The Joint Ventures' Blog

Treat Your Own Back

Monday, April 23, 2018

Today marks the start of a well-deserved vacation. At the airport, as you bend forward to lift your bag, your back quickly tightens up and your big week abroad flashes before your eyes. What do we do when our back starts talking to us?

As we have covered on this blog before, the pain experience is driven by more than just the quality of your tissues. In fact, with low back pain, very rarely is the issue with the tissue (1). The truth is, back pain, while never fun, is rarely dangerous. Most people will experience back pain at one point or another, and most individuals will be significantly better by 6 weeks. The best evidence even suggests that 33% of people with low back pain will have a recurrence within 1 year of recovering from their last episode. Back pain is a normal predicament of modern day life (1). A life without back pain is the outlier. Our thoughts and beliefs surrounding our back pain can influence the severity and duration of our symptoms. As you take stock of your symptoms, consider the big three presentations that would require further medical attention: physical trauma, changes in bowel or bladder symptoms, and progressive weakness and numbness associated with your leg. If these symptoms can be ruled out, the single best thing to do is to remain active (2). If you like walking, please keep walking. If you enjoy swimming, keep swimming.

Understanding the benign nature of back pain and remaining active will put you in a position to avoid persistent pain. But what about your vacation? You don't have 6 weeks to wait this out. For a large number of you, movement and exercise in one particular direction may be even more beneficial than simply staying active. If you notice your pain decreases while walking or sitting, or if you experience pain while rising from a chair, you may benefit from a particular direction of movement. Another key indicator that you may benefit from a particular direction of movement is an inconsistency in your pain experience. For example, rising from a chair, walking or rolling in bed only hurt some of the time.

To find your preferred direction, consider how/if your symptoms change with different movements and positions. If you are better with walking and sitting upright, try extension based exercises (back bending/cobra). If you are worse walking, but better sitting and slouching, try flexion exercises (knees to chest, sitting forward bends). If you are worse with both walking and sitting, you may need lateral movements to alleviate your pain (back bends with hips off center). Before jumping in and looking for a direction, please establish some mechanical baselines to refer back to after each set of exercise. For example, if you have increased leg pain into your calf with walking 20 feet, take note of the pain location and behavior during the walk and then recheck the walking after 10 forward bends. As a general rule, pain that moves away from the center of your back is an indicator that a different direction is needed. Pain that moves towards the center indicates you are moving in the appropriate direction.  But pain does not have to move toward the center to indicate that you’re on the right track; any improvements in your functional is also a good indicator that you have found your movement.

Of the individuals with a preference for certain directions, the majority will demonstrate a preference for extension exercises (back bend/cobra movement), while some demonstrate a preference for flexion exercises (forward bending) or lateral exercises (movement at the hips) (3). Individuals who exercise within their preferred direction experience significantly improved outcomes compared to both individuals who choose exercises opposite their preferred direction and individuals who were instructed to just "remain active" per the current best guidelines.

If you have questions, please contact our office at 617-536-1161 or email Greg Talbot PT, DPT at


1) What low back pain is and why we need to pay attention, Hartvigsen, JanBuchbinder, Rachelle et al., The Lancet, Volume 0 , Issue 0 

2) Low back pain: a major global challenge, Clark, Stephanie et al., The Lancet , Volume 0 , Issue 0 

3) Does it matter which exercise? a multicentered RCT of low back pain subgroups, Long, Audrey et al., The Spine Journal , Volume 4 , Issue 5 , S14



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