Lower back pain is the number one cause people are not able to work. According to the World Health Organization, about 60-70% of all people will experience lower back pain at least once in their life.
Unfortunately, there is a lot of bad advice or even dangerous advice given to many people about lower back pain.
Also, a lot is not correct or even complete nonsense.
I’ll name a few here:
- Your lower back is dislocated
- Your lower back is out of place
- Your lower back is damaged
- Your lower back is out of line
- You have the lower back of a 70-year-old
- You should avoid bending or lifting
- Stop if you feel pain
I can continue for a while, but you’ll understand. I will explain why it is not true later.
These phrases do not help you to get better.
That’s why I wrote this page: I want to show you what is causing your lower back pain and how you can treat it yourself. There is a difference between nonspecific lower back pain and not knowing what is causing your lower back pain.
I’ll teach you what an MRI can tell you, and what it doesn’t tell you. I’ll also show you why medication or surgery is not a long-lasting solution.
Except for some cases.
I will also teach you how to regain control over your back pain to restore the life you want to live. The most important thing here is to take away the fear of your back problems.
To do that I’ll explain a little bit about how pain works. Pain does not equal damage.
I’ll show you how to train core stability in the right way.
It’s all possible if you get faith in it again. That’s what I want to give you back.
Lower back anatomy
So first I’ll explain a little bit about how your back is built and what happens when you bend forward or backward. I’ll also explain common MRI findings and why they don’t explain your pain.
Your back is formed by five vertebrae. They are stacked on top of each other and formed to be a perfect fit. They fit so good that there are only a few degrees of movement possible on each level.
As you can see in the picture, a lot needs to happen before your “back gets out of line.”
You can imagine that this causes all kinds of nerve damage and ruptured muscles, which is not the case.
The vertebrae are covered with cartilage to protect the bones and absorb forces. Intervertebral discs are placed between these vertebrae. This intervertebral disc is usually filled with water. Their role is also to absorb the forces that work on your spine.
This is held together by your joint capsule.
Furthermore, you have two types of muscles in your back. You have small muscles like the multifidus muscle that runs from vertebra to vertebra. Their function is to prevent your vertebra from sliding forward about the underlying vertebra when moving your back.
The second group of muscles runs along your entire back. Their function is to move your back and keep it upright when you stand.
As you age, the cartilage and vertebral discs wear slowly. How fast this goes depends on person to person.
We know however that MRI findings don’t match with the pain people feel.
In a study conducted in 2016, they found that MRI findings people associate with back pain are just as prevalent in people without back pain. These are not factors that will predict your chances for recovery.
I explain more about that here.
This also means that operating to solve these findings will not help you.
The only time an operation is indicated is when you have pain and loss of muscle strength for more than three months without any improvement or when you experience loss of bladder control in combination with back pain.
These are symptoms for severe back pathology and could require surgery.
But if you have no radiating pain or bladder problems, surgery is never indicated. A herniated disc or bulging disc on an MRI without radiating pain is not an indication for surgery.
There are however factors that do affect the recovery of your lower back pain.
I will now discuss these factors.
Prognostic factors for lower back pain
Prognostic factors are factors that influence your recovery.
In a study conducted in 2010, they found 12 factors that impact your recovery of lower back pain negatively.
You can find the findings right here:
|Back pain related factors||A high amount of pain and disability|
|Duration of the pain|
|Individual factors||Older age|
|Poor general health|
|Psychological factors||Psychological and psychosocial stress|
|Work-related factors||Poor relations with colleagues|
|Heavy physical demands|
You can see that there is no evidence that MRI findings of changes in the anatomy of your lower back have any effect on whether or not you will recover. This means that “having the back of a 70-year-old” has nothing to do with whether or not you will recover from your lower back pain.
When you have radiating pain, a lot of stress, pain-related fear or no confidence in your recovery, your recovery will take longer. This doesn’t mean that you can’t recover.
Especially, when you have radiating pain in your lower leg, combined with the loss of muscle power, it can take a long time to recover. These are signs of a herniated disc which is one of the back pain causes that sometimes requires surgery.
Later, I’ll show you how you can treat these factors yourself to recover.
The most important thing now is to take away the fear about your lower back pain. This will be the best way to help you recover.
To do this, I’m going to teach you something about pain and what it says.
How pain works
Pain is a funny thing and can be very weird. You can have pain without damage, and you can have damage without pain.
Pain with damage
This is how it usually works:
Let’s say you hit your foot against the chair. This causes a bruise in your foot.
Your foot sends a signal through your spinal cord to your brain. Your brain assesses the message and decides whether you should feel pain or not.
Whether or not you’ll feel pain depends on the intensity of the signal, your emotional state and any previous similar situations you’ve experienced as well as the amount of danger that is present at that time.
So if this happened before and the last time it happened you broke your foot, the pain you feel this time will be more intense than if you had not broken your foot in the past.
Also when you are unhappy or anxious, it increases the pain you feel. The fear of a hernia also increases the lower back pain that you feel.
So knowing that nothing serious is going on will already reduce the pain you feel.
When you keep bumping your sore foot, something else happens:
In your spinal cord, there are also sensors that determine whether the signal can go to your brain or not. The pain must have a certain intensity to continue. The more often a sign tries to get through, the lower the threshold becomes. This means that even a weak signal can cause pain. Eventually, the threshold becomes so low that even a light touch or cold temperature can cause pain.
Here is a perfect example of how this works:
When you put your hand in hot water, it hurts at first. The high temperature causes pain. If you hold your hand a little longer in the water, your body will adjust. The water stops causing pain, even though the temperature is still the same. Your body raises the threshold for passing the signal. This is called adaptation.
With longer-lasting pain, the opposite happens. The threshold is lowered where a lower temperature of the water causes the same pain as the hot water did. Eventually, even cold water can cause pain.
There doesn’t have to be damaged any more to cause pain.
As a result, the pain in your foot will become more intense and usually the area where you feel pain will also increase.
We call this sensitization.
It means that you feel more pain than based on the signals needed. This is mostly influenced by your emotional state, which turned out to be one of the negative prognostic factors for back pain.
That is why you do not have to find problems on an MRI to still feel pain.
Another explanation about how this works can be found here.
Also, the following video might be helpful to understand how pain works entirely.
Later I’ll show you how you can cure this pain.
Pain without damage
Most people do not know this, but you can also feel pain without physical injury.
The best example is phantom pain. This is a pain in an arm or leg that has been amputated in the past.
Even though there is no tissue left to be damaged, people might still feel pain.
This happens because there is an area inside your brain that contains a map of your entire body. This is where the localization of the pain occurs. It wants to receive information continually to know what is going on in the body.
But when a limb is amputated, no more information is sent. But the brain area is still present. What we think happens is that the brain produces signals by itself.
It produces pain signals despite the fact that there is no tissue damage.
In your back, these two factors are also present. I’ll try to explain where the pain in your back is coming from and how we’are going to tackle it.
How lower back pain works
Lower back pain often develops the same way:
It starts with throwing out your back somewhere in your 20’s. You feel pain in your lower back when you bend over to pick something up. It happens in a situation that requires no force.
The problem here is that your multifidus muscle reacts too slowly. As you know, it is his function to stabilize your back to prevent your vertebrae from sliding forward due to gravity. So when it realizes that it is too late, it contracts very firmly to prevent damage.
The problem is that this damages the muscle and this causes the pain in your back. Within a few weeks, this will usually recover automatically.
Research shows however that the multifidus muscle doesn’t recover completely without the right exercises.
So after it happened the first time, you’ll have a higher risk of throwing out your back in the future. The second and third time it happens, it becomes more painful because of the previous experience as I have told you before.
Many of you will recognize this: You experience an episode of acute back pain once or twice a year.
And when this happens so often, and for so many years things change in your brain.
You will develop a fear to injure your lower back again. Since the pain occurs while bending over, you try to avoid bending like a normal person and lean forward by supporting your back with your hands on your knees.
You tighten your back muscles and try to keep your back straight.
The problem with this approach is that you’ll make the problem worse. By supporting your back, you use your large back muscles and put them in a state of chronic muscle fatigue. Try to bend your arm for a whole day. This also hurts a lot.
What happens then is the sensitization I discussed earlier. Even a weak signal can be interpreted by the brain as a lot of potential damage causing a lot of pain.
So by avoiding bending and healthily using your back, the muscles weaken as does your intervertebral discs. This increases the chance of developing chronic back pain or a herniated disc.
This is not necessary. We know that when you train your multifidus muscle, you can prevent throwing out your back.
We also know that the multifidus muscle is weaker and smaller in people with back pain compared to people without back pain.
So to prevent lower back pain in the future, it’s important to keep your multifidus muscle strong and healthy as well as your other back muscles.
It’s also vital to regain the confidence to bend your back forward in a normal way without any fear.
And that’s precisely what I will teach you now.
Retrain your muscles and regain confidence in your back.
Lower back pain treatment with four exercises
So to cure your back pain once and for all, we’ll have to do a couple of things:
- Train you multifidus muscle
- Train your big back muscles
- Remove the fear for bending forward
When you do the right exercises for your back pain, there is a good chance you will recover eventually.
With every exercise, I’ll explain what they do, why they work and for which back pain problems they work.
Lower back pain exercise 1: Training your multifidus muscle
As you already know, your multifidus muscle is the most important aspect of treating low back pain in the right way.
But you have to do it the right way.
Many people aim to train the multifidus muscle by training core stability. They try to achieve that by planking and training abs and back muscles.
This is not the right way.
To treat your back pain, you have to train the multifidus to respond more quickly. You do not do that with planks. Instead, you tighten your abdominal muscles and back muscles, so your multifidus does nothing at all.
What you have to do instead is called the pelvic lift.
With this exercise you let your multifidus extend your back and keep you in line as much as possible. And the best thing is that your large back muscles do nothing because you lie down. This way you only focus on your multifidus muscle.
I know that this exercise is being taught in different ways. But in my experience, the way I explain it here is the best way:
- Lay down on your back with your knees bend
- Place your hands over your chest
- Lift your pelvis for 10 seconds
- Repeat this ten times
By crossing your arms over your chest, you will prevent compensation which affects the effectiveness of the exercise.
You can see how to perform the exercise in the video below:
Repeat this exercise twice a day.
In the beginning, you can suffer from cramps in your hamstrings during the exercise. This is because they compensate for the fact that your multifidus muscles are too weak. They pull together to keep your pelvis up. This is a sign that this is a good exercise for you.
When you continue the exercise, you will notice that these cramps disappear and you’ll feel pain in your back instead. This is a sign of improvement, and you should continue.
To further increase the difficulty level, you can lift one leg for 10 seconds. This creates even more imbalance, causing your multifidus muscle to respond to sudden changes. This simulates its exact function.
Pro tip: You can even place your legs on an exercise ball to create even more imbalance and a better function.
This exercise is excellent in removing back pain when bending forward, during sleeping, turning in bed and during standing and walking.
Lower back pain exercise 2: Training your back muscles
The second exercise is intended to train the large muscles that help you get up and stand for long periods.
The function of these muscles is to extend your back.
This is something you do when you reach a high point or when you come back up after bending forward.
You can do the exercise like this:
- Lay down on the ground on your stomach
- Place your arms under your head
- Lift your upper body including your arms
- Keep your feet on the ground
- Repeat this ten times
On the image below you can see how to perform the exercise.
Try to increase the number of repetitions to 15 or 20 times and repeat it three times.
Do it two times a day, both in the morning and in the evening.
Pro tip: You can increase the difficulty by extending your arms or keep some weight in your hands.
Lower back pain exercise 3: Regain the confidence to bend over in the right way
This is important. As long as the fear of bending over remains, your back pain will continue to exist.
That is why I will teach you how to regain your confidence to bend normally.
To do this, we will bend in small steps. In this way, you do not hold your back straight to protect it, but you bend it as you should.
You can see the steps in the picture below.
As you can see, you must first bend your neck and your chest. This is the easy part and will not excite fear. However, it ensures that your lower back is already slightly bent so that you can no longer brace it.
Now comes the tricky part: bending your lower back.
When you’ve bent your neck and chest, you should now bend further down.
Do not forget to keep your lower back bent. Try to reach as far as possible without the fear strikes.
Now come up again, without using your hands to support you and do it again.
You will see that when you do it more often, you get a little further each time.
It’s okay to feel some stretching or discomfort in your lower back.
What you do not want is an increase in radiation in your leg. If this is the case, you must stop this exercise and continue to exercise 4 instead.
When you don’t feel this, you can continue until you can touch the floor with your fingers. It is possible!!.
Pro tip: make sure you also bend the right way when you pick up your bag or shoes. If you find that you have not done so, do it again to train this new behavior in your daily activities so that it goes automatically again.
Lower back pain exercise 4: Reduce radiating pain in your lower leg.
The next exercise is designed to reduce radiating pain in your leg as I told you before this is a factor that reduces the recovery speed. By solving your radiating pain, you will recover faster.
You can combine this exercise with exercise 1 and 2, but not with exercise 3 if this exercise increases your radiating pain.
The easiest way to do this exercise is by standing straight up:
- Place your fingers on the painful spot on your back
- Push your back forward with your fingers
- Bend backward at the same time
- Repeat this ten times
You can also see how to perform this exercise in the video below:
Repeat this exercise several times a day. Do this especially when you’ve to bend forward a few times or when the radiation in your leg increases again. You want to keep the radiation away as much as possible.
Pro tip: You can also do this exercise when lying down if you have balance problems. Just lie down and push your upper body up with your hands for 3 seconds and repeat this ten times as well.
Lower back pain exercise 5: Increase the mobility of your back
The last thing that can influence your back pain is stiffness of your back. Although the natural degeneration of your back doesn’t have to cause back pain, it can cause general stiffness of your back.
This can contribute to the difficulty and fear of moving your back which by itself does cause pain in your back.
When the cartilage in your back reduces as well as the size of your intervertebral disc, the movement between the vertebrae might decrease. Your back needs a little extra help to stay flexible.
That is what this exercise is designed for.
Perform the exercise like this:
- Lay down on the ground
- Spread your arms sideways
- Bend your knees
- Turn your knees aside. Keep your shoulders on the ground, but your pelvis may rotate
- Hold it for 10 seconds and do the same to the other side
You can see how to perform the exercise in the video below:
You will feel the stretch in your lower back when performing the exercise.
You can also use exercise 4 to increase the mobility of your back. This will reduce tension in your back and will make moving it easier.
Pro tip: you can also stretch your leg on the side you’re rotating towards so that your back rotates even more.
With these exercises and tips, you should be able to greatly reduce your back pain. The most important thing is to overcome your fear and train you in the right way.
If you have any question left you can send me an e-mail to [email protected]
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