Contents:

About the Author Justin Thompson Page 2

About This Report Page 2

Facts About Back Pain Page 3

Standard Treatment for Back Pain Page 3

Causes of Low Back Pain Page 4

When To Rest and When To Move? Page 4

Self Treatment Ideas Page 5

Chronic Back Pain Page 7

Now What? Page 9

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 About the Author

Welcome to Thompson Physical Therapy! My name is Justin

Thompson, and my goal is to help you ​understand your pain and
​take an active role in your recovery​​. I received my Doctor of
Physical Therapy degree from the University of Florida, and
completed my Certified Manual Physical Therapist education
through the Florida Institute of Orthopedic Manual Physical
Therapy. I believe in taking an active approach to decreasing pain
and improving function. I do this through education, manual
therapy, and giving my patients the tools they need to treat
themselves.

About This Report

Congratulations!​ You have made the first step to helping resolve your back pain by taking
action and seeking out a solution. I commend you for taking this step as it is usually the hardest
to take. We are all busy people, and we sometimes let our health take a back seat to the hustle
and bustle of daily life. So if you have been suffering with back pain for the last 24 hours or for
the last 20 years, you have gotten over the first hurdle of freeing yourself from the grip of pain:
​starting!

In this report, I will go over a few facts about low back pain including types, causes, standard
treatments, best practices, and steps you can take to get back to feeling your best ​FAST!​ ​I
make no guarantees that this will solve all your low back pain as you may need specific
evaluation and treatment by a pain and movement performance professional that is
catered to your particular needs.

My goal for this report is that you will find value and ​gain an understanding of your back pain​,
and take away a few things that you will be able to implement into your daily routine to help fight
pain and take back your life. You deserve to be able to do the activities you love without the
physical and emotional distress that back pain can bring. ​Thank you for trusting in me to
start your journey back to the pain free lifestyle that you enjoy!

-Justin

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 Facts About Back Pain

-Back pain is one of the leading causes of going to a primary care physician

-Most back pain is​ ​NOT​ serious

-Most people will experience an incidence of low back pain in their lifetime​ (about half will
experience it again within a couple years)

-Most acute low back pain resolves within a few days

-When you have low back pain, it is important to​ be ​proactive​ and begin treatment ASAP

-Your spine is designed for controlled movement (​​so move!​​)

-Those who remain active through back pain tend to cope better than those who just rest

Standard Treatment for Back Pain

The traditional western approach to low back pain typically involves medications (pain killers,
muscle relaxants), imaging, and injections. If the pain continues, then surgery is often another
option that is considered. There are a few ​dangers​​ with this standard of care.

You may have heard that there is an​ epidemic​ occurring of ​dependence on pain medications​.
These medications can be ​highly addictive​, and actually make pain worse when you try to go
off of them after long term use. This can lead to obvious ​health concerns as well as
​increased cost of healthcare​ across the country.

Similarly, expensive imaging is often unnecessary as it can also contribute to rising healthcare
costs. It has also been shown that imaging of the low back is very ​poor at figuring out the root
cause of the problem​. This has been shown in studies where perfect MRIs belong to people
with back pain, and MRIs showing severe disc degeneration or herniated discs belong to people
with no pain at all.

Finally, in terms of medication and injections, these merely ​mask your pain​​, but frequently don’t
address the root cause of the problem. And as mentioned before, they can actually​ ​make your
pain worse due to increasing the sensitivity of the nerves​ in the body​.

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Surgery should only be a ​LAST RESORT​ after all conservative treatment has been exhausted!
Even so, many of the surgeries that are performed are about 50/50 success rate. I don’t know
about you, but I am not taking my chances with the odds looking like that!

Causes of Low Back Pain

The spine is extremely strong!​ Made of solid blocks, and reinforced by strong ligaments and
muscles, our spine was meant to withstand a lot of of stress.​ ​However, as our culture
becomes less active and more overweight it can lead to a lot of discomfort.

As mentioned before, an MRI or x-ray may not be able to identify a specific cause of the
discomfort that you are having, and this can be very frustrating. Since our spines were ​meant
to move​​, it is often due to a lack of mobility, increased sitting, and poor posture that we develop
aches and pains in our back.

There are pathoanatomical reasons for low back pain such as spinal stenosis, herniated discs,
lumbar strain, SI joint dysfunction, sciatica, and lumbar instability. There are also postural
dysfunctions such as anterior or posterior pelvic tilt, which places the spine into suboptimal
positions.

So what is the solution? What did we do before there were cars, and TVs, and cell phones that
keep us sitting on our back sides. ​We moved! We worked! We played!

​THE KEY IS MOVEMENT!

When to rest and when to move?

Total bed rest used to be suggested for low back pain. We know now that​ ​more than a day or
two of immobility can lead to stiffness, weakness of muscles and bones, decreased
fitness, mood changes, and even increased pain.

It just doesn’t work! Obviously if there is a spinal fracture or something serious then the rules
change, but for most back pain ​movement​​ is going to be a​ ​necessary​ ​part of the recovery.

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Movement and exercise help keep muscles and joints strong and mobile by maintaining blood
flow. Weight bearing maintains strong bones. ​Chemicals which inhibit pain​ perception are
released into the body when we exercise (same as the “runner’s high”).

The sooner you can start moving again, the sooner you will begin feeling better overall and
prevent pain from becoming a chronic condition (which is much more difficult to manage).

Self Treatment Ideas

So let’s say you have a flare up of low back pain. Suddenly you are stiff, sore, hurting, and you
can’t do the things you want to do. What is your approach? Lay in bed for the next week and
hope that the pain just goes away? Or do you actively try to attack it and ​make it go away ​on
your terms​​?

A little disclaimer here: ​ DO NO HARM!​ If you hurt your back lifting a 100 lb sandbag, don’t go
lifting 100 lb sandbags the next day for the sake of “being active.” A little common sense goes a
long way in active management of your pain.

Instead: go for a walk, go swimming (or pool walking), or ride an exercise bike, and continue
with most of your daily routine. There may be some temporary modifications you have to make
in order to not flare the pain up more, but for the most part ​keep things fairly normal​.

Use modalities such as heat or ice. A general rule of thumb when deciding when to use these
modalities: If the pain is sharp or intense, there is likely inflammation, so use ice to calm it down.
If the pain is dull, achy, or stiff, there likely needs to be an increase in blood flow, so use heat.

Quick test: Does your pain hurt more with ​flexion​ (bending forward) or ​extension​ (bending
backward)? Early on in your recovery, treatment will involve movement in the direction away
from the pain, then gradually work toward the direction of pain as it calms down. If it hurts to
bend forward, walk or swim as this puts your spine in an extended position. If it hurts to bend
backward, ride a bike or stretch forward so you are in a flexed position. If it hurts both
directions, then do small gentle motions forward, backward, and side to side within a
comfortable range of motion.

(Examples of tests and exercises are available below.)

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 Flexion test to determine directional preference
If you have pain with this test, then do extension based exercises
such as walking, or Mckenzie extension (below)

Mckenzie Extension- 5 second hold, 10 times

(Perform on elbows if full press up position is too much)

Extension test to determine directional preference

If you have pain with this test, then do flexion based exercises such
as cycling, child’s pose (below), or forward flexion stretch

Child’s Pose- 5 second hold, 10 times

(Perform sitting in chair and touching toes if you have pain in knees in this position)

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Breathing exercises can also help calm pain, as it slows the heart rate, decreases stress
hormones, reduces lactic acid in the body, and moves the diaphragm ​(which attaches to
the lumbar spine and rib cage). Try this exercise either sitting or lying on your back comfortably.
Inhale for 3-5 seconds taking air in through your nose ​(your belly should rise before your
chest​)​, hold for 3 seconds, exhale for 6-10 seconds. The hold allows for gas exchange in the
lungs, and the longer exhale makes sure you are ridding your body of the waste product carbon
dioxide. Breathing deep into your belly instead of your chest ensures that you are using your
entire lung rather than just the upper half!

Watch this video for demonstration of diaphragmatic breathing. See the belly rise and fall, but
the chest stays stationary.
https://youtu.be/exNzkvgnXyI

Finally, ​think positive!​ If you believe your back pain will limit you severely then it may do so,
even though it doesn’t need to. If you think that your pain is just a temporary limiting factor, and
it won’t keep you down forever, then you are off to a good start.​ ​Attitude is everything​ ​when
you face trials in life. ​

Chronic Back Pain

Chronic back pain is a different animal on it’s own. If you have had pain for​ ​longer than 3-6
months​​, then the pain you are feeling is likely no longer due to damaged tissues of your back
(muscles, ligaments, discs). Most tissues heal themselves prior to this 3-6 month time period.
So what causes the constant discomfort of chronic pain?

Let’s look at the definition of pain according to my good friend Merriam-Webster.

Pain:
1.​ usually localized physical suffering​ associated with bodily disorder (injury); a basic
bodily sensation induced by a noxious stimulus, received by naked nerve endings,
characterized by physical discomfort, and typically leading to evasive action
2. acute ​mental or emotional distress​​ or suffering

In summary, pain is defined by​ physical or emotional experience of suffering​​. In chronic

pain, the physical and emotional can become one and the same. When physical pain
increases, it causes emotional distress. If an emotional event occurs in life, it can exacerbate
physical pain. It is an endless cycle, which is why chronic pain is so difficult to manage.

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Also, chronic pain is characterized by pain occurring ​disproportionate to the stimulus. The
brain is not interpreting the stimulus properly, and is creating a perception that is not normal for
for the stimulus. We intuitively know that bending over to tie your shoes should not be a painful
activity. But for someone in chronic pain,​ the threshold for discomfort is much lower​​, and it
takes very little to set off the perception of pain.

Finally, the definition stated that pain is​ “usually localized.”​ However, in chronic pain the
discomfort can become ​diffuse​​, covering a wide area of the body, including ​areas that were
never injured​ in the first place. Again the brain is developing new neural pathways which poorly
represent the actual stimulus. Proof that the issue is not always in the tissues!

Another disclaimer: I understand that those with chronic conditions hear the phrase​​“the pain is
in your head”​ and they want to hit me. When people say that, it is often a dig at the patient
which implies that they are making it up. Let me reassure you...​THE PAIN IS REAL!​The brain
is just interpreting things in a way it wasn’t meant to.

Fortunately, ​chronic pain can be treated!​ Manual therapy can be used to decrease the
perception of pain in the body. Comfortable exercise can then train the nervous system and the
brain to raise the threshold at which pain is experienced. And an understanding of “hurt doesn’t
necessarily equal harm” can immediately reduce the emotional side of chronic pain because
you become less worried about damaging the tissues in your back.

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 Now what?

I hope this information was helpful and allows you to understand your pain a little better.​ ​This is
obviously not all encompassing, as each person has their own individual nuances
surrounding their pain.

If you still have questions concerning your back pain, please seek out a pain or movement
professional as soon as possible to more specifically assess your needs.

If you would like to speak with me about your back pain, but you aren’t quite sure if physical
therapy is right for you, I would love the chance to meet you for a discovery visit at my office or a
brief phone call so I can better explain what you can expect to achieve ​(​pain relief!​)​ by working
with me.

Dedicated to serving you,

Dr. Justin Thompson, DPT, CMPT

Back Pain Specialist
justin@thompsonphysicaltherapy.com
www.thompsonphysicaltherapy.com
(352) 281-9660