Your Guide To Back Pain Recovery

By Dr. Ben

I've treated thousands of people with back pain. It’s a large portion of my practice. And I’ll tell you this -- suffering from back pain is NOT COOL!

Back pain can be debilitating. It can cause suffering for days, weeks, months and even years!

 

But besides that, it can ruin your plans. Not just playing with kids or doing sports. Just simple everyday things we take for granted. Putting shoes on, picking something up off the ground. Even climbing out of bed in the morning can be an agonizing start to your day!


And it’s not just physical -- being sidelined with back pain can lead to depression and anxiety. Here’s why:


Avoiding the fun things in your life -- or even the normal everyday activities -- can make you depressed. And the anticipation about doing those activities that might cause pain can bring about all sorts of anxiety or worry.


If you’ve never experienced back pain at any point, you’re an outlier. And it’s likely you’ll be experiencing back pain in the future. Here are some stats:  

  • 80% of people have experienced back pain at some point in their lives.
  • 50% of people say they had back pain sometime in the last year.
  • And about 33% of people have had back pain in the previous three months.

This is how common back pain is in our society right now! But having back pain is not a death sentence. You can recover. You will recover.


With the right approach.


I’m not going to leave you hanging. I’ll cover in depth what back pain management looks like. You can use this to get on with your life without having to suffer.


Soon you can get back to kicking ass --and doing even better than before!

The Three Pillars

These are the ‘three pillars’ to recover from back pain:

  • Identifying Painful Movements
  • Identifying Pain-Free Movements
  • Staying Active with a Comprehensive Plan

I bet you didn’t think it would be as easy as 1-2-3, did you?

To start on this plan, you’ll be taken through a movement assessment from a licensed professional. Later on, I’ll tell you how to choose the right healthcare professional -- and the kinds of questions they should be asking you.

1. Identifying Painful Movement

This is more involved than “Doc, it hurts when I do this --”, and the doctor tells you just don’t do that anymore!

A clinician will take you through a movement assessment. This will identify all the movements and postures that cause pain. Sometimes there are specific scenarios that cause pain every time. You’ll want to talk about that.

For example, someone could tell their clinician, “Every time I bend over to pick something off the floor, I experience pain! I have to really squat and keep my back straight.”

Or: “Every time I reach into the upper cupboard, my back hurts!“

Your movement assessment should be grounded around these scenarios that are interfering with your life. It should thoroughly address and evaluate them.

The assessment also categorizes the movements into simple directions. In most cases, all movements will be within one of these categories: flexion, extension, rotation or side bending. This is simply flexing forward, extending backward, rotating side-to-side, or bending side-to-side.

See, now you’re learning the lingo!

Using this step-by-step method, we know which movements are the worst -- the ones that are causing significant pain. Once we know those, you’ll need to temporarily avoid the painful movements so your body can recover. 

Pain: Your Body’s Alarm System

identifying painful points

Pain is like an alarm system for your body. The alarm tells you that something is wrong so you can fix it.


But when you repeatedly do movements that cause pain, the alarm is going off all the time. After a while, the alarm actually becomes recalibrated!

It gets tuned up -- thinking it’s in constant threat.

So we want to avoid the movements that are causing that pain. When your body experiences less pain, we interrupt the pain cycle. And the alarm will go back to normal --calming you down. That lets you recover faster.

Fast and easy. That’s what we’re aiming for!

The information from the movement assessment -- categorized as simply as possible -- lets us make modifications so you can work around the pain. This is temporary. But it’ll allow your body to recover. 

2. Identify Pain-free Movements

That’s right!

We need to know what movements don’t cause pain. This is almost more important than identifying the painful movements! Why?

Because when you have back pain, you're stuck.

You feel like you can't do anything. You don’t want to attempt any movements out of fear they might cause pain.

We use the pain-free movement assessment so you can get on with your life. We find ways to make modifications that don’t hurt. This restores your ability to do your everyday tasks. And when you can do that, confidence returns!

3. Staying Active with a Comprehensive Plan

back exercise

You gotta make a plan. And stick to it!

There are a lot of ways that you can treat back pain, including massage therapy and other techniques. But these are just for temporary relief. The most reliable way to get out of back pain is activity and exercise. This what I like to call the ‘meat-and-potatoes’ of your plan.

Let me address a few common questions about other treatments:

Should I be stretching?

Surprise! Stretching for back pain relief is actually not a good idea!


Stretching may feel good because you have tight muscles. But tight muscles are not the cause of the back issues. They are just a symptom.


Also, you may have to get into a painful motion to get that stretch relief. This is especially true if you haven’t done a movement assessment to identify the painful and pain-free motions.


That means you might get temporary relief when stretching -- but you could be making your back worse down the road.


Instead, I recommend simple, pain-free movements and exercises that help loosen your muscles. These won’t put you in scenarios that could make the pain worse. 

What about getting a massage?

My answer to this is always “Yes!”.


Massages feel good. They help you relax. They won’t hurt you in most back pain cases. They have a whole host of benefits that can aid in your recovery from back pain.


Getting a massage is simply a great idea.

But just using general massage to get out of back pain is not a long-term plan. It's won’t get to the root of what caused the pain. And it won’t keep the pain from coming back.

And foam rolling?

In general, foam rolling should be fine. But it shouldn't be the crux of your recovery plan. And if it doesn’t seem to be helping you, don’t continue to do it.

Should I at least be icing my back?!

When it comes to back pain my general recommendation is don’t use ice -- use heat instead!

Your muscles may already be tight and locked up. This is how your body protects itself from experiencing more pain.

But ice can make the muscles of the back stiffer and tighter.

We don't need more tightness. That can cause its own discomfort -- which is a separate major problem when dealing with back pain.

Heat, on the other hand, relaxes your muscles. It allows things to calm down.

So that’s my general recommendation. 


Remember, there aren’t any hard and fast rules here. Use what works!

There are some situations where you’ve been using ice and it feels like it’s helping. Then you use heat and it doesn’t help. If that’s the case, then continue with ice!


If you've been foam rolling, massaging, stretching, etc.-- and it doesn't help -- then don't continue to do it. And if it’s making it worse you definitely should stop!

Designing Your Relevant and Comprehensive Rehabilitation Plan

You didn’t think I was going to leave you hanging without telling you how to design your plan, did you?

Of course not. Let’s get on with how your exercise plan will help you recover. Here is the framework for how your plan will be created.
Goals

Your exercise plan has to match whatever your short-term and long-term goals may be. Otherwise, it's going to be hard for you to stick to it.

For example, your goal could just be getting out of pain as quickly as possible. This process has to be simple. It's going to be much easier for you to stick to your plan if you have a goal. And if it's easy, you’re more likely to do it!

road to recovery
Goals

Your exercise plan has to match whatever your short-term and long-term goals may be. Otherwise, it's going to be hard for you to stick to it.

For example, your goal could just be getting out of pain as quickly as possible. This process has to be simple. It's going to be much easier for you to stick to your plan if you have a goal. And if it's easy, you’re more likely to do it!

Your Current Fitness Level

Your exercise plan is going to depend on your fitness level and your current exercise abilities.

If you're a competitive powerlifter, you’re going to need a different exercise plan than someone who simply wants to get out of pain.

It’s okay if you haven’t been active before! Your plan will be customized to you.

Personal Situation

Are you a new parent? Are you an executive that works 12-hour or even 16-hour days? Everyone has a different situation that needs to be taken into account.

Busy people have to incorporate exercise throughout the day whenever they have a spare moment. That means it has to be planned in a way that's simple and easy to do. 

Optimal Outcome

The optimal outcome is that you don’t experience back pain in the future. Of course! And if you do, you know exactly how to get out of it.

This should be the long-term sustainable thinking that goes into your plan -- get you down the road in the most the efficient way possible. And make sure it’s sustainable for the long-term.

Otherwise, you could end up on the “injury roller coaster” -- where you're consistent for a while. Things get better. But you slack off and things get worse. You’ll experience a yo-yo effect -- where you're going up and down through progress and regression.

We don’t want that!

Independence

The plan should put you in the driver's seat of the recovery process. This will greatly accelerate your ability to recover. Why?

Because you can see that you’re directly causing your recovery - at your own pace, multiple times per day. You don’t need a healthcare provider standing next to you each and every time!

And this encourages you to keep going. Which makes you feel good and stay consistent.

See how we’re always making it as easy as possible to be consistent?

That leads to the next important topic:

Consistency

One concept rules the day when it comes to recovery... Consistency!

Many light and small exercises -- multiple times per day -- are much better than heavy exercise sessions a few times per week.

light exercise

Your body is getting consistent input that feels good all day long. That pain alarm system recalibrates back to normal. You’ll feel better and recover faster!

I grew up on the video game Street Fighter II. So I always relate consistency to the car destroying bonus round. For those that never played it -- the purpose of the round is to destroy a car with punches and kicks. Weren’t the 90’s fun?!

The only way to blow up the car under the time limit is to use a ton of the lightest and fastest attacks. If you threw heavy punches or huge kicks, you would always run out of time.

It’s the same with your recovery plan. You want consistent feel-good inputs -- multiple times per day. This is much better than heavy exercise sessions 1-3 times per week.

Consistency and consistent input is always going to win out.

Keep Moving and Improving

You can still keep your active life and even improve it while having back pain.

It doesn’t matter if you’re an athlete or weekend warrior -- a plan that’s built for you will find a way to keep you doing what you love. You don’t have to be sidelined!

This could be something like alternative exercises -- such as a weightlifter that can’t squat. There are leg building exercises that can still be done. It could also be simply modifying the training volume or the number of repetitions.

If you are thoroughly assessed, then this is almost always possible.

A good healthcare provider will not only be able to work this into the recovery process -- but also communicate with your trainer or strength coach to implement it.

I’m almost always able to find ways for my patients to operate above their baseline activity level. I’ve seen people become better at their surfing, jiu-jitsu, and weightlifting -- all during the recovery process!

You don’t have to put your progress on hold!

Active Recovery

You should always prioritize staying active and exercise beyond just passive care. Passive care treatments are done to you -- rather than you doing them yourself.

These treatments would be things like massage therapy, joint manipulation, chiropractic adjustments or joint mobilizations. And that includes those decompression machines or those topsy-turvy traction machines that hang you upside down.

Don’t get me wrong -- passive care like that is an excellent supplement! But your recovery plan should always be centered around staying active and exercise.

Think of it like this -- the main plan of exercise is like a bowl of ice cream. Passive care is the toppings.

If you take away the ice cream -- you’re left with just nuts and chocolate syrup and sprinkles. Maybe a cherry. You’ll still have something sweet, but it’s not a sundae.

Exercise and staying active is going to give you the best long-term outcomes. And it’ll put you in control of your recovery! 

see a doctor

Red Flags -- See a Doctor!

Sometimes back pain can be a symptom of something more serious.

It’s unlikely that you have to worry about these -- only about 3% of the population has back pain from reasons like these listed here. But they are very serious and should be considered in all cases.

Don’t ignore these red flags if you have been showing these symptoms. They can lead to catastrophic issues down the line -- much worse than just back pain itself!

If you have any of these, you absolutely must see a doctor or a licensed healthcare professional:

  • History of cancer
  • Unexplained weight loss
  • Ongoing infection or fever
  • Prolonged use of steroids or any drugs that are meant to inhibit your immune system
  • Significant trauma (such as an accident that caused the pain)
  • Prone to bone fractures (potential osteoporosis or osteopenia)
  • Bladder or bowel problems
  • Numbness or tingling in the groin area (Saddle anesthesia)
  • Major motor weakness in lower extremities (such as drop foot)
  • Limited spinal range of motion 
  • Neurologic findings persisting beyond one month

When You May Need An MRI

Many times people run out and get an MRI at the first sign of back pain. But in most cases they’re just wasting their time -- and a lot of money!

Your clinician is the one that’ll decide if you need an MRI. If there are indications, such as the red flags from above -- or your pain doesn’t improve over the course of treatment -- that’s when we use imaging. And usually we start with X-Ray before doing an MRI.

In many cases, a thorough assessment and history will be much more important to put you on the path to recovery. 

What Your Clinical Examination and Assessment Will Look Like

The first part of your recovery process is the clinical examination and assessment by a licensed healthcare professional. Not just anybody. That’s someone who has been trained extensively and has passed some sort of professional licensure.

There are a lot of smart and caring professionals out there that can help with back pain -- strength coaches, trainers, and massage therapists. Plus other manual therapy workers like yoga and Pilates teachers.

They’re all great at helping with some areas of your back pain -- but they should not be performing any sort of clinical assessment! It's simply out of their scope of practice and training. If they miss something, you're taking a gamble with your health.

Get your examination from a licensed healthcare professional. It's just not worth the risk.

Questions That Should Be Asked During a History

Don’t worry -- it’s not a history exam!

A ‘history’ is what we call all the questions the clinician will ask you before they do any kind of physical test.

This is the entire background story surrounding your pain -- all of those data points that led up to and currently surround your problem. This helps us get a complete understanding to form your plan.

Here is the type of questions and follow-up questions that should be asked in a history:

  • Where exactly is your pain?
  • When did your pain begin? Was it a specific incident or did it come on gradually? 
  • Is the pain constant? Does it come and go? Is it getting any better or worse?
  • What does your pain feel like? Common descriptors of pain sensations are sharp, dull or achy.
  • Rate your pain from 0 - 10. Does the rating change after different activities?
  • Are there any medications or movements that make your pain better? Worse?
  • Do you have any numbness, tingling, or weakness -- anywhere in your body that is associated with the back pain?
  • Have you been seen by anybody for this in the past? What helped and what didn’t? 

Functional Questions that Create Your Plan

​How is this back pain hampering you? What are you unable to do now that you could do before?

The plan starts here!


This includes normal everyday activities -- going to work, getting out of the car, training at the gym. What’s blocking you?

Relieving pain will definitely be one of the primary goals. But so is making sure that you're able to maneuver. And get back to your normal life again.

Understanding how it’s getting in the way of your life is important to take into consideration. You and your priorities should always be the focus.

What are your short and long-term goals?

Your plan will always revolve around your short-term and long-term goals. This important information to know!

Your short-term goal could simply be to get out of pain.

Your long-term goal could be to become strong and resilient -- and not have to worry about back pain interfering with your life anymore.

Here’s another example of different short-term and long-term plans:

You have an upcoming important event. It could be an athletic competition that you need to train for.

Your long-term goal is to kick ass at this event. But your short-term goal is to be able to train consistently. 

doctor and patient

Or another long-term goal could be to learn something new -- like surfing. And you don’t want to deal with back pain during that process.


You can still flourish and grow with a proper plan!


The entire history process takes time.

A history in my office usually takes 20 to 30 minutes. I need to understand all of the information. After that, a clinical examination is probably going to be another 20 minutes.

The provider you're looking for should spend an ample amount of time listening to your story. They should be asking you many, many questions.

In my opinion, you’re not getting the care you deserve if you’re being rushed through a clinical exam.

That leads to my next topic:

What to Look for in a Healthcare Provider

A major component of recovering from back pain is finding the right healthcare provider. This person should have the ability to help you navigate this whole process.

But don’t fret! I’ll tell you what to look for!

Here are the qualities of a good healthcare provider. I would recommend these even to my family members when they need to find someone.

A good healthcare provider...

​Spends plenty of time with you.

As you saw above, there are many questions to be asked. A 5-minute or 10-minute appointment isn’t going to cut it. There’s no way they’ll be able to hear your full history.

And what’s more -- there’s no way they can develop a plan for you in that short amount of time. I wouldn’t recommend any healthcare provider that can’t give you the time of day.

​Performs physical tests

A thorough clinical assessment and physical test identifies what is relevant to your situation and your goals. This takes time, too -- because it’s important that nothing is missed!

​Focuses on your concerns and priorities.

What matters most to you? This needs to be the primary concern of your healthcare provider as well. Your concerns and priorities lead to your goals. Someone that isn’t listening won’t be centering the plan around your needs.

​Lets you be independent.

A good healthcare provider will always figure out what you can do to help yourself for the long-term. They won’t keep you relying on them forever to get out of pain.

​Doesn’t rely on gadgets

If your treatment plan revolves around gizmos and gadgets, it’s not going to be in your best interest. No professional should rely on a magic cure-all machine or tool to treat your pain!

The person you need is going to take an active approach and put you in the driver's seat to recovery.

​Maintains focus on your personal goals

They’ll constantly focus on your personal goals and revisit them to make sure they're being addressed. 

​Finds ways to keep you moving

You gotta keep moving, stay engaged, and continue the normal activities of your life! They’ll find ways to get you moving without pain. Your ability to move is a priority.

​Continuously updates the plan as you progress

Because things always change. And the plan will have to change as you move forward.

You can also just take these questions and ask a prospective healthcare provider, “I’m looking for someone that does this or that...Are you that person?”

Simply ask that question.

If they can't say “Yes” -- look for somebody else!

Final Thoughts

The road to recovery is a winding road.

There's going to be ups and downs. As you temporarily avoid those painful movements and start to incorporate them back, you may experience some pain at times. That's normal!

Just stick with the plan -- adjusting as necessary --and you'll be well on your way. This isn’t something that you should have to be dealing with for the rest of your life.

Typically back pain only hangs around for a week. But I've seen back pain that's lasted months, even years. I’ve even seen people that have been suffering with back pain for over 15 years!

There’s no reason to have to live with that.

I generally am able to get people out of pain in 4 to 6 visits. Sometimes even one visit is enough!

And they’re not just out of pain. They have the education and understanding that empowers them to keep it from happening again. If it does, they know how to get out of it quickly and efficiently. All by themselves.

In fact, I’ve seen many times this ordeal of dealing with back pain turns into a launching pad for improving yourself -- in many ways.

Overcoming this obstacle can catapult you toward training smarter, more consistently, being more productive, and making positive choices in the future. Not just in back pain, or athletic performance -- but life in general!

Use the information provided here to recover in the short-term. Then build a long-term sustainable plan to keep you living the life you want -- and doing what you love every single day.

On behalf of FlowForce Rehab, thanks for reading! We hope you’ll be able to manage your back pain better moving forward.

And if you need help navigating recovery -- give us a call. We’re ready to get you back in action!

***The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.***

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P: ​(619) 734-9794
movebetter@flowforcerehab.com