Low Back Pain Management

First, I request that you read it in its entirety!  Don’t read some then come back; this article will give you the big picture on back pain and what you can do to finally get back on track.

Each day a major portion of the population actually suffer lower back pain.  As a matter of fact, most people are dealing with low back pain everyday or are dealing with this issue ongoing for years and/or decades.  Often times, this type of pain will linger around for their entire life and go unmanaged.

The truth is that you can get out pain and manage it better and you do not need to suffer the way you have been.

Easy for me to say right? 

My name is Dr. Josh Jagoda and I am a Sports Chiropractor in San Diego and I have managed hundreds of cases (maybe even thousands now) of lower back cases.  I can confidently tell you right off the start that a lot of lower back pain is treated incorrectly by poor advice, not seeking proper care, and outdated treated techniques and methods.

Here is how most people deal with back pain.

  • Rest
  • Ice / Heat
  • Stretch
  • Medications
  • Pain Management
  • Injections
  • Avoid activity  (“You should give up _________”)
  • MRI/X-Ray

Lower back pain it often affects peoples life activities ranging form of sports, social interactions, mood, energy levels, and most commonly avoidance of certain activities.  Many individuals feel frustrated and defeated and after going through some care with minimal to no results. 

After you complete physical therapy, Chiropractic or injections what else is there to do?

Surgery for your lower back anyone?  I am sure you likely want to avoid this if possible!

From there, YouTube, Google, Low Back Pain forums become a real thing.  Eventually you start to sympathize with other friends and family members who think they know because they have dealt with this as well. 

This is a common social interaction and eventually it gets frustrating because there is so much BULLS**T information on the Internet and despite all this information, therapy, and interaction you still have the pain that interferes with your life.

If you are still reading this article I ask that you read it in its entirety without disruption because its important that you finally learn some myths, tips, and tricks that provide sound advice.

I wills say this again, PLEASE, PLEASE, PLEASE, dedicate at least 20-30 minutes of your time to learning more about low back pain so that you can know what you can do to at least jump-start the process in the right direction.

Ready?  Lets go!

Quick Statistics on Low Back Pain

  • 80% of people will have debilitating lower back pain at some point in their life.  (When we say debilitating, that means you are in severe enough pain that you have to take off of work, activity, and this typically means “bed rest” for some.  As a Chiropractor, I would even say that more than 80% of people will suffer lower back pain at some point in their life).
  • About 90% of low back pain cases will have some sort of reoccurring episode in the future.  This means that if you have one episode of back pain, you are very likely to get some sort of back pain again in the future!
    • In my opinion I would say that more than 95% of people deal with this issue!
  • We spend about $240 BILLION dollars world wide annually on neck & back pain. 
  • $64 Billion goes to low back pain and sciatica related symptoms specifically.
  • Low back pain costs about $90 BILLION in the USA.
  • 3rd highest spending cost in health care

These stats are meant to show you that true impact of back pain on your life and the economy.  As a practitioner in the health field, it is my duty to help with this public health epidemic of low back pain!

“Back Pain is an Epidemic and Worldwide Problem”

Red Flags & Warning Signs (real things to watch for!)

In rare cases some people can have lower back pain that warrants immediate medical attention.  We call this a “red flag” if you have any of the following it should be taken care of immediately.  Additionally, red flags can indicate that there may be something deeper going on. 

  • Loss of bowl or bladder control
  • Bilateral limb weakness
  • Progressive neurological weakness
  • Trauma associated with low back pain
  • Unexplained weight loss
  • Saddle anesthesia
  • No or very little improvement with 6-8 weeks of conservative care

Is Rest Best for Low Back Pain?

Rest is by far one of the most commonly utilized treatments of lower back pain yet it is one of the most ineffective treatments, as it does nothing for your body.  Evidence shows that those who rest lower back pain have a slower recovery and more limitations than those who engage in active care.

If you are thinking rest is best, I understand that this is a common belief but consider the evidence and opening your mind to why it may be more harmful than helpful.

When most people are resting after an injury, they are typically engaging in bed rest and avoidance of activities.

As a practitioner, when I think rest from lower back pain, I think that you may not be engaging in full activity but you should NOT avoid all exercises/activity and bed rest is not helpful in the short and long term.

“Rest is one of the most ineffective treatments”

Why Shouldn’t You Rest Completely?

If you think about lower back pain and spine pain, it is essentially composed of the spine and muscles that surround it.  We know this is as the core or trunk.  This includes the quadriceps, hamstrings, hip flexors, gluteal muscles, low back muscles, and of course the abdominal regions. 

When we engage in complete rest, these muscles that support the spine are no longer working.  Skeletal muscles can degenerate and weaken quickly and if you are in complete rest, you are weakening your entire body by not using it.

But… My Low Back Pain is gone!

As I said in the beginning, 90% of people with low back pain will have a reoccurring issue in the future.  Whether that be just as bad or less is irrelevant at this time.

The reason this is true is because once you have an injury, you are more prone to the injury since there is damage to the area, altered mechanics, and possibly even other issues like neurological compromise. 

So many patients come to me for pain relief and then leave within 1-3 weeks.  Why?  Getting out of pain is easy and most people do not want to put in the CORRECTIVE effort to strengthen and fix the problem!  Your back pain did not happen over night and neither will your back pain fix! 

My suggestions are to always help people get out of pain, build endurance and strengthen so that they can be resilient and reduce their low back pain once and for all.

“ Your Back Pain Didn’t Occur Overnight”

Does Posture Affect My Lower Back Pain?

Have you ever heard anyone say, “Oh, that doesn’t affect my back though.”  While they say that I am thinking “Yeah right it doesn’t.”   Everything in the body has a direct affect on another part. 

They way you carry or your body is called posture & that posture affects how your body moves or doesn’t move.  Posture consists of both static and active movements and if you want to get a better back then learn to move better and do it more frequently.

“If you want a better back then learn to move better”

The quality of your movement is critical here, not quantity.  The better you move the better your back will be.  Don’t be fooled in that self talk that your body isn’t affected by the movements you do or don’t do. This is particularly true if you can recreate or reduce your back pain with specific motions or activities.

“Posture is the way you carry your body and has a direct affect on other parts”

Do You Need an X-Ray/MRI for Low Back Pain?

This is definitely one of my most frequently asked questions and typically the answer is no.  First, it is my job to evaluate the individual to see if they even need any imaging. 

Imaging can be warranted if there are any red flags or signs that there is more trauma or something else going on.  Don’t worry; we take this into consideration on every patient. 

Imaging is something I rarely send out for because patients first need to follow a standard of care, meaning they need to commit to some care, rehab, strengthening, before they even are considered for imaging.  This is because most of the time patients WILL get better if they follow their care plan.  As a result, imaging may not necessary.  Imagine if we do a few exercises and the pain goes away?   Was the imaging really necessary?  You already know the answer.

Imaging has its benefits but the problem with imaging is that it is very structure dependent.  It’s like looking at the blueprint of the house and tells me nothing on how you function, how the spine or your body moves. 

“Most of the time patients will get better if they follow a plan”

Also, research has shown that patients do not always correlate pain with imaging.  This means that you can some arthritis in your back and have ZERO pain, while someone else may have minimal or no arthritis but a lot of pain.  Patients do not follow textbooks and your pain typically does not have much to do with an image. 

The WOO-WOO About Imaging

I am hesitant to even tell you about this but I will because I see it all the time.  A lot of people get imaging and then hold that black and white image as a crutch for their life.  “My doctor said I have a L5/S1 Disc problem according to the MRI.” 

Don’t let back pain become your identity!

This is important because once people get the diagnosis of an injury, they literally take it, hold on to it, live with that as an excuse, and NEVER LET IT GO! 

They use the image & injury and it mentally and physically consumes you.  I tell you this because people will use this as an excuse not to get better and they will continue to blame this image for their pain instead of actually working on it.  As a result you’ll see people mentally check out of their rehab, avoid activities, chalk it up to old age, and accept defeat via the imaging results.  This is sad when I have cases like this because its what they have been told to expect!

You are not a piece of paper and you should not define your life because of an image, paper, or what someone told you about your low back pain 2 years ago.

“Don’t let back pain become your identity”

Is Squatting and Deadlifting Bad for the Back?

How do you think you hurt your back in the first place?  Really think about this before moving on!  Seriously, do not continue unless you really think back to how you hurt your back.

Was it when you picked up your son or daughter?  Was it cleaning the house? Sports? Lifting incorrectly? Was it a squat or deadlift? 

Squats and deadlifts are among some of the most important movements we can do.  Every time we stand up, sit down, pick things up from the ground, go to the toilet, etc we are performing a squat and/or deadlift.  Basically what I am saying is that these are absolutely essential movements that we need. 

The problem is that these movements when combined with heavy load/weight is where people get in trouble and hurt their back.  Most people never practice lifting correctly, improving their strength, and eventually when they do this movement they hurt themselves and blame the movement.  It’s not the movement, its how YOU MOVE or DON’T MOVE.

“It’s how you move or don’t move!”

One of the best ways to protect your lower back is to do what Grandma always told you… “Lift from your knees.”  She had it partially correct in the fact that you need to bend your knees but she left out the hips. 

To truly have a solid back you most have solid hip strength.  The hips are where everyone gets most of their power and guess what? What lies on top of your hips and pelvis?  Your spine! If your hips do not have the proper strength and movement within these areas first, you will eventually succumb to additional movement into the spine.  Overtime this will lead to extra and unnecessary forces to the spine and can cause your back pain.  The hips provide the stability, the power, and the movement to support the spine and body.  They truly are the engine of human movement and most people don’t use them properly.

“The Hips are the Engine of Human Movement”

Before you dive right into squatting and deadlifting, just know that this is a complex movement in the fact that many joints have to do many different functions.  Many people get injured at this level so its advised that you go through a proper screening, rehab, training, and seek someone who knows what they are doing before you engage in this.

Don’t Tell Me About The Core & Abdominals!  I’ve Heard That Before

When it comes to low back pain, shoulder pain, hip pain, the mother of all movements comes from the center (which is your core).  Most people understand this, know this, but avoid it or they train the core improperly.

If you think about the spine for a second it is just a bunch of bones or blocks that are stacked on top of each other and glued together by ligaments.  The spine is extremely dynamic & flexible but you should have the ability to stiffen it up.  Well, the structures that provide stability or stiffness to the spine are the core. 

The core is much more than having a 6-pack and that should NOT be used as a litmus test because that is just the rectus abdominals, which are the most superficial muscles (closest to the surface).  While it’s nice to have the 6 pack, abs it is not necessary to have and likely indicates that you potentially over train the weakest core muscle in the body or that you have a fairly low body fat.   It is more about how your core functions.

The core is more than this muscle.

This includes:

  • Diaphragm
  • Transverse Abdominals
  • Oblique muscles
  • Rectus abdominals
  • Gluteal muscles
  • Hip Flexors
  • Hamstrings

And Much MORE

“The Mother of All Movements Come From The Center”

A Concept you MUST understand – Proximal Stability for Distal Mobility

In order for you to properly move any joint you need to have the capability to move it and stiffen it!  When we say proximal stability, we are saying that you should be able to stiffen your core and spine so that you can easily move other areas of the body. 

For example, if you want to squat, deadlift, or just pick up something from the ground quickly you need to stiffen your spine so that you can move your hips through the range of motion.  This motion helps to avoid extra strain on the lower back. 

I Just Need to Stretch More

I hear this every day!  I would say that close to 100% of people coming in to my office say this.  If stretching got you the result you are looking for then why are you still in pain?  Why does stretching feel good for 15 minutes, 1 hour, and then the pain or problem come back? 

The more important question to ask is WHY ARE YOU TIGHT?  Why do you feel like you need to stretch? 

Stretching is not useless but when it comes to back pain, injury, tightness, it is very close to that.  Most people are tight or stiff because there are muscles that guard the spine or legs that go into spasms.  The spasms are then the protective mechanism to prevent against further injury in the body.  This is neurological and you are not going to override the system very easily.  If you do, you may be increasing your risk for an injury.

“spams are a protective mechanism to prevent further injury”

Another reason stretching may not be working for you is because you are stretching or tensioning a nerve.  In low back pain and sciatica, a lot of people will have pain, numbness, tingling extending down into the leg and butt or hamstring area.  This is as a result of the nerve being irritated. 

If you go ahead and stretch this area, you are not just stretching the muscle but you are adding tension to the nerve.  Nerves do not like to be tensioned for a very long time, EPECIALLY when they are already irritated.  So when you stretch your hamstring when you have sciatica, you are stretching a nerve that is already angry. 

“Nerves that are already irritated do not like to be stretched”

Then Why Do I have Some Relief When I Stretch?

This stretch is an analgesic effect.  Much like scratching an itch or a mosquito bite, you will have some relief but it won’t last long.  In the end you are still irritating a nerve that is already angry.

Breathing For Low Back Pain?  Comon’ Doc, This Won’t Help Me.

“People look at me as if I have 3 reptilian heads”

When I tell people that the way they breathe affects their back pain, they look at me as if I have 3 reptilian heads.  Just as I ask them, I am going to ask you to stick with me for a second on this. 

Breathing does many things in the body from nervous system control, oxygen exchange, improving mental clarity, and of coarse it improves your core strength!  Really, core strength?  Yes, and here’s how.

When you breathe properly, you are supposed to be using your diaphragm and abdominal muscles to control breath.  Most people with pain, who don’t practice proper breathing techniques, or sit for too long tend to have altered breathing patterns and tend perform chest breathing.

A recent study showed that 93-94% of people with chronic pain have altered breathing patterns, therefore when we are in pain, you are likely to have an altered rhythm. 

When you breathe into your diaphragm you are improving intra-abdominal pressure.  This pressure helps to stabilize the spine and control the abdominal contents. 

Low Back Pain and Your Happiness

Have you ever been in a lot of pain and truly been happy?  We both know that the answer is no and lower back pain can be debilitating in many ways and affect your happiness as a whole.

Social Events, Relationships & Back Pain – What are some social events you enjoy doing?  Going for a walk, sitting down for some coffee with friends?  What about going bowling or other recreational events?  When you are in pain the last thing you want to do is socialize.  Many people with lower back pain will often avoid social gatherings or events because of the pain.  Many patients will say, “I don’t want to complain so I rather just not go.”  The premier topic of low back pain can be a constant reminder and many often rather avoid social interactions with others as a result of back pain.

Travel & Back Pain – Could you imagine traveling 1,3,5 or 12 hours in a car or plane with your back injured?   We both know sitting for long periods of time is not good and when there is a risk of excessive sitting, stress from airports, carrying luggage, you are risking a major flare up.   This could sideline the trip and I have had to personally write letters for patients who have had to cancel their trip due to lower back pain.

Recreation & Back Pain – What do you enjoy doing?  Walking? Golfing? Running? Bowling?  Say goodbye to them when you are injured and if you don’t manage this pain well then you are risking flare-ups and increased risk of injury every step or swing you take.  Most people enjoy leisure activities for the outdoor time, workout, and social bonding it gives them.  Don’t let back pain take this from you!

Sleeping, Sex & Back Pain – Most people with lower back pain often have difficulty sleeping and/or finding a comfortable position at night.  They often toss, turn, and are achy at night and in the morning.  If you cannot sleep well, it takes you time to get your morning started then how do you think your performance in bed will be.  Believe it or not, sex with your partner requires physical effort, stamina, and sometimes changing position.  All this can be very physically demanding and if your back is injured then are you doing a disservice to you and your partner. 

Dependence on… with Back Pain – Back pain can lead to dependence on medications, devices, routines which can sometimes help you but lets face it, if you are having low back pain, you likely do not have a routine that is working.  Many people will opt for the easy medication to dull their pain.  Depending on medication can be helpful at times but do you want to be that person that is known for carrying medication all the time?  What about the side effects of overuse?  Wouldn’t you rather just be healthy and pain free?  I am all for using whatever tools you need to get through your pain but depending on medication or anything for that matter can be a chore in itself.  

Those people who suffer from depression, anxiety and some other disorders are more prone to back pain!  The question begs does back pain contribute to declining mental thoughts or does poor mental thinking contribute to back pain?  Either way there is a link between mental conditions and lower back pain.

So What Are Some Things I Can Actually Do To Help My Lower Back Pain?

I know there are a lot of videos so my initial suggestion is to subscribe to my videos and bookmark this page! Do it now so you don’t forget!

Basically, there are way too many videos for you to get through all at once and not all of them area posted.

Exercise for Low Back Pain

When we talk about exercise we typically have to do a few things.  First thing is to take into consideration your goals, what you want to accomplish, do you play any sports, or are you just looking for pain relief?

Typically, we will start you out with proper breathing drills and doing any and all exercises that offload the structures.  This means we are talking pressure and irritation off of the lower back or nerve and allowing it to heal temporarily. 

Below are some of the best exercises we use for low back pain.

Best 3 Exercises for Back Pain (Big 3)

Easing Intense Sciatica?

Bird Dog Back Pain

Side Lying Opener

Sleep position to help lower back pain?

Breathing for a better back?

Reduce Back Pain In the Morning After Sleeping?

Exercise Ball for Back Pain?

Healing Back Pain exercises?

Easy Low Back Pain & Meditation Exercises?

Figure out what is hurting it and stop.

While this may seem obvious, you have no idea how many people are doing things they think are helping but are actually triggering their own pain.  Things such as getting up improperly, getting in and out of a chair or car, bending, or stretching improperly.  I have posted some of the most common problems I see regarding back pain below.

Getting out of bed with low back pain?

Low Back Pain While Sleeping?

Why You Shouldn’t Stretch Your Injury?

Why Hamstring Stretches Don’t Help Low Back Pain?

Low Back Pain When Getting in and out of chairs?

Low Back Pain when sitting?

Low Back Pain with dishes, brushing teeth, or other chores?

Why You Have Low Back Pain to Begin With?

See a PRO!

I love YouTube and articles but man, “It Depends” really means that everyone is different.  I have NEVER SEEN THE SAME PROBLEM TWICE!  Let me rephrase that, I have seen people with the same injury but people respond differently to different loads, exercises, times, treatments.  If you really want the best results, get a pro coach!  The best athletes, business people, etc have them.  You may not want them or need them forever but you will learn some skills that last a lifetime and it will help you get out of back pain faster.

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