Low Back Pain

The causes of low back pain are complex and multi-factorial, meaning there can be multiple contributing factors. Let’s explore the science…

Low back pain (LBP) is one of the most prevalent medical complaints, 7.5% of the global population suffers from it at any given time. Experiencing back discomfort can impact one’s quality of life, interfering with favourite recreational activities, daily routines, and ability to work productively.

LBP is defined as pain, muscle tension, or stiffness localized below the rib margin and above the inferior gluteal folds (bottom of butt cheeks), with or without leg pain.

Picture obtained from Breathe Education Clinical Pilates Diploma lectures, 2022.

For prognosis and outcome purposes, LBP is described as either:

• Acute where the pain has been around for less than 6 weeks

• Subacute where the pain has been consistent for 6-12 weeks

• Chronic where pain lasts longer than 12 weeks

For Acute LBP, there are two events that cause it:

1) Trauma: where you had a severe accident that caused damage to the tissue

2) Too Much Too Soon: where you loaded your muscle without progressively overloading it, like moving day where a person who doesn’t normally exercise carries heavy boxes for 12 hours straight and has overloaded the muscle.

The good news with Trauma and Too Much Too Soon injuries is that most bodies heal within normal tissue healing times. Muscles heal within 3-6 weeks, bones heal within 6-8 weeks, and joints within 12-18 months. You can lightly load healing tissue around the 7 day mark, but most likely you can begin simple movements within a couple days (examples of simple exercises pictured below).

Chronic LBP is a little different.

There are three causes of chronic LBP:
1) LBP associated with specific spinal cause (cancer, fracture, infection, ankspondylititis)
2) LSP caused by radiculopathy (nerve pain) or spinal stenosis
3) Non-specific LBP

The first two are fairly rare, with 90% of all chronic back pain being non-specific LBP, making it the leading cause of back pain. Non-specific LBP is caused by many factors.

A few of the most common:

• lack of sleep

• worry

• low physical activity

• tissue status

• poor nutrition

• increased stress

• lack of social support

The Cup of Resilience is the perfect metaphor to describe long term pain issues. Your body can only handle so much for so long until it becomes overloaded. Using the imagery of an overflowing cup, we then can become over sensitized to pain - feeling pain all over or in a specific area.

Photo from Dr. Greg Lehman's website, a pain specialist, link in resources

There is a way out of chronic LBP.

If we can find a balance of stress, physical activity, and healthy eating habits our cup will not over flow. Plus we begin to build a bigger cup.

My favourite way to reduce chronic pain is through nutritious eating and focused controlled movement (like Pilates!), where relief from stress is a natural by-product. Visiting a physiotherapist is also highly recommended to receive a clear diagnosis and treatment plan.

For movement, luckily we have very thorough exercise testing and prescription guidelines based on years of solid research. In Canada and United States we use the respected American College of Sport Medicine’s (ACSM) guidelines.

ACSM’s Guidelines for Low Back Pain

✓ Move your body within your pain tolerance, and limit certain exercises that seem to make symptoms worse. If you perform a movement and it hurts outside of your personal pain tolerance don’t do it. If you perform a movement and it doesn’t hurt continue with it. Expect to feel discomfort, but again within your personal limits. This is very individual and may need to be explored and changed often with your certified movement specialist/trainer.

✓Progressive low grade to moderate aerobic exercise helps relieve symptoms, eventually high intensity is allowed once symptoms lessen within your pain tolerance. Caution with walking downhill as it seems to aggravate LBP in older adults. Walking on incline is beneficial.

✓Flexibility exercises are encouraged (with hip and low limb emphasis).

✓Repeated movements have been shown to help with pain - called Directional Preference. This means if you find forward folds reduce symptoms, it is beneficial to consistently do forward folds every day 3 times per day. It’s not really about a certain exercise per say, its more individual to each person. Directional Preference is connected with your neural pathways, similar to the effects of self-massage via balls and foam rolling.

Types of movements shown to relieve LBP, especially sciatica:

Picture obtained from Breathe Education Clinical Pilates Diploma lectures, 2022.

If currently experiencing LBP, here is a quick 3 minute guided workout of five gentle movements to help provide temporary relief.

If experiencing any pain, I always highly recommend visiting a physiotherapist. And then working under the guidance of your physio, we can modify your movements in your classes here at the studio.