Why Stretching Makes Your Acute Back Pain Worse (Do This Instead)

Back pain. My favorite thing to talk about as a physical therapist. I’m kidding, but not really. Back pain. It’s number one thing I see as a PT. I see it every day. Everybody gets it. It’s It’s all over the place. Um, so in this video, I want to talk about what you should do when back pain strikes. It’s the number one thing I see as a PT. Like I said, I see it all the time. I’ve seen, you know, teenagers with it, older people, obviously, um, middle-aged people like myself. It’s it’s all over the place. And I’ve seen so many different sides of back pain, different types of back pain. And it’s so subjective because again, pain is a subjective experience, right? And especially with back pain, it it’s all over the place sometimes and it can be scary. I’ve had so many people tell me about back pain. Their their back pain hurts more than the kidney stones they’ve had or I’ve had people tell me their pregnancy felt better than their back pain. And they always hurt themselves doing something so mundane like bending over to pick up, you know, something a thing of laundry or picking up something that fell on the floor like a pencil. Someone last week told me that they were trying to tie their shoe and their back just kind of gave out, right? So many different types of stories like this that I hear all the time. It’s happened to me. I remember twisting to grab something for a patient one time and my back felt like it just blew up and it was not fun and I was walking like like Gumby for a while. But, you know, again, scarier than it seems. But so again, this video I want to talk about things you could to do to kind of deescalate the situation of your back pain of your back pain episode because again, it’s always scarier than it seems, but it’s not anything you can’t get over. It’s just the initial shock that always stuns people like, “Oh, I need something drastic for this or I’m damaged forever.” which is not the case because again myself I’ve had really bad back pain for um man I think I had it for about a year and a half uh when I was around 27 28 and it took forever to get better but you know I didn’t do anything besides obviously physical therapy which I love and other things that we’ll talk about but this video again is more so like if back pain just happened and you’re in shock and you don’t know what to do. So, the first thing is more so, you know, especially if you’re watching this and you have like a heating pad on right now or or you’re just kind of chilling trying to stretch it out, terrified to bend over, right? I’ve seen it all the time. Every time someone hurts their back, they’re afraid to do that same move that hurt them initially, right? Like they bent over to to pick up some laundry, right? And they don’t want to do that again. They’re just like, “Oh my god, this is something that’s going to hurt my back again.” Which is not the case. So again, thinking about it this way is your brain sends these signals, these massive alarm signals to yourself, causing the surrounding muscles after the pain episode to just tighten up and to guard and to be super aggressive in that guarding. And they clamp down on your spine like a vice, right? And the intense pain is more so of an emergency threat response. It’s not proof that your spine is broken or damaged. And again, it’s hard for people to kind of think about this, but pain is not always an indicator of tissue damage or damage in general, right? And that’s where we kind of have to deconstruct your pain. So, three-step plan, I’ll talk about it here in a second, but first, let’s talk about red flags. And again, it’s important to screen out anything medically crazy going on, any red flag signs going on because again, back pain can be scary. At the same time, if there’s no none of these red flags, it can be rehabbed. It can get better with physical therapy. So, I’ll I’ll link something in the description about, you know, these red flag signs. I’m not going to read them all out right here, but again, when it comes to back pain, if you’re having sudden loss of bowel or bladder control, if you have numbness or tingling in your inner thighs called saddle anesthesia or in the groing area, if you have if your foot just all of a sudden just drops and it just starts slapping on the ground, that’s a sign of pretty bad nerve damage. We call that foot drop. If you don’t have any of those things and other things I’ll link in the description, again, your pain can be rehabbed. And if all that is screened out, it’s pain. It sucks. I get it. But you need to rehab the pain and work at it. So again, all that signals that we could work on it and it’ll get better with a thorough evaluation and PT plan, which again, I know is not what people want to hear. They want to get better now. It’s it’s a whole process and they don’t want to exercise to get rid of the pain or be active to get rid of the pain because initially movement just feels like a chore and it hurts a lot and it it stinks to move. Um so but again as I I always say we’re living organisms. We need to be moving and adapting. We don’t adapt by doing nothing. We adapt by moving and circulating that blood and joint lubrication and all that good stuff. So, and again, I do want to emphasize that pain is different for everybody. Pain is a subjective experience by definition. It could be different for everyone. And it’s it’s not a one-sizefits-all. I’ll do my best to give some general advice here, but the best thing to do is always to get a thorough assessment by your physical therapist. And if your symptoms are more localized and it’s sharp and it’s more of a guarding type pain, this three-step process that I’ll walk you through will definitely help the pain. So, let’s talk about first some back pain patterns that I usually see when patients come in and see me for physical therapy. Usually, your spine has a preferred direction when it comes to pain. Meaning, let’s say you bent over to pick something up and then again your back just felt like it gave out or blew up. However you want to describe it, it sounds it’s a sudden shock to your system, right? Usually when that happens, your body does not like flexion or bending over, right? And every time you bend over, you get that sharp pain. It hurts. Your muscles guard and it stinks and you don’t ever want to do it again. Usually when that happens, your body prefers extension or arching back. The opposite of flexion or bending forward. So if you were to test this on yourself right now, stand up slowly, place your hands on your low back if you have pain with bending over and try to arch arch backwards. If that feels better, that means that’s your preferred direction right now. Your back prefers spinal extension or arching back. And that’s something we can kind of work on that gives us more clues as a PT to tailor your rehab plan. And again, that’s the usual clinical pattern that I see with with back pain. There’s also the the idea of centralization versus peripheralization, meaning the pain will centralize or peripheralize. And if it centralizes, the pain goes back up into your spine. It’s not radiating anywhere. It’s not tingling down your hip, down your glute, down your thigh. That’s usually more nerve- related usually. Um, again, it’s all it’s it’s always different, but if the pain is more localized in your back, that’s kind of what we want and that’s a better prognosis when it comes to healing your back pain. Um, not to say that if it is peripheralized or radiating into your glutes or even down your leg into your foot that it can’t get better. it it can get better as well. But usually if it centralizes or come comes back towards your spine, that’s something that we want and that’s that’s a good thing. I know it sucks and it sometimes it gets more sharp in your low back, but that’s a better sign that it means that it’s getting better. Okay, let’s talk some more neuroscience of of pain. And I don’t want to get too much in the weeds of this, but it’s more so about spasming and again just pain in general. So, you know, let’s say you bent over and again, you felt that sharp pain or you’re tying your shoe, you’re bending over to pick up a pencil, whatever it is, pick up a sock, um, a book, whatever it is, sharp pain ensued. And think of it as whatever structure in your back just got irritated, a disc, a facet joint, uh, which thankfully I have a little model right here. The discs are these guys in between each vertebrae, which are the bones in your spine. The facet joints are these kind of joints on the side right here. If those get irritated, sometimes your brain makes it more of a threat than it is. And they get irritated for whatever reason. You know, maybe you’re just stuff happened. It’s it was a weird position for yourself. They got a little bit irritated, but again, your brain magnifies it even more. And it’s not necessarily a sign of something that’s crazy damaged. Something irritates those structures doesn’t mean that they’re permanently damaged. The brain activates muscle tension in the area and then a crazy spasm ensues. Right? your spinal erectors, your the quadrus lumboreum muscle, which are these muscles on the side, the erectors that run down your spine, like big long bands of tissue of muscle. And so, think of it more so as the intensity of your pain is more of a measure of your brain’s sensitivity setting, not the actual damage in your back, in the tissues of your back. So, in other words, pain, especially when it comes to back pain, because I, again, I see it all the time clinically, is more so a sensitivity meter than a damage meter. And it’s a big reframe in your mind to think about pain that way. Um, but it’s very helpful when it comes to pain. It doesn’t scare you as much when these things happen. So, let’s kind of walk you through these three steps of what to do when back pain strikes. And quick pause. This video is brought to you by Art of PT. It’s my physical therapy practice here in Neapville, Illinois. It’s all personalized. It’s all individualized. It’s all one-on-one physical therapy. So, if you are an athlete or someone who does the high rocks or plays a lot of pickle ball or jiu-jitsu person or combat sports, you go to the gym all the time, you’re around Neapville and something hurts, I’m here to help. Come check us out. Again, it’s all personalized. It’s not the like the usual corporate physical therapy place where the PTC see three patients at once. It’s all individualized to you. So, check us out. It’s arttopt.com. The link is in the description. It’ll go right to us. Tell us your story. We’ll get you back to 100%. I promise. Back to the episode. The first thing that you want to do, and again, this is more this is customizable to you. So you can customize it as you see fit. I’m going to try to walk you through the process here if this just happened. If again you something happened, you bent over, your back hurts a lot, it’s day one, day two, and it’s still kind of on high alert. So the first thing you want to do is to decompress or turn down the alarm system. And what I mean by that is you can decompress yourself by elevating your legs. There’s a Instagram reel I just did on this and which we can pull up here in a second. And you want to put your calves on a chair in a 9090 position, like 90 degrees of hip flexion, 90 degrees of knee flexion. And when you’re in that position, when your calves are on the chair, what you want to do is take some big deep breaths, relax, try to calm down your nervous system. And again, I did a an Instagram reel, which we can pull up, that is perfectly suited. Here it is right here. So, if you hit play on this, here’s me doing some um cat cows, which we can talk about here in a second, but and me talking, but this is what I mean. So, here’s my feet and my legs are up on a chair. I’m taking big deep breaths, decompress, decompressing my back, trying to get everything to relax. So, we could pause it right there. And then so that’s kind of decompressing and turning down the alarm system. That’s what I mean by decompression is that position I showed you in that Instagram reel. And also regulating your breath, your breathing, which also turns down your nervous system, your sensitivity system, your alarm system, which is your sympathetic nervous system. So different positions for everybody too. Like that’s the one that I found generally that helps people. You could also just lay on your stomach, on the ground, on the, you know, on a bed, um, on lay on your side, whatever position is better for you. Try to breathe, try to relax, try to decompress, but that’s the one that I found that helps a lot of people. Step two is this is a little bit more in the weeds here, but I’ll try to explain as best I can, is you want to find your directional preference, which is what I talked about earlier. Do you prefer extension right now? Do you prefer flexion? It depends on the back pain um and what happened initially. But you also want to reset your positioning or your alignment. Right? A lot of times if people have back pain like let’s say they have you have right-sided low back pain. Right? Now if someone has rights sided low back pain usually not all the time they tend to lean away from the pain. So they develop this posture to get away from the pain which makes sense because it’s a threatening stimuli stimulus. So your body tries to get away from it. So let’s say right side low back pain, they develop like a left side lean to get away from it. So what to do in that instance is if you have that kind of, you know, painful lean away from the pain, you want to do something called wall slides or wall glides, which I don’t have a video on, but I’ll put a link in the description on. Essentially, you want to put your left arm on the wall kind of towards where you’re leaning towards since your pelvis is kind of coming out to the right side because you’re leaning away from the pain. Forearm on the wall. You’re leaning that way. And you want to push your pelvis into the wall a little bit. Kind of correcting that posture to essentially straighten yourself back out as opposed to developing that chronic lean away from the pain because you don’t want that either. You don’t want to be walking around crooked all day. So you want to have do your best to get back your normal alignment and be yourself again, right? So depending if you have a lean away from the pain, you do some wall glides and again after that you want to find your directional preference. You want to find if flexion is better for you, which can happen, or extension is better for you, bending or extending or arching back. Usually people have an extension bias. they like extension for pain that they have bending over. So, I’m going to give you an example of this. So, let’s say again you’re bending over is not your best friend. You hate it. It hurts. It’s it gives you a six or seven out of 10 pain. What you want to do is do the opposite. You want to do some press ups. You want to do some laying on your stomach to have your your spine in a little bit of extension. Press ups. Again, it’s hard to visualize possibly maybe, but I’ll put a video in the description again. And it’s more so laying on your stomach and doing some gentle kind of like cobra poses in yoga, gentle press ups, putting your spine more into extension and generally that relieves the pain of the bending over. So you want to do the opposite of what hurts essentially. So gentle extension, gentle pressing up from your belly helps that type of flexion pain. Also, if people have pain with extension, I’ve seen this a lot with with gymnasts or volleyball players, people who go into forceful extension, they prefer more flexion. And what you want to do with that is more flexionbased treatment, active treatment, like a a stretch into a prayer pose, right? A three-way prayer pose, some sort of flexion that we can teach you as physical therapists. And you want to find which one is better for you. Step three is my favorite and it’s in my Instagram reel. If we could bring that up again. Um, it’s my favorite because it gets you moving more and that’s exactly what I’m doing right there at the end is walking. So, you know, you could call them vascular walks. Uh, walking is great for a lot of things. It’s great for back pain because again, doing them, I don’t know, let’s say every hour, right? You want to find your limit. And if you can only walk for five minutes and the pain starts coming back, that’s okay. That’s your limit for right now. Eventually, you want to build on that. Walking is a natural fluid pump. Circulation, it’s all great for your back. Essentially, what you want to do is not is to do something and to not lay on the couch all the time because that’s worse. Your body gets stiffened up. It gets tighter. There’s no blood flow. Your back starts to get even more tight. It’s a whole cycle. you don’t want to go through. So, what I recommend usually is every hour, get up, walk, whatever you can tolerate, 5 minutes, 10 minutes, whatever you can, and then kind of go from there. Build on it because again, it will get better. And maybe one day, the first day you do five minute walks every hour, the next day you do eight minute walks every hour, 10 minute walks, and then before you know it, the pain is pretty much gone after a week or two. more of a again this is a three-step approach but it’s try to customize it to yourself. So do your best to decompress the area downregulate your nervous system. Step two would be to find your directional preference fix your alignment if needed. And step three is to get more active to walk. It doesn’t even have to be walking. You know an elliptical is fine. Doing some gentle elliptical training is completely fine as well. Walking is just the easiest thing to do because it’s such a human thing to do, right? And you can just get up and start walking. So, very customizable. Customize it to yourself. If you need help, you could obviously message me on Instagram or send me an email. So, that’s the three-step process. I want to walk you through kind of the first 48 hours of, you know, really bad back pain because again, when it, especially when it first happens, it’s like such a huge shock to people that they just start freaking out and they’re like, “Oh my god, I need an MRI or something just I’m everything is my spine is broken.” But so here’s like your little 48 hour playbook. What to do in the first two days. The first thing you want to do is modify your activity. Avoid prolonged static positioning like sitting or laying down all day and just waiting and hoping and praying that it goes away because again prolonged static positioning like prolonged rest increases stiffness in your back. It delays functional recovery. And again the our favorite saying as physical therapists is motion is lotion, movement is medicine. I mean everybody says it now because it’s true. We’re not trying to make you move to hurt yourself more. It’s going to make you feel better better. Initially, it might not feel great, but after a while, you’re like, “Oh, this actually does help.” Because again, blood flow, circulation helps everything. So, first thing to do is to modify your activity. Meaning, don’t just lay on the couch and do nothing all day. Second one is protect. protection I put. Meaning like if bending over does hurt a lot, it’s okay to avoid that for 24 to 48 hours. If you need to pick up something like a grandma and just do a squat and grab something, that’s okay initially, but eventually you want to get out of that and not be afraid of that. So, we start training into more bending over. But again, initially you want to avoid those things because it is so irritable to yourself and your back. So, avoid those things for a little bit. Don’t push it and just try to force it. it’s just going to make your body more it’s going to turn up the alarm signals even more and you don’t want that. So protect it for 24 48 hours. And the third thing to do is to avoid any aggressive stretching, meaning like static stretching, meaning like just, you know, a a prolonged hamstring stretch, a prolonged back stretch, aggressively stretching your low back, your hamstrings, all that stuff. If it’s already super tight and you’re just kind of pulling on it the whole time, it’s again, it’s going to tell your nervous system to just turn up the alarm system even more, your the signals even more, and it’s going to be even more irritable. So, gentle movement, gentle exercises, actually dynamically moving is much better than just prolonged static stretching. So, avoid that. So, again, three things, modify, modify your activity, avoid prolonged rest. Number two is protect the area. If bending over hurts, avoid that for the first 24, 48 hours. And number three is avoid aggressive static stretching because that could just keep pulling on tight tight muscles, making it worse. Hopefully that all made sense. That’s all things I see every day as a physical therapist is explaining these kind of like these this three-step process and you know lifestyle modifications because again initially that shock of back pain is just it’s so it it kind of changes the way you think about pain you know especially when it happened to me I remember when I first had really bad back pain it’s like oh I don’t know what’s going on and again being the physical therapist working in a PT clinic at that time it was just it was it was really bad but you Initially, you want to definitely stay optimistic about it. Nothing horrible is going going to happen. It’s just the first 24 48 hours are always the scariest. And then after that hump, it gets better and better. I promise. So, if you’re someone with back pain and you’re struggling with back pain and you don’t know what to do, you can definitely reach out, especially if you’re in Neapville. Um, my physical therapy clinic is called Art of PT. website is in the description. It’s artf.com. We work with athletes and active adults, people who especially nowadays doing all the high rock stuff, crossfitters. I get a lot of pickle ball people who just jump in and they hurt themselves. I get obviously my jiu-jitsu guys, people who do Muay Muay Thai, uh any type of grappling. Um the average weekend warrior, gym person, gym rat. So, I’m here to help all you guys in Nepville. And it’s all personalized. It’s all one-on-one physical therapy. It’s not the usual physical therapy corporate company who sees four patients at a time or three patients at a time because I remember doing that and I hated doing that. So, it’s all one-on-one. It’s all you get all the attention that you need and that’s how physical therapy should be. So, I’m here to help. Whether if you’re in Neapville or if you’re someone who’s watching and you’re not in the area, we could definitely work together online. I do remote rehab coaching. So, I have a lot of clients with that as well across the country. So, it’s something that I I definitely love. It’s a different set of rehab that we could do a whole assessment through video like this. Uh a full movement assessment, full rehab plan customized to you for your back pain. I I’d love to help you out. And I also have my free newsletter in the description which is called the PT Handbook. It’s completely free. I do a lot of back pain newsletters because again it’s something I see all the time. And so that’s on there. My Instagram, which you pulled up for a little bit, is apt.g. You could message me on there. I’m pretty readily available on there. I’m always kind of posting some reels or or some advice. So, you can message me on there. If your back hurts or something else hurts, your shoulder hurts, your ankle hurts, your you slept weird, and your neck kind of feels funny, and I see that all the time, too. I’m here to help. Um, there’s my Instagram right there. You guys can message me on there. It’s uh something I I definitely I’m very active on, and people message me all the time. So, I love answering your your injury and pain questions. And so, yeah, hopefully this video helped. Back pain. I’ll do more videos on back pain. Such a complex topic, back pain or just pain in general that I’ll I’ll keep kind of adding to these to these videos. But hopefully that all helped and I’ll see you guys next time. Peace.