Virtually everyone has had lower-back pain at some point, but some people struggle with it regularly. If you are struggling with recurring pain, you should probably see your doctor for a physical exam, but let’s also try to approach lower-back pain in a way that could help you right away.
People commonly experience lower-back pain after strenuous activity, including bending over or lifting things, or they have an ache that worsens after prolonged sitting or standing. Sometimes, people will not know why their lower back started to hurt, but will notice that the pain seems to have been triggered by a simple movement: even reaching up to grab a cup out of a cupboard.
I have seen sudden low-back pain that has put people on the floor and brought them into the emergency room because they couldn’t move. It’s very common to think that something might be seriously wrong with your spine if your back hurts so much. This is rarely the case, though, unless you have experienced a high-velocity trauma like being hit in the lower back with something hard or have been in an accident like a motor vehicle collision.
Sometimes, if there was heavy lifting, it is possible that something more serious could be going on, like a disc “herniating,” which means slipping out of place, but most of the time these pains are likely mechanical or muscular, and your pain is due to your muscles being in spasm.
Think of the spine as several bricks that sit one on top of the other. These bricks have softer discs between them, like stiff cushions, but they also require all sorts of small but mighty muscles to connect them. Many of these muscles interlace around the spine to hold it together. Suppose the muscles are either not strong enough, or are tired due to recent activity: in that case, there may come a time when they have been “hanging on” for long enough that any further movement or strain, literally “the straw that broke the camel’s back,” will cause the muscles in the lower back to seize up. This last effort to save your lower back from slipping out of place leaves the muscles aching and hurting.
I recommend that you do something about this pain immediately and not let it affect how you carry yourself and walk. What you should not do is rest for a while, hoping it will get better, whether by lying in bed or minimizing your movement. The sooner you get moving normally, the sooner you will feel better. Some people are concerned that taking medication will mask the pain in a way that could be harmful. What is more harmful, in my opinion, is letting the pain get ahead of you and changing the way you move.
With the type of mechanical back pain that I have described, the kind that takes place without trauma and is fairly sudden in onset, I recommend you think about muscle relaxants. Over-the-counter muscle relaxants like methocarbamol, which, where I live, goes by the brand name Robax, can be very helpful to help those muscles ease up and give you some pain relief right away.
There are also prescription medications like baclofen and cyclobenzaprine, for which you need to see a doctor. Sometimes doctors will provide prescriptions or repeats in advance for people with chronic lower-back pain so they can tackle their pain immediately if it ever flares up. Usually, these medications are taken three times a day. If you have not taken them before, you should start with lower doses, even half a tablet, just in case you are one of the few people who experience dizziness or lightheadedness with these medications.
Please do not consider these medications a long-term treatment for lower-back pain, but think about them as something you should take for at least a few days if you are going through a back pain flare. If these medications don’t work on their own, or you cannot tolerate them, keep in mind that over-the-counter acetaminophen or over-the-counter anti-inflammatories, like ibuprofen or naproxen, can also provide pain relief.
Sometimes, if needed, your doctor may prescribe stronger pain medications like opioids to help you get through the tough part, but this is not that commonly required.
In any case, once you get some pain relief that lets you start to move more normally, the sooner you can return to normal activities and the sooner you will be able to continue those activities without any medication at all. Although, you may still want to avoid any heavy lifting or frequent bending.
The more complicated part for people is finding a way to prevent these lower-back pain episodes from happening repeatedly, as some people may deal with this problem over months or even years.
It is generally a good idea to see some sort of practitioner: a physiotherapist, or a chiropractor, or even a personal trainer, to try to help you strengthen your core muscles and your lower back with some sort of weight-bearing exercise. Many people in our society are inactive, and do not spend time keeping their bodies strong. But strength training is an essential strategy for preventing injury in the long run and improving daily well-being.
If all of this is a bit overwhelming, do consider walking as a great first step! Walking will strengthen your core, and the longer you walk, the better. Consider watching another video I have recorded about proper footwear, to ensure you are preparing yourself well for longer walks if you are not used to them.
Another thing that any exercise will do is improve your mood, and I find it helpful to consider the psychological side of this kind of “chronic” pain. Pain does not just exist in the part of your body that hurts: it’s your brain’s specific response to a danger signal it has received. As such, the pain that you experience may very well be affected by movement and manipulation of your lower back, but it will also change depending on your mood. It will even be affected by your attitude about your pain. This may sound strange, but it is a fairly common experience that people have in certain scenarios, such as giving birth to a baby or experiencing a sudden accident: some people may find a certain level of pain unbearable, while others might seem not to notice it at all. None of this means that the pain you might be experiencing isn’t real, but it does mean that it cannot be dealt with just by focusing on that part of the body.
There is a practical strategy that I would like to share with you for preventing recurrences of lower-back pain that comes from an inspiring leader in this area, Esther Gokhale. Her Gokhale method is taught worldwide, and I was fortunate enough to meet her at a conference many years ago and learn about the importance of posture, especially when sitting. Please take a look at her website and consider signing up for her newsletters, which are really informative with regard to different ways of looking at lower-back pain and posture. Interestingly, she even gets into many specific activities like bicycling, riding a horse, and even playing the guitar, all with a view of performing these activities with the right posture. I will describe the basic principle here, but I refer you to her website and books for more details.
The simplest way I can describe her message is to say that we often sit on our tails. I know we don’t have tails, but if we did, they would probably arise from the top of our buttocks at the buttock crease. Imagine, instead of sitting down on that part of your lower spine, you were to stick it out and behind you, and you might be able to picture your pelvis tilting forward in order to do this. You may also find that you need to sit a little bit forward in your chair. This is hard to do in any seat that has a bit of a bucket shape to it, as in many cars, but if you can stick that tail out and tilt your pelvis forward, you will be able to feel a curve in your lower back, enough that you could place a small cushion there. Esther Gokhale calls this the J curve, which is a critical part of setting up your lower spine to support the rest of the spine safely and securely. With that curve to the lower spine, the upper spine will be straight if you keep your chest out and your shoulders in. You may notice that doing this brings your head from a forward position, almost hovering in front of your body, into a straighter position, where your head sits above your body. I have found this to be an incredibly rewarding way to eliminate and prevent lower-back pain: not just for me, but for so many patients with whom I’ve shared this strategy.
What I found particularly helpful was using some small cushions, that I actually purchased from Esther Gokhale’s website, that can sit in my car and on my office chair to remind me to maintain that curve in my lower spine and stick my “tail” out.
Before I finish, I want to mention a few scenarios where there might be something more serious going on in your lower back.
A feature that often accompanies lower-back pain, and sometimes even happens without you feeling pain in your lower back, is shooting pains through one or both buttocks, often running down the leg or sometimes even below the knee and into the foot. This type of pain is common, and has many names, like sciatica, or a very long medical word called radiculopathy. These pains differ from the pain you would commonly feel in your lower back, and they tend to be classed as nerve pain. You should see your doctor if you are experiencing this type of pain, to make sure that they agree that it is likely arising from your spine.
Nerve pain is different from the usual pain we feel when we hurt ourselves, and is often hard to describe. Some people would describe it as a burning or tingling, and some even describe it as numbness, but the common feature is that this type of pain does not often get better with acetaminophen or anti-inflammatories, or even opioids. This is similar to the pain that someone might feel if they had shingles, to give you an example. If you have this pain for any length of time, even longer than a week or two, it may be the case that your doctor will offer you nerve pain medications. Nerve pain medications work differently than other pain medications in that they do not relieve pain immediately, but gradually reduce the pain over a period of weeks, once you find the correct dose.
Some features of nerve pain might actually indicate a problem in your spine that may require further intervention. If you have unrelenting shooting pain down your legs that is preventing you from being able to walk properly, you should definitely see your doctor as soon as possible.
If you are over the age of 50, we consider lower-back pain to be more serious, particularly if you have not experienced regular lower-back pain before. Experiencing pain while lying in bed at night is also considered a “red flag,” that often warrants further investigation.
If you are having problems emptying your bladder, or if you experience leaking from your rectum, these would be considered medical emergencies, and you should go to the emergency room. And if you are feeling unwell with your lower back pain, for instance if you are experiencing fevers, chills, sweats, or fatigue, you should see a doctor as soon as possible.
Thankfully, though, most of you will be able to use some of the strategies in this video to improve and manage lower back pain in a logical and step-by-step way, that will not only let you feel better sooner, but also prevent you from having to deal with lower-back pain as much in the future.
