Low Back Pain
By Dr. Jesse Riley, MS DC
Low back pain, or back pain of any kind for that matter, can be a very scary experience. When we have pain that is debilitating or lingering for many days, weeks, or months – it takes a lot within us to carry on with normal tasks and responsibilities. And being in the greater Denver, Colorado area – we all have some level of activity or hobby we have to get back to.
When low back pain becomes limiting enough, this interferes with your identity as well. Many of us take on roles like partner, caretaker, and many others depending on our social circle. This limiting behavior takes away from everyday activities and functions that make us feel more like ourselves which has its own effects on our psyche.
You should be aware that low back pain, as scary and personal it seems to you now, is actually something that many people experience in their life.
Hopefully these stats help settle the nerves a bit more in knowing, you’re not alone. In fact, you’re amongst good company and you will get better and recover with a good plan and some proper education.
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Keys to Recovery
What Hurts? What Feels Okay? What Does That Mean?
We often overcomplicate pain to a point where we feel hopeless and just “stand still”. Pain can be outsmarted by you if we just slow down and listen to what our body and mind are telling us. When in acute pain, we get anxious and therefore time is sped up so we have a natural tendency to miss the signs our body is telling us. When in chronic pain, our anxiety turns to more hopelessness and we inevitably stop paying attention all together. Stick to these three as a general foundation to get things back on track. It all sounds easy in theory but we MUST commit to slowing things down and using our scientific theory of trial and error. The last part you read correctly. There will be some error involved as we can’t expect you to get this right initially but with gaining more clues, we get closer and closer to our solution.
What Hurts With My Back Pain? – Identifying Painful Movement
Sometimes this is as simple as “When I do this, it hurts” and sometimes there are many things that elicit pain during a movement.
Any good clinician and therapist should take you through a movement assessment. This is typically what separates a traditional Chiropractor or Therapist from a Modern based practitioner as we know that anatomy rarely ever dictates pain unless acute trauma is involved in which you would likely know (broken bones, lacerations, etc.) which even then we have seen great feats from the human body to overcome these in times of threat.
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”.
This dictates our movement assessment and you could see why, right? Our job is to help provide you with answers to your current troubles but if we don’t have much context, it just makes it much more difficult to do so. This would be like trying to describe directions to someone over the phone without any GPS or turn by turn on our phones. This is much harder for a lot of us in this day and age compared to before these things were available to us.
The movement assessment revolves around these scenarios where we replicate portions of the actions that are interfered with currently categorizing them into 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.
As we do this, we put together a story of what we might limit or modify for the time being to allow the body to calm down and flush out of the irritation in the area.
Now let’s talk about what feels good.
What Feels Okay With My Back Pain? – Identifying Pain-Free Movements
We can’t JUST focus on the bad right?! We need to know what is okay. Imagine if we were ship wrecked on an island with no idea where we were. You wouldn’t just starve right? You’d have to do some exploring for things that you CAN eat while making notes of things you CAN’T eat.
We use the clues from our movement assessment to get an idea of what movements do not cause a threat right now, knowing that as time progresses, this catalog will get bigger and bigger and you’ll be able to do more things with way less pain. For now, we have to start moving somewhere or modifications that allow us to move. This also takes down our level of fear as well as you start to gain back your ability to everyday tasks.
What Does That Mean? – Making Sense of Everything
I’m not sure we have to spend much time on what we took away from what hurts and what feels okay, as one should surmise that we should limit what hurts as much as we can while trying to do more of what feels good. Novel idea right? Making sense of what’s going on is very important though.
Your Nervous System - Your Body’s Alarm System
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 or threat indicator for your body, NOT A DAMAGE INDICATOR. The alarm however may tell you something is amiss but not always what the extent is. Think of it like a smoke alarm. We often associate smoke with a fire but have you ever had your smoke alarm go off with no real threat of a fire? If you’ve lived in an apartment with your alarm right by your oven, you likely have.
Also, when we repeatedly force our body into movements that feel more painful, the alarm may be going off all the time and might even become a bit more touchy. Perhaps going off more often now because it believes there is a constant threat.
This is why we want to modify or avoid irritating movements and actions right now as this interrupts the cycle of pain. As we do more of what the body wants for the time being, that alarm starts to calm down and you recover faster.
Again, this is all gained from just a movement assessment. Traditionally speaking, do you think you can honestly look at an X-Ray or just by touch that we can gather this kind of information? Not even remotely unless there is acute trauma or red flags you’ll read below. Movement tells us the directions to where we need to get to…pain-free-ville.
Red Flags - When You Need to See a Professional
Back pain isn’t ALWAYS caused by a mechanical event and can be from something underlying.
That being said, this is a very unlikely scenario as only about 1% of the cases in primary care fit into this field where about 90-95% of the cases fit under non-specific categories of which you would see a movement therapist like at Modern Movement Clinic. Even cases of radicular symptoms like what you might know as Sciatica or stenosis encompass about 5-10% and are still managed conservatively with a movement therapist, chiropractor, or physical therapist. For the 1%’er group, we want to make sure we don’t ignore the signs you can see below.
If you have any of these, you should seek out a licensed Medical professional immediately:
- 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
Do I Need An MRI For My Low Back Pain?
We as a society have been instructed that imaging is the golden tool to explain our pains we might have and as a result we often seek to get one at the first sign of pain. If you recall from the %’s above, I know we all think we are special in our own way but more often than not, we are spending a lot of money and time for something we likely don’t need.
Working with your movement therapist or clinician with your low back pain, you both will come to an agreement that an MRI is warranted. Indications like the red flags above or if during the course of treatment, we do not see improvements, an X-Ray is typically suggested first before an MRI. Even with insurance purposes, most providers commonly want an X-Ray initially.
What Do I Need To Do About My Low Back Pain? - Getting Through This Crap
Summed up in two words: keep moving. A common trait many people have when they are hurt is they stop doing everything and rest. Now although rest is relaxing, our body is wanting to get rid of this as much as you do but current research actually says rest is less beneficial than if we just kept moving on with life. After all, this is just a speed bump or imagine a road trip and we hit some traffic. We’re slowed down but it doesn’t mean we won’t get to where we want to be, a pain free low back. Things like massage therapy, dry needling, soft tissue, and adjustments or mobilizations are a nice adjunct to the therapeutic experience but this is providing temporary relief as the most reliable way is activity and exercise.
The next thing I see is people often don’t make a plan. Any means of success always starts with a plan. Let’s see what else makes up a good plan to get through this pain journey.
Setting a Goal
Your goals have to align with you as a person. We often make goals that have no identifiable feature to us meaning it doesn’t relate to who we are. They should be realistic and have personal attachments to you.
An example would be less “I want to get rid of my back pain” and more “I’d like to be able to play with my kids or work out with my buddies so I’d like to get past this back pain”. It’s simple, it’s got meaning, and it’s personal to you and your needs and wants.
Where Are You At Now? – Current Fitness
You activity should revolve around where you feel you are fitness wise matching your exercise capabilities. From there this should follow a pace of progression you feel comfortable with. If you have never been active before, that’s okay. You may just feel new experiences that require a bit more thought and mindfulness to understand “what am I feeling here, work or pain?”.
Working with therapists and clinicians at Modern Movement Clinic have a great approach to this along with keeping the discussion going with you to make sure the pace pushes you but at a speed you feel confident enough about.
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 your partner/close one has needs that must be met during the day. Everyone has a specific situation that we must consider.
This doesn’t absolve you from being an active individual. We just need to find when that should be and what does it look like.
Consistency – Can’t Water Your Lawn With a Bucket
How on earth are we supposed to gain expertise and get through a challenge with minimal effort? Don’t mistake that as working out really hard or lifting a lot of weight…it takes consistency. Lighter and less aggressive exercises more frequently are much better than heavy and aggressive exercise a couple 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, you can’t expect a green lawn by slinging water out of a bucket into the backyard. Consistency is key and you learn a lot along the way.
Control – What We All Want Out of This
When we are having low back pain, or pain of any kind, we often believe this is out of our control. This automatically disassociates ourselves from the issue and therefore we naturally care LESS. Buckle in. You’re in the driver’s seat here and you get to control the acceleration and ETA most of the time.
This also gives us the sense of being more aware of our recovery too and thus a higher success rate. This encourages you to keep going and yep…more consistent.
Outcomes – Don’t Expect Easy Street
Any good plan has pitfalls. Some we may see and some we may not see coming at all. We often expect because we are doing all of the things that a positive response will result 100 times out of 100.
No, I’m not saying you have to be physically active all of the time for the rest of your life. But this mindset of setting goals of moving, self-efficacy, and consistency do make things more sustainable and you’ll likely notice many other positive benefits included with that.
Sometimes people believe that rehab from an injury should be this progressive upward slope as well. Injuries and pain are simply just tough. Everyone responds differently and at different rates. We all come from different backgrounds and experiences with pain and injury as well which can manifest in recovery. However, by having a plan in place, we do create a better amount of organization to help in controlling some of the uncontrollable.
What Do I 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 low back pain or hip 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 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 meant you need to put your activity to a halt. Movement is medicine. Let’s see what else might be common queries.
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 passive care in regards to that the treatment is done to you.
When we have you do things yourself, we call this active care and 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 the 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 yields the best long-term results and you guessed it, gives you control.
Should I Be Stretching My Low 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 actually have found that stretching out the low 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 times when we stretch this actually makes the nervous system tighten up MORE.
At the 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. Many have their theory of what it is doing but they are all just modifying the sensation of pain. Although, these should not be viewed as a long-term solution to the problem and doesn’t address the problem in how it likely manifested, they have benefits that many people see everyday.
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 low 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 the Modern Movement Clinic, we know that the evidence has shown that ice doesn’t historically do what we thought it did previously in regards to the healing process. 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 pains 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.
What to Expect From Your First Visit (And Practitioner)
Whether you work with the Modern Movement Clinic in the greater Denver area, online with us (oh yeah, we can do that), or another therapist, make sure the first part of your recovery comes from working with a licensed healthcare professional. Not you gym buddy Jim, not your athletic sibling, 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 back pain, but they are not trained to make clinical assessments and diagnoses as this is out 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 Dever 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. Dress in comfortable clothing that allows for freedom of movement. This can be brought with you to change into BEFOREHAND as well. We’re not THAT harsh.
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 would be recommended that you leave 10 minutes earlier than what the navigation says on your phone if it is your first visit. This ensures you find the location well enough without being rushed for 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 to 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 AND for us. We have an online booking option that allows you to have the control, your payment is taken care online through our scheduling app, your exercises (when becoming a member) will be in your file with videos that you can pull up to look at on your phone on your schedule, and your intake forms to fill out…all digital and emailed to us after you finish and before we see you. After all it is the 21st century and your rehab and performance should be a part of that 21st century.
We’re Here For You. Not Our Egos.
Finding the right healthcare provider can be hard as it does set the tone for your recovery process. I often say that if they can’t work on my family members or myself then I will not suggest them. Some other 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 the Modern Movement Clinic in Denver, Colorado, you’re not a number. You’re not even a deductible. If you come here, you are a priority. What matters to you in all this? That’s the same answer we have! Did we just become best friends?! Well your concerns and priorities are goals of ours too and we make sure you know we listen. Now let’s get you better so we can go do karate in the garage.
Let’s 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! That’s what makes us the beautiful people we are. We aren’t pushy however 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 are well informed about what option fits best for you.
Updating To the Newest Operating System – things always change in a plan good or bad and with that you want someone who can change the course of action to avoid as much bad as possible. Conversely, if you improve, you don’t want to be doing the same things right? BOOOORRRRIIIINNNGGG. At the 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 Low Back Pain?
During a history, we are simply creating the story that surrounds the problem you face and getting more background information and ask you things you may have not considered yet. These are all put together as consideration in regards to what your plan or goals are.
Here are some other types of questions that should be asked in your history:
Where is your pain located?
When did this all start?
Is this something that is constantly around or comes and goes?
What does the pain feel like when present?
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 low back?
What’s been your experience with this pain thus far? Seen anyone? Experienced before?
How is this low 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?
Whether it is getting back to playing the piano, back on the soccer pitch, hitting a PR in the Denver Marathon, or simply catching your littlest one running around the house. We all need to have these types of questions asked in our history to set the best and most successful plan. You’ll find that at Modern Movement Clinic.
Promise I’m Done - In Summary
You might be thinking at this point “Okay whipper snapper…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 in 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 this day and age and quite honestly what separates insurance based clinics from cash based clinics. Don’t read that the wrong way. The clinic is trying to make ends meet but the system itself needs a “modernizing” of its own.
In any recovery plan, there will be ups and downs, but in working with someone like a movement therapist and chiropractor at Modern Movement Clinic for your low 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 low 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.
If you’ve made it this far and are just thirsting for more, check out the other guides I’ve made below.
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***Content of this blog not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.***