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A Guide to Managing Low Back Pain

By, Elliott Jermyn - Physical Therapist/Assistant Athletic Trainer 
       Washington Redskins

Redskins Physical Therapist/Assistant Athletic Trainer Elliot Jermyn is currently in his sixth season with the Redskins. Prior to the redskins, he specialized in sport-related injuries and spinal conditions at an outpatient sports medicine clinic in Bethesda, MD.

I often encounter friends, family and acquaintances who ask me about a variety of musculoskeletal complaints. The most common begins something like this: “I just woke up this morning, put on my shoes, and all of a sudden I could not stand up!”

If you have ever felt this, you are in a large majority of roughly 80 percent of Americans who have suffered from Low Back Pain (LBP).

LBP can have such varied severity from minor aches to debilitating spasms, and unfortunately has a strong probability of reoccurrence. It can cost the unfortunate victim in time lost at work, and disrupt their normal recreational activities.WASH_ELLIOT

Far and away the most common form of LBP is termed “mechanical low back pain,” and as the name implies it occurs due to abnormal movement and function in the spine.

Some of the common causes of this pain that we see in an NFL training room include bouts of arthritis, degenerative disc disease, ‘slipped” or herniated discs, pelvic dysfunctions/leg length discrepancies and biomechanical foot problems.

When these underlying problems are combined with unexpected forces, it can lead to painful strains and sprains in the spine.

It is always advised to seek the help of a doctor or qualified health care practitioner who can help you diagnose the cause of your LBP and can lead you in the right direction to help correct any problems and prescribe appropriate exercises.

When an athlete enters our training room it is our job to thoroughly evaluate their signs and symptoms to isolate the cause of the pain into a few treatable dysfunctions.

 

The following is a typical evaluation based on an athlete with mechanical low back pain:

Skeletal Alignment

One of the first things that we do when an athlete comes to us with LBP is to check under their pelvic and low back (or lumbar spine) alignment. With all the sprinting, diving and contact that our players experience, it is no wonder that we often see misalignments and differences in their leg length.

I often use the analogy of a car’s tire wearing down faster when the chassis is out of alignment. Over time, this can lead to weakened or tightened muscles that will break down quickly and progress to multi-joint symptoms.

Your therapist will utilize a series of manual techniques to help realign the bones in your low back and pelvis to help restore normal function.

Muscular Assessment

Once the “pelvis is aligned,” we begin to check other joints for muscular weakness or tightness.

A very common pattern that I see in our training room is tight hip rotator and mid back muscles, weakness in the abdominal and low back musculature, and biomechanical faults in the foot and ankle complex.

Each of these joints will be assessed and treated to ensure that tissues on both sides are equal and symmetrical.

Core Strength

Finally, we will utilize different assessments to identify weakness in the “core” muscles. These are termed core muscles because each one has an attachment and effect on the spine.

Weaknesses in any of these muscles will lead to poor spinal mechanics and a greater risk of losing the ability to move normally.

One of my favorite ways to evaluate core strength is to examine the amount of motion in the hips as different exercises are performed. Excess movement generally correlates to weakness in specific deep abdominal musculature.

At this point, I have narrowed down the search for the culprit of their symptoms, and I can begin to build a solid rehabilitation plan that an athlete can begin to address on a daily basis.

Maintaining proper flexibility in the lower body in combination with creating a strong “core” can minimize the probability and severity of LBP.

There are several exercises that we recommend our players perform daily. These exercises are simple and can be preformed in any open area. They are designed to address general deficiencies in LBP.

On the right is a sample of the exercise handout we distribute to our players at the beginning of the season. These exercises are designed to promote improvements in mobility, flexibility and lumbar stability.

Because LBP is so prevalent, it is important to understand that quick treatment can often reverse the effects of overstrained joints and muscles. Most symptoms will respond better to motion versus rest, however it’s best to avoid activities that increase symptoms.

The general goal of pain management in the first several days is to decrease muscle spasm and inflammation caused by the injury. As this subsides, our programs are geared more to movement restoration and gradual return to activity and recreation.

 

General Guidelines for Treating Discomfort

  • Liberal use of ice (in the first 2-3 days) and heat will help ease pain and decrease muscular spasming
     
  • Over-the-counter medication such as ibuprofen and acetaminophen will also help reduce symptoms and allow you to begin early motion exercises.

    PiriGlutStretc
  • Continue activities that do not exacerbate your symptoms. This may include treadmill walking, exercise biking or gentle calisthenics.
     
  •  “When your back is tight, stretch your buttocks!” This can be heard around our training room on a daily basis. 
     
  • Maintain healthy respect but not fear of your pain. Again, continuing light activity is almost always helpful.

 

When to seek help?

  • If symptoms progressively worsen or are not easing in a few days.
     
  • If pain is radiating below your hips and into your legs, or if you feel weakness and numbness or tingling
     
  • If you have problems sleeping or cannon find a comfortable position.
     
  • If you experience unexpected weight loss or develop a fever or rash.

 

While low back pain can be quite debilitating, it is important to know that most episodes are very treatable.

Additionally, maintaining proper flexibility and strength in your body will not only ease discomfort, but will help decrease the reoccurrence and severity.

Remember, it’s always best to discuss any LBP symptoms you may have with a health care professional. 

 

Helpful Stretching Techniques in the Treatment of Low Back Pain

 

Hamstring

Stretching: Hamstrings with Stretch cord

Lying on your back with cord around toe pull up to feel stretch in hamstring. Hold 3 times for 30 seconds. Pull across body to increase stretch on outside of HS and pull away from body to increase inside of HS.

 

 

 

 

 

 

Stretching: Hip Flexors and TFL with stretch cordHipFlex

Lying on stomach as pictured with cord around toe of leg being stretched. Move other leg as far forward as you can and pull cord to bring heel to your buttock. Hold for 30 seconds repeat 3 times.

 

 

 

 

Piri

 

Myofascial Foam Roller Piriformis

Seated on foam roller as shown, find areas of most tension and maintain pressure for 30 seconds. Repeat 2-3 times

 

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