By Stephanie Mikoliczak, Doctor of Physical Therapy, Howard Young Medical Center

The large variety of treatments and the advertising of cures for people with back pain can be confusing. There is no one treatment that has been proven to be “best practice” among all the treatments available, and for many people, a mix of treatments is necessary to provide relief and restore function. This is why physical therapists use both scientific approaches and non-traditional approaches to help each patient reach her/his goals. The best research shows that people with back pain benefit from movement over rest for better recovery and this is why many of the treatments for back pain that physical therapists employ involve incorporating movement into patterns that promote healing.

Understanding this, and understanding that the majority of literature and training concerning proper care of one’s back involves avoiding too much flexion or forward bending through the spine, there are a few simple tools that can be employed, in many cases, to reduce and even eliminate back pain as the back heals:

• Lifting to avoid bending through the spine by bending the knees, coming down on one knee, or lifting the back leg behind you as you reach toward the ground (also known as the golfer’s lift) is helpful to avoid too much force through an injured back.
• Promotion of body awareness and preventing patterns of movement that promote pain and tone is commonly helpful in treatment of patients with back pain. Treatment may incorporate massage to promote relaxation and the introduction of new patterns of movement that are pleasurable and pain free.
• Training in ways of alleviating stress, such as deep breathing techniques or imagery may be incorporated into treatment because stress promotes increased muscle tone and can cause as well as contribute to back pain, neck pain and headaches.
• Sitting with lumbar support and “being tall” when you sit. The support should be just enough to preserve the curve in the low back while allowing you to comfortably bend the upper back over the top (a small pillow, paper towel roll, rolled up facial towel or whatever other creative thing you can think of) to encourage more upright to slightly extended posture through the spine. It should be used everywhere you sit, whether in a car, on a couch, or on a hard chair. Relying on “lumbar support” in a car is usually not enough support for a person with back pain because it doesn’t allow for the body to bend back over it for tall sitting.
• When transferring from sitting to standing, or from standing to sitting, it is frequently helpful to break the movement down into two steps, so that, when coming into sitting, you first sit on the edge of the chair keeping your back up tall, and then slide back into the chair, rather than just bending forward to get your bottom all the way back in the chair. When standing, first slide the bottom to the edge of the chair, then, keeping upright and tall, lift the body out of the chair. This two-step process helps to keep the back from bending to lift and lower the body into or out of a chair.
• Walking with long strides as tall as you can imagine being encourages upright to extended posture through the low back as well.
• Sleeping on the side with the bottom leg extended and the top leg bent forward with the knee on the bed, or sleeping on the stomach are also frequently helpful for people with back pain.

I like to teach my patients using the image of the back as a bank account. The more bending one does throughout the day, the more money gets taken out of your “back account.” The back can tolerate a lot of money being taken out, but at some point, for the majority of people, the back account gets overdrawn. To put money back in, so to speak, one can try to extend the spine. Try to place your hands in the small of your back and bend backwards to look up at the beautiful northern Wisconsin sky. Be sure that if anything you try aggravates your symptoms or makes you dizzy to stop immediately.

Stephanie Mikoliczak, PT, is with the Ministry Health Care Rehabilitation Department at Howard Young Medical Center. She is a graduate of Carroll University in Waukesha where she received a Bachelorette in Psychology and Doctorate of Physical Therapy.