Low Back Pain and Low Hanging Fruit
Dr. Molly Pierson, PT, DPT • March 11, 2025
Low back pain: What is it and what steps can I take to improve it?
Low back pain is one of the leading causes of disability worldwide, and millions of individuals of all ages suffered from back pain in 2020 (IHME, 2023). It can hinder people from performing daily activities, working, and enjoying a good quality of life. While many instances of low back pain do resolve with proper care, including PT, a significant number of individuals experience chronic low back pain that lasts for weeks, months, and even years. While many believe low back pain is predominantly a musculoskeletal issue, it can also have a huge impact on your social life, mental health, and even have economic consequences from the limitations and restrictions it can create in your daily life.
Low back pain is defined as pain in the lower part of the spine. It can range from being mild to severe in intensity and range from being acute, lasting a few days to a few weeks, to severe, lasting more than three months. There are many factors that can contribute to the severity of the pain, including factors that are modifiable and nonmodifiable. Nonmodifiable factors include our age, past medical history of back pain or other injuries endured that cause pain, and our genetics. Modifiable factors include occupation, increased body weight/obesity, lack of quality and quantity of sleep, increased stress levels, poor activity level or sedentary behavior, and poor eating habits.
While it is not as easy to change our occupation or age, we can make other adjustments to help improve our pain and therefore, quality of life. Many of the modifiable factors listed above pertain to our behaviors and over wellness, which often have a big impact on our pain and symptoms, severity of discomfort, and even our perception when it comes to addressing our aches and pains. Taking the time to improve these modifiable factors can often help to alleviate the severity of the pain, and help people get back to living a more meaningful life.
You can do this by:
- Aim to get 150 minutes of moderate intensity exercise throughout the week.
- This will improve activity levels throughout the day and increase blood flow throughout the body.
- Walk frequently throughout the day
- Increasing activity levels will help to reduce sedentary time as well as static positions. Posture is often questioned as being a contributor to pain, however, the duration of a position is a bigger cause of discomfort.
- Reduce screen time up to 30 minutes to 1 hour before bed and aim for 7-8 hours of sleep
- This can help to improve the quality of sleep, all and allow the body to recover from stress the day before.
- Work on managing stress levels with meditation, therapy, journaling, and more exercise!
- Mental health and stress are often big contributors to pain and can often worsen symptoms. Taking time to improve this area can often help alleviate symptoms as well as perception of pain.
- Lastly, aim to focus on consuming 1 gram of protein per lb of body weight and consuming whole foods
- Sugar and alcohol can often be irritants for pain, and can exacerbate symptoms.
References
https://www.healthdata.org/news-events/newsroom/news-releases/lancet-new-study-shows-low-back-pain-leading-cause-disability
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Typically, once people get into their 3rd trimester of pregnancy, they focus on winding down, resting, and focusing more on stretching. While stretching is helpful, there is more you can do in your 3rd trimester to better prepare for labor, delivery, and recovery after childbirth. Birth prep physical therapy during the third trimester (weeks 28–40) focuses on helping the body prepare for labor and delivery, relieve discomfort, and support postpartum recovery. Here's what it typically includes: Optimize Pelvic Alignment & Mobility Encourages smoother fetal positioning and reduces chances restrictions from your pelvis and surrounding structures. This can include incorporating different positions to help open up different areas of the pelvis, which allow for a smooth transition as the baby moves through the pelvis. Reduce Pain & Discomfort Targets low back pain, pelvic girdle pain, sciatica, and round ligament pain as the baby continues to grow. Diaphragmatic breathing to help manage labor pain and regulate intra-abdominal pressure Prepare Muscles & Tissues for Labor Pelvic floor coordination and perineal mobility can ease labor and reduce tearing risk. Learning to engage abdominal muscles to assist with pushing. Gentle core exercises for transverse abdominis support. Empowerment Through Education Helps you understand pushing mechanics, breathing techniques, and labor positions. This can include: Pelvic Floor Work Focus is on coordination between diaphragm, pelvic floor muscles, and abdominal Learning how to relax the pelvic floor (just as important as contracting it). Gentle perineal massage techniques (usually after 34 weeks). Postural Adjustments & Alignment Body mechanics for daily life (getting out of bed, lifting other children, etc.). Pelvic tilts, cat-cow, and modified squats to maintain mobility. Laboring positions and strategies for fetal positioning Practice labor positions using birth balls, stools, or partner-assisted techniques. Learn strategies for optimal fetal positioning (like Spinning Babies techniques). Manual Therapy Myofascial release, sacral mobilization, and soft tissue work to relieve tension. Addressing hip or SI joint pain. Ultimately, birth prep is tailored to the needs of the mother and her goals when it comes to her birthing experience. The items listed above are just a snapshot of techniques that can be incorporated into sessions to help one become more educated and aware of what the birth experience may encompass, as well as address aches and pains along the way.
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There are three primary categories to classify joint mobility: normal mobility, hypermobile, or hypomobile. Hypermobile joints are classified as those that exceed the normative range of motion values. While being extra flexible sounds advantageous, it also requires increased strength and coordination through a larger than usual range of motion. When considering the stability of a joint, there are passive structures such as the shape of the bones, ligaments, joint capsules, labrum and bursa which help the joint maintain its alignment without muscular activation. Dynamic stability of a joint comes from the nervous system working together with our muscles to create smooth and efficient movements. With hypermobile joints, we can work to protect them by improving their dynamic stability through their large range of motion to help reduce risk of injury. Joint hypermobility is also a common presentation in patients with genetic connective tissue disorders such as Ehlers-Danlos Syndromes. Some patients with EDS may experience frequent subluxations, sprains and dislocations due to the instability of their joints. Because of the compromise to their passive stabilizers, sometimes patients with EDS will present with complaints of muscular tightness that truly are stemming from decreased muscular flexibility, as the muscles have been essentially working double time to create stability. A common complaint I often hear from patients is “feeling tight.” But when we check their active and passive range of motion and muscular flexibility, their mobility is above average. Instead, their symptoms of tightness are often caused by muscular weakness, poor endurance, or suboptimal coordination. One treatment strategy I like to try is dry needling with electrical stimulation for pain modulation and improved activation of the targeted muscle’s motor unit, followed by neuromuscular stabilization and strengthening activities to provide long term benefits. Although joint manipulations and stretching feel good at the moment, these treatments are essentially reinforcing excessive mobility in already hyper flexible joints. As Uncle Ben warned Peter Parker (aka Spider Man), “With great power comes great responsibility.” If you have the superpower of being extra bendy, then take into consideration the increased demand on your neuromuscular system to keep your joints stable, and train accordingly! Dr. Rebecca Acevedo, PT, DPT - Holly Springs, NC Physical Therapy
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