How To Identify The Cause Of Low Back Pain and Develop A Treatment Plan

At the time of writing this blog post, I am on week four of managing a serious bout of low back pain. Recovery has not been linear, and I am just coming out of a recent exacerbation - but we will touch more on that later.

As a clinician in the musculoskeletal field, I treat a lot of people struggling with low back pain. There are many different classifications of low back pain, and everyone’s case can be truly unique. However, there is typically always one thing in common when it comes to someone experiencing a bout of pain – the amount of stress on the body has outweighed the amount of stress the body can handle.

We see this instantaneously with acute injury or we see this accumulated over time from smaller, repetitive actions that eventually lead to injury (think that nagging, recurring knee pain or neck pain after “sleeping wrong”). Sometimes, it can even be a combination of the two.

In the case of the acute injury, typically the type of stress is something physical – meaning you took a spill at the ski hill and your knee was physically stressed in a way that damaged some tissue, or you fell over the bars while mountain biking. However, with nagging or recurring injuries, we don’t typically see just one physical stressor affect one specific part of the body. Usually, it’s a few underlying issues that slowly chip away at the body’s ability to tolerate force.

An example of this would be a lack of strength, stability, and/or mobility in your ankle and hip, that eventually wear on your knee, ending up in some tendinopathy. It may not even solely be a physical stressor – maybe you haven’t been sleeping well and haven’t been recovering, or your diet has been inconsistent, or you’re going through a mentally/emotionally stressful life event.

Take the underlying physical issues, and combine them with a lack of sleep, poor diet and stressful life event and boom – you find yourself waking up with neck pain for no apparent reason, other than you feel like that stupid pillow you got just simply should be replaced.

Navigating The Intricacies Of Low Back Pain

From a treatment perspective, my job is to reduce the acute inflammatory phase (decrease your pain), and then help build your body’s resilience to stressors back up. Usually, that begins with a conversation around movements that will help, and what won’t, as well as whatever manual therapy or corrective exercises you may need to help calm the site of injury down.

In an ideal world, we address all of the weaknesses you may have, and you leave the clinic stronger and more resilient than you ever were before – ready to tackle the stresses of the world again.

This acute inflammatory phase can be very tricky as we are trying to find a balance between how much activity your body can handle, while still being able to recover. Very rarely do we want to completely stop activity, or jump right into intense activity after being sedentary for a long time. Examples of this can look like:

  • A reduction in activity volume (less exercises, less reps, less sets)
  • A change in tempo during an exercise (slow squat with a pause)
  • A change in depth or range of motion of a movement (box squat, deadlift from an elevated block)

Finding the balance can be difficult. It requires patience, as well as the discipline to listen to your body when it is trying to warn you that you may be doing too much.

Those last two sentences are where I failed..

Stay tuned for part two of this series to learn more about my early stages of injury recovery and how we identify the root cause of low back pain.

If you are experiencing low back pain or physical pain of any kind, book an Initial Assessment with Dr. Ben or Dr. Annelies on our website to uncover the issue and establish a treatment plan.

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