My lower back ached – what's the advice?
Don't panic! 99% of pain is not dangerous.
Situational assessment: are there other symptoms such as radiating pain symptoms in the legs, asthenia, numbness in the legs or in the groin and butt area, difficulty in holding urine or feces? This may signal Cauda Equina syndrome, which is extremely rare (less than two cases out of a million), but it is a very serious situation that may require urgent medical intervention.
In other words, it is likely to be a so-called 'green card'. nonspecific low back pain, which is very common and most often goes away on its own in 2-6 weeks. The causes and mechanisms of pain are discussed in detail in the "what is low back pain" article. LINK TO ARTICLE.
What can I do about it myself? Below are guidelines for actively treating low back pain.
What should I know?
Movement is medicine.
International treatment recommendations strongly emphasize that with low back pain, one should primarily stay active and move despite the pain, as well as continue to go to work (1, 2, 3). Movement and work may need to be modified if necessary, but the most important thing is to keep moving and continue with normal everyday routines. Exercise can be increased depending on how you endure it, but being inactive and avoiding movement for fear of pain can even make the pain worse (4). So rest is not helpful. It is also OK if you feel pain when moving; this does not mean that the movement should be stopped. In fact, research has shown that moving with pain can even contribute to the improvement of symptoms. This could possibly be due to the fact that training with pain affects the pain regulation system of the central nervous system (the topic discussed in the article "what is low back pain" discussed in the article), signaling to the brain that pain does not mean damage and movement can be done despite the pain, which helps to reduce the sensitivity of the nervous system to sense pain (5). So remember that pain does not mean that there is damage to the tissue or that movement does bad, it can even have positive effects. However, if the symptoms clearly worsen from a certain movement, preventing it from continuing, you can temporarily change the movement. At the end of the article there is a concrete way to implement this as an example of pain in the gym. Remember that the most important thing is to stay active.
Pain medication should not be the primary method of treatment.
Medical treatment is currently recommended to be used after the primary drug-free treatment such as general activity and exercise, as well as e.g. exercise. manual therapy (more on this below) does not help (6, 7). If primary treatment does not bring help, then pain medication can be used, however, its use is recommended in the smallest possible quantities and only for a short time (1).
Lower back imaging (magnetic resonance or X-ray) is not worthwhile.
Treatment recommendations do not support routine imaging for at least the first six weeks as this does not provide additional information about the diagnosis and may even actually worsen symptoms, thus worsening the prognosis of recovery (8, 9). Imaging is also not recommended because it does not generally change the treatment plan, leading only to additional medical costs (10). Back imaging with MRI or X-rays can also reveal a number of different findings that often do not correlate with pain, thus leading to overdiagnosis of low back pain (11). Spinal and disc-related changes such as degeneration, lowering of the intervertebral disc and disc bulge are very common findings in people who do not experience back pain; these are therefore normal age-appropriate imaging findings (12). In 90-95% of cases, a MRI or X-ray does not tell the cause of the pain, but in rarer cases, when the suspicions are, for example, a fracture, cancer-related disease or cauda equina syndrome, imaging can be invaluable. However, this is very rare, and as mentioned above, routine imaging is not recommended (13, 10).
An example of a clinical study that examined the consistency of MRI reporting:
"A 63-year-old woman experienced prolonged low back pain (more than 3 months) and radiation pain in her leg. He was sent for MRI scans in ten different hospitals, resulting in a total of 10 MRI scans with reports, each of which was prepared by a different radiologist. In total, 49 different finds were found in the reports. In addition to this, a single finding was not mentioned in all ten reports, and only one finding was mentioned in nine reports. There was not even agreement on the bulging of the intervertebral disc or the pressure on the nerve roots."
So the woman in question went to the doctor complaining of two symptoms and went home with 49 different problems. This illustrates why imaging is not generally worthwhile (14).
What could I do myself?
The strongest evidence for treating low back pain in numerous systematic reviews and international treatment recommendations has been found to be exercise (6, 15, 16, 17, 18, 19). Regular exercise is also the only method that has been shown to reduce the risk of low back pain (20). If we understand pain better and exercise, research has shown that we can reduce the risk of low back pain in the future by almost half (20). All types of exercise are good, and the way we exercise does not seem to play an important role either (16). Thus, the form of physical exercise does not matter, but what matters is that we enjoy the form of exercise we choose and can do it regularly (21).
There is also no such thing as "good" or "bad" or "dangerous" movement for the lower back. More importantly, the body is used to making movements such as lifting or rounding the back (22). Because of this, the saying "practice movement more, not less" is very apt (22). The spine has a strong structure and is protected by several strong muscles, so there is no reason to be afraid of "breaking" the back, even if you experience a little pain. Lifting with a round back has not been found to predispose to pain, nor has it been shown to be any more wealthy than lifting with a straight back (23, 24, 25). Normal use of your back, such as rounding and lifting, strengthens your back, keeps your back moving and maintains your ability to function.
It has been found that those who have experienced low back pain for a long time move more slowly, tensing the back/abdominal muscles to protect their back (26, 27, 28). Being careful with the back can even have negative effects, since fear of movement and its association with pain or danger can maintain pain and thus slow down healing (29). Moving gently for fear of pain can therefore sensitize the pain regulation mechanism, as movement is perceived as a danger that makes a person more prone to experience pain (30).
As mentioned above, the only way to avoid low back pain is through regular exercise. The new exercise recommendations published by the UKK Institute provide tips for independent exercise, telling how much should be exercised per week, and give examples of forms of exercise (31).
Heart rate-boosting, i.e. brisk exercise, is recommended to be done for 2 hours and 30 minutes a week. This can be, among other things, swimming, brisk walking, dancing or hiking. Movement is brisk if you can speak despite being out of breath. The same health benefits can also be obtained by doing 1 hour 15 minutes of strenuous exercise per week, which can be, among other things, running, cycling, ball games or skiing. Moving is strenuous if speaking is difficult due to shortness of breath. This type of exercise develops fitness and functional capacity, as well as promotes overall health.
In addition to this, muscle fitness training should be done at least twice a week. This includes heavy yard work, stair walking, group exercise and gym training.
You don't have to exercise all that time in a row, but just a few minutes at a time is enough and promotes health. The activity pacing strategy, i.e. starting small and gradually increasing physical activity, is a habit that, among other things, has been considered to be good for those experiencing low back pain (32).
Light exercise also has important health benefits, especially for those who exercise little. Even light exercise can lower blood sugar and fat levels, stimulate blood circulation and stretch muscles and joints (31). This includes household chores, shopping trips and other common everyday activities. You should choose the stairs instead of the elevator, walk the dog, visit the park with the family, etc.
It would be a good idea to exercise and take breaks from being still as often as possible. For example, at work, this break is recommended, as science does not currently seem to support investing in work ergonomics such as various chairs or tables. Ergonomic factors have not been shown to reduce the risk of low back pain (6). In fact, sitting postures or posture, as well as work-related/prolonged sitting itself, have been found to be associated with low back pain (33). However, we know that immobility itself is a risk of experiencing low back pain (34), and a higher amount of exercise compared to a low amount of exercise reduces the risk of low back pain (35). Because of this, taking breaks from work and sitting can be a good strategy to increase the amount of daily exercise.
This renewed exercise recommendation also takes into account the importance of sleep alongside exercise. Together with exercise, adequate sleep has significant health effects. The effect of sleep on recovery is great, and sleep deprivation and poor night's sleep quality have been shown to predispose to pain conditions up to double or triple, as well as lowering self-perceived health status (36).
When to seek treatment, for example? for a chiropractor?
Symptoms are prolonged and do not go away by themselves in 2-6 weeks.
Pain/symptoms worsen.
Begins to appear other symptoms that we talked about at the beginning of this article, eg. numbness, tingling, asthenia.
Pain begins to clearly limit life and hobbies.
Uncertainty about pain, worry about it, or you don't know what to do.
How can a chiropractor help?
A chiropractor is trained to make a differential diagnosis and find out what kind of treatment would be best for you. A chiropractor can help you better understand pain by supporting active treatment, in addition to which you can be offered manual therapy as well as individual training. International treatment guidelines support the use of manual therapy in combination with active therapy (19). Manual therapy can relieve pain which in turn can promote movement especially if pain is a limiting factor, thus helping your functional capacity (37). In addition to manual therapy, the chiropractor will help you find a starting point for exercise and create an individual training program that also includes supervised training if necessary, as well as monitor development and update the program, making sure that the training is progressive. Practice can be, for example, doing movements that help you get back to things and chores that you feel are important and that you have not been able to do due to pain. These can be, for example, playing with children, household chores or gardening. The number of exercises adapts to the needs and goals of individuals.
Exercises performed with KiHy are often based on mobility and strength training. Strength training has been found to be a useful way to treat prolonged back pain and is therefore recommended for use in rehabilitation (38, 39). Strength training can also have a preventive effect, as it has been found to reduce, among other things, the risk of injury in overexertion-type injuries in athletes by up to half (40, 41). Training can be carried out using, among other things, your own body weight, resistance rubber bands and free weights, enabling you to develop towards more challenging and stressful movements in training. Here, too, the needs of the individual and what each person needs in everyday life, hobbies and sports are taken into account. Basically, the training is based on the above FAQ model, which is also intended to promote health and general well-being.
A concrete example – My lower back ached while working out in the gym, for example. back squats (barbell in the neck), what should be done now?
Don't panic, as we went through "what is low back pain" as well as in this article, we know that 99% of low back pain is not serious. Your back may have been irritated by the strain on it, but it is very unlikely that there is a tissue damage that would require an acute medical consultation or treatment.
However, assess the situation to see if the pain is accompanied by symptoms such as as asthenia in the legs or sensory changes, pain leading to incapacity or any symptoms suggestive of cauda equina syndrome (see the beginning of the article). This is very rare, but it is important to recognize the symptoms.
You should try to continue exercising and training. We talked above about how it's OK if you feel pain in a movement, but if the symptoms clearly worsen, it would be good to change the movement.
Possible movement variations that we can do so as not to aggravate the symptoms, but we can still continue to train:
Try reducing the external load (weights) of the movement made – can you find a load with which you can perform squats without it exacerbating the symptoms? If so, good, as you can still make movement, the back is just possibly sensitized to a larger load. Here, tempo training can also work well, giving you a more challenging workout despite the smaller load, for example. 3 seconds down, seconds stop, and 3 seconds up. Keep working out with that load, and gradually lift the weights back up. The symptoms will usually go away in the short term.
If you can't find a load that doesn't cause pain, and just a movement with body weight makes your back sore, can you find the stage of the movement where the pain gets worse? If the pain worsens in the very lower position of the squat, temporarily shorten the trajectory of movement, for example. in the form of a box squat. If the symptoms are reduced with this, fine. Continue training with a shorter trajectory and increase the trajectory with time.
If, despite the above variations, the back squat worsens the symptoms, then the entire movement may have to be temporarily changed. You can choose many good variations of what you can do at the gym, such as for example. front squat, hack squat, leg press, step squat, etc.. Work out this variation of movement for a certain period of time, after which you can try to do the back squat again without the symptoms getting worse.
The most important thing is that you try to keep moving and try to continue training, primarily treating the symptoms yourself, so that in the longer term we avoid the sensitization of the pain regulation mechanism of the central nervous system from avoiding the movement that can occur if the movement is combined with pain. You may often hear that "deadlift is bad" or that it causes back pain. This is not true, but it may be that the nervous system is only sensitized to movement, either due to too much training or load, or because it is avoided due to fear of pain.
If the training is stopped altogether from the feeling of pain, this risks and disadvantages of stopping the training and possibly avoiding the subsequent movement are much greater when it is brought by the benefits (possibly momentary pain relief).
If you do not know how to act and proceed in the situation, and the pain worsens despite various attempts, it is a good idea to make an appointment for a consultation so that you can find ways to control and relieve the pain with the guidance of a specialist.
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