In the first part of our acute injury series, we covered the PEACE and LOVE approach to managing soft tissue injuries—our updated, science-backed protocol to optimize healing and promote the best recovery and return to activity.
Over the next few months, we're diving into specific action steps for different body regions: what to do, what NOT to do, and how to get the movement your body needs without irritating injured tissue.
Important note: This isn't a substitute for proper evaluation and progression with a PT. Our team at Pack Performance PT in Rocky Hill, CT is here to guide you through the entire recovery process and get you back to performing at a high level. But this information provides safe, effective steps to self-manage your injuries until our pros can help you out.
Let's dive in!
Why We're Starting with the Low Back
Low back pain is the leading cause of disability worldwide. It’s also a leading cause of economic burden to the ever increasing healthcare costs associated with poor management. Low back tweaks can significantly limit your daily function in a way that's profoundly different from any other body region. I routinely hear patients tell me they hurt their back so badly they couldn't get off the floor for days—or had to call an ambulance to get to the hospital.
That level of pain can be pretty scary. And when it happens, you need to know what to do immediately. We're going to cover some of the most common back pain presentations. This doesn't account for everything that you might feel but it will give you a great starting point.
STEP 1: Rule Out Red Flags (When to Get to the ER)
There is a time and place to get to the hospital when you have back pain. These are true red flags that warrant immediate medical attention:
Go to the ER if you experience:
- Traumatic injury like a fall resulting in pain (possible fracture)
- Numbness/tingling in the saddle region between your legs
- Loss of bowel or bladder function
- Loss of motor function in your legs
- Progressively worsening neurological changes in both legs (weakness affecting your ability to walk, loss of sensation)
There's good news! These signs are EXTREMELY rare and account for less than 1% of all low back pain cases. If any of these accompany your pain, stop reading and get to a hospital. Otherwise, proceed to the next step.
STEP 2: Find Your Movement Preference
The next step is to find a way to move that's relatively comfortable.
When you tweak your back, you'll likely feel general discomfort. However, you'll typically have a movement preference—meaning your back will feel better moving in one direction or another.
We see this most often with:
- Flexion (bending forward)
- Extension (bending backward)
Here's what those patterns look like:
- Flexion-sensitive back pain → Your back likes bending backwards (extension)
- Extension-sensitive back pain → Your back likes bending forwards (flexion)
This preference will inform the best ways to move your back, set up your bed, sit at your desk, and manage daily activities. If we can modify positioning and move as much as possible in pain-free ways, your back will recover better.
STEP 3: Start Walking
The first movement you should be doing is walking.
Walking may be uncomfortable, but getting up off the couch or bed and moving within tolerance provides healthy compression for your spine. This supplies nutrition for the joints and discs and promotes blood flow to the low back muscles. As we discussed in the PEACE and LOVE article, blood flow is mission critical for healing!
Walking also helps turn down your pain-sensing system. When your back is flared up, your nervous system goes into overdrive—meaning you're "feeling" much more than usual. By walking outside and getting some sunlight, we can help calm down the nervous system and turn down pain-sensing pathways.
Flexion-Sensitive Back Pain: Your Action Plan
Flexion-sensitive back pain likes extension (bending backwards). If this is you, rounding your back will hurt. This includes:
- Bending forward
- Going into child's pose
- Sitting slumped forward
- Tying your shoes
What to do:
1. Lie on your stomach and perform press-ups. This gets your back moving into extension! Prop yourself up on your elbows or hands to whatever height your back will tolerate. This video goes through progressions for increasing range as symptoms improve.
2. Support your low back when sitting. Put a rolled towel in your low back to maintain the natural extension in your spine. This works great in a car, at the dinner table, or on your couch.
3. Get your steps in. Walking keeps your back in extension, which will feel good to a flexion sensitive back.
4. Sleep strategically.
- Lie on your back with your legs straight, OR
- Sleep on your side with legs straight or only slightly bent
The more you bend your legs up, the more you'll round your lower back. Lying flat on your back puts your spine into slight extension, which will feel good if you're flexion-sensitive.
Extension-Sensitive Back Pain: Your Action Plan
This type of back pain hurts when bending backwards or arching your back. We tend to see this more with:
- Hypermobile patients
- Active gym-goers, athletes, dancers, and gymnasts
This type of pain likes some rounding in the low back. Because our low back naturally rests in extension, you'll likely feel okay in neutral. It's when you go beyond neutral (arching back) that pain gets fired up.
What to do:
1. Work on child's pose with a rock back. This moves your spine into flexion with repeated reps. Watch the video here.
2. Fire up your glutes with a bridge in posterior tilt. This creates some flexion in the low back while activating your glutes. Check out this video for a demo.
3. Squeeze your glutes when standing. If you need to stand for long periods, squeeze your butt! When your glutes are engaged, they naturally reduce extension in your back. You can also put one foot up on a small stool to encourage slight rounding in the low back.
4. Sleep with a pillow under your knees. This helps encourage some rounding in your low back and takes pressure off.
5. Walk with modifications. Yes, walking does keep your spine in neutral extension, but it's still important to move. To prevent your back from going into extra extension:
- Take shorter steps than usual
- Intentionally squeeze your butt with each step
What NOT to Do (Critical Mistakes to Avoid)
Regardless of your movement preference, avoid these common mistakes:
Don't stay in bed for days. Complete rest delays recovery. Move within tolerance.
Limit your anti-inflammatories. As we discussed in our PEACE and LOVE article, this can slow healing. Focus on movement instead.
Push through pain. At this stage, pain indicates tissue irritation, which we need to respect. Listen to your pain and move in as many pain free ways as possible!
Don't assume it will just go away. Even if pain resolves quickly, the root cause likely remains (more on this below).
Your Next Step: Get a Professional Evaluation
Once you've taken these initial steps to manage symptoms, your next step is to schedule an evaluation with a professional who can walk you through the full rehab process.
Here's the reality: Very often, acute episodes of low back pain will resolve on their own within a couple of weeks. That sounds great, right?
But here's the problem:
The strongest predictor of future low back pain is a previous episode of low back pain.
Left untreated, there's a high likelihood the pain comes back—and may become chronic in nature.
This isn't meant to scare you. It's meant to be a wake-up call that NOT addressing the root cause of your low back pain will likely result in it returning at some point in the future.
Remember the I3 Model of Pain? Your back tweak didn't happen in that one moment. It was the result of months or years of incomplete mechanics creating accumulated stress. If we only treat the pain (the symptom) without fixing the movement patterns that caused it, you're just waiting for the next flare-up.
How Pack Performance PT Helps You Break the Cycle
Our team at Pack Performance PT has advanced training in managing low back pain with athletes and active adults in Rocky Hill and Central Connecticut.If you're looking for a long-term solution—not just a series of generic exercises—our pros are ready to help you at every stage:
Understand why you hurt your back in the first place
Restore pain-free movement with personalized progressions
Rebuild a robust spine able to handle anything life throws at youWe don't just get you out of pain.
We build capacity and resilience so you can:
- Deadlift without fear
- Pick up your kids confidently
- Sleep through the night
- Say yes to activities you've been avoiding
Nobody should have to figure out their pain alone. When you join the Pack, you've got a supportive community at your back through the entire journey.
Sources:
GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023 May 22;5(6):e316-e329. doi: 10.1016/S2665-9913(23)00098-X. PMID: 37273833; PMCID: PMC10234592.
Matthew Szymanski
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