📖 DEEP DIVE

If you’re reading this, you’ve likely been battling back pain for awhile and it’s put your fitness goals on ice. You’ve probably been to different medical professionals, gotten lots of different opinions, and tried several treatments that didn’t work (or didn’t work for long).

Physicians give you pain meds. Surgeons say you need surgery. Physical therapists provide generic “stretches” and chiropractors only offer temporary relief that fades too quickly. 

If you’ve heard statements like "It's just part of getting older," "If it hurts, stop doing it," or "Back pain is normal," you’ve been misled.

I’m here to expose these myths and introduce a proven process that has helped hundreds of people just like you overcome chronic back pain and reclaim their active lifestyles.

The truth is, conquering back pain and reclaiming your life is 100% possible with the right approach.

Debunking Common Myths About Low Back Pain

Before we dive deep, let’s dispel some pervasive myths that may have shaped your understanding of back pain:

Myth 1: “It’s just part of aging—learn to live with it.”

Reality: Aging doesn't doom you to back pain. Staying active and maintaining muscle mass and cardiovascular fitness can significantly mitigate age-related physical decline.

Quick Tip: Incorporate activities like strength training, swimming or yoga to maintain mobility, cardiovascular fitness and strength without overstraining your back.

Myth 2: “Pain equals damage.”

Reality: Pain is a warning system, like an alarm–not necessarily a direct sign of injury. It alerts you to potential harm, which means sometimes the alarm is overly sensitive.

Quick Tip: Incorporate gentle, non-threatening movement and stay as active as possible to teach your brain that movement is safe and pain-free in order to turn the pain ‘alarm’ down.

Myth 3: “You need to stop if it hurts and rest completely.”

Reality: While rest can sometimes be necessary, complete inactivity weakens muscles and may worsen pain over time. Gradual, controlled activity is crucial for recovery.

Quick Tip: Start with gentle activities like walking or gentle mobility (more below) to keep your body moving and pain at bay.

When to Seek Professional Help

While back pain is very common, there are some rare instances where you'll want to involve a qualified medical professional right away. Seek medical advice if you experience:

• Severe, persistent pain that doesn’t improve with rest

• Pain that radiates down your legs, causing numbness or weakness

• Difficulty controlling bowels or bladder

• Pain accompanied by unexplained fever, chills, or weight loss

• History of osteoporosis, cancer, or significant trauma

For most cases of garden-variety back pain though, you won't need to rush to the doctor or skip the gym entirely. What you do need is a comprehensive approach that addresses the underlying causes of your pain.

Systems Approach to Solving Low Back Pain

Traditional treatments often fail because they only focus on symptoms rather than the system as a whole. Here’s how we approach back pain differently:

1. Environment: Could the real culprit be how you sleep or how little you move throughout the day? Improving these conditions could make your body less sensitive to pain. It’s like avoiding a cold by managing stress—similar rules apply for managing pain sensitivity in your low back.

2. Movement: Your body is built to move. But sometimes, your brain might flag a regular movement as problematic. It’s not always about a specific muscle or joint; it’s about teaching your brain to map movements differently, understanding that you can move without pain.

3. Joint Function: If your upper back is stiff, it might be throwing your lower back out of whack. And tight hips? Definitely a factor. Improving how your joints function can make a huge difference in how you feel.

4. Muscle Function: Are your muscles tight, under-functioning, or just not communicating well with your brain? Addressing these issues is key because tight or poorly functioning muscles can send pain signals to your brain that something’s amiss.

5. Myofascial Systems: Your body should move smoothly, like silk sliding over steel springs. But if tissues get stuck, it can feel more like sandpaper than silk. Working on these myofascial systems can help send soothing signals to your brain, easing the pain.

By tackling all these systems together, we don't just aim for quick fixes but for lasting relief. It’s not just about dialing down the pain today—it’s about recalibrating your body’s systems to handle what comes tomorrow, next month, even next year.

Managing Your 'Stress Cup'

Your body’s reaction to pain isn’t just about physical strain; stress plays a huge role too. Imagine your body's tolerance for stress as a small cup: everyday stressors fill it until it overflows, manifesting as pain.

Flare-ups can happen even if you didn’t “do anything,” often because your body isn’t handling the stressors being placed on it. 

To manage pain effectively, consider:

• Reducing Load: Remove some stressors to lower pain levels to keep the cup from overflowing.

• Building Capacity: Increase your tolerance to handle more stress so you have a ‘bigger cup.’

This dual approach helps manage and reduce back pain sustainably.

The Treatment Model: Relieve, Restore, Prevent

Our treatment model is straightforward—RELIEVE pain, RESTORE function, and PREVENT future injury:

• Relieve Pain: We use gentle movements and breathing drills to reduce pain sensitivity.

• Restore Function: We focus on mobility exercises to restore normal function of your spine, hips & surrounding structures.

• Prevent Injury: By adjusting movement & lifestyle habits, we help safeguard against future issues.

For best results, here’s what to expect:

• Relieve pain: 5 minutes of daily breathwork to calm pain signals.

• Restore function: 5-10 minute daily mobility sessions to restore function & mobility.

• Stay active: 20-30 minutes of walking each day to maintain mobility and reduce pain sensitivity.

• Sleep well: Improving sleep quality & duration to aid recovery and reduce pain.

Follow this plan diligently for two weeks, then adapt the techniques that benefit you into a daily mobility routine.

Relieve

In the first step of our process, we focus on RELIEVING pain through gentle, specific movements that calm your nervous system and dial down the pain signals. You won't find any standard lower back or hamstring stretches here; instead, we've curated a set of techniques that have proven most effective for the vast majority of our clients.

A key element of this phase is practicing specialized breathing techniques. These are designed to reprogram how your brain interprets pain, helping you move more comfortably and setting the foundation for lasting relief.

Breathing to relieve pain

When you’re in pain, often the last thing you want to do is move. By starting with breathing, we can get some gentle, pain-free movement of your spine and calm those pain signals down. This is where we start with all of our clients who come to us with low back pain.

Rx: practice this for 3-5 minutes per day.

Spinal segmentation

Now we want to get the muscles of the spine moving and working again in a non-threatening environment. Work through your full range-of-motion here, just make sure to keep it pain-free.

Rx: when in pain, 10-20 reps 2-3x per day

Walking

When people are in pain, the first thing they do is stop moving, which often only compounds the problem and increases your sensitivity to movement.

Instead, we want to get as much gentle, non-threatening movement as possible to turn those pain signals down. 

Rx: walk for 30 minutes per day; can be split into multiple short sessions, but aim to accumulate 30 minutes per day

Restore

The next phase of our process is to RESTORE normal function to your lower back, hips, and surrounding structures.

This stage includes targeted mobility sessions designed to be completed in sequence. Aim for 10-20 minutes of focused activity per day, spread across multiple short sessions for optimal results. After progressing through all the techniques, incorporate those that were most beneficial into your daily routine for sustained improvement.

Gut Smash

Part 1:

Part 2:

Part 3:

Tool: Coregeous Ball

Rx: 3-5 minutes total

QL Mobilization

Tool: Alpha Ball

Rx: 3-5 minutes per side

Couch Stretch

Rx: 3-5 minutes per side

Prevent

When pain interrupts your active life, it's tempting to focus solely on the quick-fix. However, this often overlooks essential long-term strategies to prevent recurrence. Our initial approach with clients experiencing pain involves identifying potential contributing factors, such as stress, increased activity levels, or even new footwear.

The spine is a complex structure, and understanding the root cause of pain is as crucial as addressing the pain itself. A key focus is on sleep, due to its significant role in the body’s recovery processes.

Additionally, we utilize an "After Action Report" with our clients. This strategy helps identify behaviors or conditions that may have triggered the pain, moving beyond mere treatment to learning from the episode to prevent future occurrences.

Sleep

If there's one strategy paramount to combating stress and systemic inflammation, it's prioritizing quality sleep. Even brief periods of sleep deprivation can trigger a systemic inflammatory response, impair brain function, and heighten pain sensitivity.

Research consistently links poor sleep quality and short sleep duration to an increased risk of chronic pain. Moreover, sleep deprivation can negatively impact body composition. A study found that individuals limited to 5.5 hours of sleep per night experienced a 50% greater loss in muscle mass and a lesser reduction in fat compared to those who slept fully, despite consuming identical calorie amounts.

Sleep forms the cornerstone of effective health and stress management. The belief that one can function optimally on just 4-5 hours of sleep is a misconception. Prioritizing adequate sleep every night is crucial for overall well-being.

For practical tips on improving sleep, check out this Twitter thread I compiled:

Morning Recharge

Just like brushing your teeth is important to maintain dental health, “brushing your spine” regularly is important to maintain spinal health. Once your pain is under control, we recommend sticking with a consistent daily mobility routine to keep everything moving & functioning well.

After going through the above techniques, identify the ones that were most helpful for you. Incorporate these into a Morning Recharge—a concise 5-minute mobility routine designed to start your day right, as discussed in a previous issue. 

This routine will help keep your spine and surrounding structures mobile and pain-free.

TL;DR: How To Fix Low Back Pain For Good!

There you have it: a strategic game plan for regaining peak gym performance and taking control of your low back pain! Keep these strategies in mind:

First, ensure there are no serious medical issues behind your back pain and stiffness, but avoid jumping to dire conclusions for common symptoms.

Second, maintain an active lifestyle—it's essential to keep moving to enhance blood flow, aid recovery, and reduce pain sensitivity.

Equally crucial, manage your 'stress cup' effectively. Make sure it's not brimming over due to inadequate sleep, poor hydration, insufficient nutrition, or too much sitting. Often, persistent pain is exacerbated by these lifestyle factors.

Once your condition improves, reintroduce your fitness routine gradually to prevent any new flare-ups. Jumping back into intense activities too quickly can lead to setbacks, so pace yourself and focus on long-term recovery.

With this back-to-basics approach of relieving pain, restoring function, managing strain, and progressing gradually, you’ll reclaim the active, high-performance lifestyle you love in no-time!

That’s all for today!

Keep moving,

Dr. Matt Longfellow PT, DPT, SCS, SFG II