down to “why do we feel like we need to stretch?” And most of your answers are “Because it feels tight”.
What if the tightness was a reaction from the body as opposed to a symptom? Remember our conversation about the body’s alarm system?
The nervous system is making this area “tight” to protect the area due to the state of threat it feels it is under. Often stretching tightens up the nervous system MORE.
At Modern Movement Clinic, we commonly suggest just simple movements that are pain-free or very minimal in pain that help let the nervous system know that we don’t have to have a “helicopter parent” overseeing everything.
What About Massage Or Cool Gadgets? – I’m Hip, Too!
In short, absolutely! My answer to these things are “if it feels good and you don’t notice any repercussions…go for it!”. Sometimes relaxing by getting something like this is the step you need to move out of the pain phase.
Foam rollers, vibration guns, cupping, performance tape…it’s all fine and I say use it if you see benefits. Each user has their theories, but the tools all just modifying the sensation of pain. Although these tools should not be viewed as a long-term solution to the problem and don’t address pain’s underlying causes, they do have benefits that many people see every day.
To Ice Or to Heat, That Is the Question!
If you live in the greater Denver area, you know cold just fine. I get the question, “Should I use ice or heat for my lower back pain?” all the time and for good reason. The RICE (rest, ice, compression, elevation) principle has been around for years and it’s just easy, right?
At Modern Movement Clinic, we know that the evidence has shown that ice doesn’t historically do what we previously thought it did. In fact, the creator of the RICE method has publicly addressed his historical claim to say as much. We suggest using what feels best to you.
In Dr. Jesse’s personal experience with pain he’s had (yes, he’s human), he enjoys heat more so than cold because he PERSONALLY feels like it relaxes his body more. In the end, use what works as there are no rules to this, just guidelines.
If it helps, use it. If you don’t see a benefit, you don’t need to continue to do it. If it makes matters worse, look elsewhere. Just don’t ask if you should eat your vegetables with this guideline.
You might be thinking at this point “Okay Doc…you sound like you know your stuff. What’s next?”
What’s next is letting all this sink in.
Modern Movement Clinic is a cash-based practice that prides itself on how efficient, well-read, and communicative we are with who we work with. Notice we said ‘with’ and not ‘on’. You’re not a patient. You’re our client and with that comes a working relationship.
The time you spend with us is exactly that, with us. If you booked with Dr. Jesse Riley, your time is spent with Dr. Jesse Riley. That’s a rare thing in clinics today and quite honestly what separates insurance-based clinics from cash-based clinics. Don’t read that the wrong way. The insurance-based clinic is trying to make ends meet by commonly having a higher volume of people at one time but the system itself needs a “modernizing” of its own. That’s for another post though.
In any recovery plan, there will be ups and downs, but when working with someone like a functional movement therapist and chiropractor at Modern Movement Clinic for your lower back pain, know those downs will come with a little motivation, a little advice, and a lot of movement to get us out of that and moving back towards our goals.
We see cases of people having lower back pain for days, weeks, months, and even years. For as long as it goes on, don’t let this dictate that will take as long to eliminate it. At Modern Movement Clinic, you’ll gain the empowerment to know you can control this, enlightenment to know what your body is telling you, and education to carry with you moving forward.
We’re only a few clicks or a phone call away and we appreciate your consideration.
***Content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition.***