Do you have any life goals and aspirations? 

Identifying what you want your life to look like in the near future can be a really good way of figuring out what actions you need to take.  

What physical activity levels do you need to be able to do? 

What positions do you need to be able to get in and out of? 

There are going to be positions that we avoid and are afraid of after sustaining a lower back injury. If you identify activities you want to get back to doing, you can then start doing specific exercises or training to get back to doing those.  

For example, many people will have trouble bending down after a lower back injury. For someone who is a parent that needs to be able to pick up and carry their children, bending is an activity they just can not avoid. Doing exercises that expose you and your discs to bending safely is a must. Progressing these exercises to ones that allow you to bend and lift weights of more than 2kg then 5kg then 10kg is essential. 

Some people just avoid bending altogether because they think it’s safer that way. They then wonder why they get lower back pain when they have to pick up their shoes from the ground.   

4. Find out what your treatment options are 

The advice you get will depend on who you talk to. 

If you see a GP, they may be more biased toward recommending medications and other medical interventions like injection therapy. 

If you see an orthopedic surgeon, they may be more biased toward recommending surgery. 

If you see traditional physiotherapists, they are more biased toward recommending hands-on therapies like massages and electrotherapies.  

If you see a modern physiotherapist, they may be more biased towards recommending more positive and healthy lifestyle changes. 

In this modern world of information overload where one person tells you to do this but the other person tells you to do the other, where this is good but that is even better, it’s no surprise that we end up choosing to do nothing. 

What treatment will work for me?  

The treatment approach you undertake should be based on whatever it is that you described in the previous steps, Step 2: Identify triggers and risk factors for your lower back pain Step 3: What are the demands of your life? 

If the cause of your back pain was that you started a new activity that your body was not prepared for, jumping in to get surgery might not be the best idea. How about trying to do things to physically prepare your body for the new activity? You can do this by doing specific exercises or breaking up the tasks of the new activity so it’s easier to do.  

If the cause of your back pain is you haven’t given your body enough recovery and regeneration stimuli (eg. you’re not sleeping enough), you may recover from taking heavy medications but not because of their effect but because you were finally able to get some sleep.  

Looking back at the cup analogy from the previous step, Step 3: What are the demands of your life? 

Is your cup currently overflowing? If so, what do you want to decrease the overflow? Here are your two options: 

1. Decrease the flow of the water 

• Rest, avoid or give up certain activities. Although this is helpful in the short term, it’s usually not desirable to give up activities that are meaningful to us.  

      2. Increase the size of the cup 

• Increase our body’s physical capacity through things such as exercise, living a healthier lifestyle, or weight loss.   

What are essential treatments everyone is recommended to do?

In our physiotherapy practice, we always ask our clients “what treatments have you tried for your lower back pain in the past?” 

The most common answers we get are rest, and pain relief medication. Sometimes people even reply “nothing”

Your treatment plan should include a combination of short-term pain relievers and long-term capacity builders. In most occasions, lower back pain can resolve quickly and without reoccurrence. However, if the issue starts to reoccur and it stops you from working or joining in fun activities with your family, it can mean you need to look at other solutions.  

Just using short-term pain relieving strategies without long-term capacity building can lead to repeated flare-ups and frustration with lower back pain.  

Just doing long-term capacity builders without short-term pain relievers is recommended when you are not suffering from a new “flare-up pain”. Doing capacity building only without short-term pain relievers can make the journey to recovery more difficult and more painful. Unfortunately, a difficult journey is usually short-lived or uncompleted, meaning you may not stick it out long enough to get the benefits of long-term capacity building. 

Short-term pain-relieving strategies 

Here is a short list of short-term pain relievers, you do not have to implement ALL of these, just some will be helpful.  If your lower back pain is usually settled at a manageable level and your main concern is that the lower back pain keeps coming back, you can skip to Part 2: Build your Capacity using Long-Term Solutions 

• Modify your activities (post – a good physio modifies activity and doesn’t tell you to avoid it) – more on how to do this.  
• Taking pain relieving medication such as paracetamol and non-steroidal anti-inflammatories 
• Manual therapies such as massages and joint mobilisations 
• Dry Needling 
• Taping and bracing  

Long-Term Capacity Building 

The long-term solutions which we talked about: 

Exercising  

• build your body’s strength  
• build your confidence with movement 
• expose your body to various movements  

• This is a broad topic and everyone will have different ideas of what this is. I often hear people say “I’ve tried exercising but it just makes the pain worse”  
• “Or I’ve tried it and it doesn’t work” 
• Because of the intensity of their pain, how bad their scans show up, and how long the symptoms have been around, I hear people say “I don’t want to exercise, I don’t think it will help me” 

• I usually assess what “exercises” they did work on.  
• When you first started exercising, did it feel like a “safe” starting point for you?  

• Did it challenge you (to a point you knew you were working but not so much that you overdid it) 
• Did the exercises look like day-to-day activities that are difficult for you? 
• If you answered “no” to any of these, then I encourage you to try again and get some guidance if you need it.  

Improving your sleep duration and quality 

Improving your diet and nutrition intake 

Improving your resilience in stressful situations 

Improving your social relationships and connectedness 

Decreasing alcohol consumption and smoking intake 

Closing words 

Resources- build a village – surround yourself with people and media that will encourage you and help you take action. 

• What comes up on your social media feeds? 
• What comes up in your emails? 
• What in-person interactions do you have about your back pain? 
  • Be careful who you surround yourself with.  
    • Sometimes it’s not helpful to speak to your friend who’s had the worse back pain in the world. If you’re struggling with the pain you’re experiencing, it’s probably best to stay away from Uncle Jim who thinks his back pain is worse than yours 
    • Sometimes speaking to other people who’ve recovered from an episode of lower back pain can be reassuring. Or someone who has lower back pain but is well-informed, positive, and doesn’t bring you down.  

Here is a list of online resources about lower back pain that I’ve referenced 

10 lower back pain myths 

EBP podcast series 

Flippin pain 

Here is a list of social media accounts to follow online:  

• Vuno physio  
• Aaron Kubal  
• Peter O’Sullivan 
• Adam Meakins 
• Craig Leibenson 

About Vuno Physio & Rehab: 

Brendon Arizala 

Physiotherapist 

Seven Hills 

Blacktown  

If you need help implementing some of the things in this guide, please contact one of our physiotherapists at 91907599.