Only in 1-2% of cases, lower back pain may indicate a serious health problem. Most episodes of back pain go away within a few days or weeks, with or without treatment.
Back pain very rarely indicates a serious problem.
Low back pain indicates the presence of a serious health problem in only 1-2% of cases. The presence of a serious problem of the spine is indicated by the corresponding symptoms, a kind of “red flags”. An example of such symptoms is a violation of the sensitivity of the limbs, weakness in the muscles, dysfunction of the pelvic organs, pain at night, fever and unmotivated weight loss, a history of cancer, etc.
Since such cases are indeed rare, most episodes of back pain resolve within a few days or weeks, with or without treatment.
The main recommendation for the treatment of low back pain is to remain as active as possible and perform special exercises. Simple but well-chosen exercises and recommendations on the motor regimen will help you cope with the problem. In most cases, no sophisticated equipment or special simulators are required. You can do the exercises at home or at work.
The recommendations are based on the Canadian Spine Institute, Canada’s most rehab center. In my practice I have been using the approach for 2 years. Most patients fit the description of one of the patterns (types) of pain, and the recommendations really help them quickly cope with the problem.
Why your back hurts: 4 types of pain
Up to 90% of back pain is mechanical in nature. This means that the pain depends on certain positions and movements. Therefore, if your back hurts, first of all you need to find out that the pain is precisely mechanical in nature.
The following questions will help determine the mechanical nature of the pain:
Does the feeling of pain decrease after rest? If the answer to this question is yes, your pain is most likely mechanical .
Does your pain depend on certain positions and movements, for example, is it worse when sitting or bending forward / backward? If the answer to this question is yes, your pain is most likely mechanical .
Can you find a position in which the pain lessens or even goes away? If the answer to this question is yes, your pain is most likely mechanical .
Do you have symptoms such as fever, weight loss, joint pain (knee, hand, hip), feeling of stiffness in the back in the morning that lasts more than 30 minutes after the start of activity, poor general health? If you have mechanical pain, you should not feel these symptoms.
How to determine the type of pain
In determining the type of mechanical pain, it is important to identify those movements and positions that cause or increase pain, or, conversely, reduce or eliminate pain altogether. The type of pain is determined by several main features:
Where is the pain worse: in the lower back or in the leg? (Does the pain in the lower back or in the leg/feet dominate)?
Does the pain increase with flexion or extension in the lower back?
Is the pain intermittent or constant? Alternate – means that you can find the position in which the pain passes.
type 1 back pain
The pain in the lower back dominates, most often intermittent. Pain can also be felt in the leg, but not below the knee. The pain appears or increases in a sitting position or when the torso is tilted forward. You may find it difficult to tie your shoelaces. Walking is usually easier than sitting. Relief comes when you lean back.
Lie on your stomach, arms along the torso,
Hold this position for about 30 seconds
If you do not experience pain, rise to your elbows on and fix this position for another 30 seconds,
If everything is still good, then rest your palms and try to straighten your arms, bending at the waist.
Did the pain not appear? Do 5 repetitions (push-ups) without lifting your pelvis off the floor. Still no pain? Did it get easier for you? Then you have type 1 pain.
This type accounts for up to 60-70% of pain in the lumbar region. The likely source of such pain is the intervertebral disc.
type 2 back pain
Dominant pain in the lower back. The pain may radiate to the leg, but not below the knee. Also always intermittent character. Pain is relieved or relieved by leaning forward and sitting. It increases with a deflection in the lower back, with prolonged standing or walking.
If you do the lumbar extension test while lying on your stomach (see above), you will likely experience increased pain or discomfort. The source of pain is in the posterior structures of the spine, probably the intervertebral joints. Types 1 and 2 pain account for up to 90% of back pain cases.
type 3 back pain
The pain is more pronounced in the leg than in the lower back (lower pain may go away completely). More often permanent in nature and increases with flexion in the lower back and in a sitting position. In the acute period, any movement can increase pain. Also, in certain positions, it can decrease.
If you have this type of pain, and at the same time you develop weakness in the muscles of the leg and / or a feeling of numbness, urination disorders, we recommend that you consult a doctor.
Perform the test above. Strictly adhere to the steps for performing this test. If the pain increases at any stage, do not force yourself to continue. If you experience increased pain in your leg while doing the test (even if your back pain goes away), contact your doctor or physical rehabilitation specialist. If the pain in your leg does not get worse, decreases or moves in the lower back, then you can try the exercises that will be described below.
This type of pain is characteristic of irritation of the nerve root by a disc herniation or protrusion (radicular syndrome, radiculopathy , sciatica, sciatica , sciatica – an outdated name).
4th type of back pain
The pain is felt more strongly in the legs and is accompanied by a feeling of heaviness, numbness, short-term weakness in the legs. The pain is always alternate and occurs, as a rule, when walking. Passes when leaning forward or in a sitting position.
Most often, this type of pain develops in old age. This type of pain is caused by narrowing (stenosis) of the spinal canal. It may also be noted as a stage of recovery from type 3 pain.
Why Exercise When Your Back Hurts
Exercise programs for back pain can be divided into 3 stages:
Stage 1 helps reduce and eliminate pain. The choice of exercises at this stage depends on the type of pain. These exercises are not aimed at strengthening the muscles, first of all, they are needed to relieve pain. These are simple and effective exercises.
Stage 2 – to restore normal mobility of the spine, return to the state that was before the pain attack.
Stage 3 – strengthening the muscles, increasing the mobility of the spine, improving overall physical fitness. These exercises are performed to prevent attacks of back pain in the future.
The basic principles of pain control in the acute period are quite simple: avoid those positions and movements that cause or increase pain, along with the performance of movements (exercises) that reduce pain.
Pain control measures can be divided into several blocks:
Modification (change) of the motor mode.
Unloading positions in which the pain passes.
Special exercises that in the acute stage of pain must be done slowly. If the pain gets worse, stop immediately.
Recommended Exercises for Type 1 Pain
Recommended Exercises for Type 1 Pain
Avoid sitting and leaning forward
Use roles (rollers) under the lower back in the supine and sitting position
Go for short walks with a gradual increase in their duration
Do the following exercises:
Extension in the lower back in the prone position: lie on your stomach and lie down for 1-3 minutes. If pain does not occur, then raise to your elbows and fix this position for another 1-3 minutes. If everything is still good, then lean on your palms and try to straighten your arms, bending at the waist. Did the pain not appear? Do 10-15 repetitions. Focus on relaxing your abdominal and back muscles. During the day, it is advisable to perform every 1-2 hours.
Extension in the lower back in the supine position
In a standing position: feet shoulder-width apart, slightly bent at the knees, hands on the belt. Bend as far back as possible. Repeat 10-15 times.
In a sitting position on a chair, perform backward bends in the lower back 10-15 times.
In a sitting position on a chair, perform backbends
- Unloading position: lie on your stomach for 1-3 minutes, every hour. You can put a pillow under the pelvis and stomach.
Recommended Exercises for Type 2 Back Pain
Avoid prolonged standing. In this position, put your foot on the stand, step more often from foot to foot, do not strain your knees (do not bend your knees)
In transport, try not to hold on to the handrails above your head.
Avoid work with your arms raised above your head (painting, electrical repairs, etc.).
Do the following exercises:
lean forward while sitting
sitting on the floor on your heels, lean forward with your arms outstretched.
Exercises: pelvic tilt, lying on your back
Lie on your back so that you can place your palm between your back and the floor. Tightening the abdominal muscles and lowering the pelvis, touch the lower back to the floor. Try to fix this position by pressing the lower back to the floor for 5-10 seconds. Repeat 10-15 times.
Bringing the legs to the chest in turn and together
Sitting on a chair, flexion and extension in the lower back
Twisting without lifting the lower back from the floor
Recommended Exercises for Type 3 Pain
If you have type 3 pain, doing the exercises can be quite painful. Therefore, the main recommendation in this case is to keep physical activity as much as possible. Avoid sitting and leaning forward as much as possible, use rollers under the lower back. Also try to change the position of the body as often as possible.
Unloading provisions: Z-shaped position lying.
Lying on the stomach with a pillow under the pelvis.
At night, bend the legs at the hip and knee joints, placing a cushion (pillow) under the knees, a small cushion under the lower back.
In the supine position – a roller under the lower back, legs bent, put a pillow between the knees.
As the pain subsides, or if you can do the lumbar extension test painlessly, do the Type 1 exercises.
Recommended Exercises for Type 4 Back Pain
For this type of pain, the same exercises are recommended as for type 2 pain. Additionally – exercise cat-camel. As well as frequent rest in a sitting position.
As the pain subsides, you can add exercises for other types (with the opposite direction of movement). This will be the transition to the second stage of recovery after a bout of back pain.
About the 2nd and 3rd stages, namely exercises to restore normal mobility of the spine, strengthen muscles and improve overall physical fitness.