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Low Back Pain - Understanding What It Needs To Improve, Part 1

atlanta back pain dr. marcus Jul 29, 2021


Part 1: The Lumbar Spine’s Fundamentals

If you are reading this blog post, you likely are having back pain or have had back pain in the past. You understand how debilitating it can be. You understand how much it can take away from you. You are not alone. 

Eight percent of all adults experience chronic back pain. Back pain is the sixth most costly condition in the United States. Back pain accounts for over 12 billion dollars of medical expenses every year. So yes, lots and lots of people have back pain!

It is rare that a day goes by in my practice that I do not see a client with some sort of low back pain. So, in this short two-part series, I’m going to go over some quick things you can do to consider if you are having low back pain and are continuing to want to exercise or play sports. 

Fundamental 1: Resume activities as tolerated

One of the biggest factors to accelerate recovery in low back pain is to resume functional activities as tolerated. It’s not bed rest. It’s not stretching. It’s using your back and body as tolerated. 

This tells us three things:

First and foremost, we are resilient! Even with pain and dysfunction, if we are able to do things as tolerated, we will recover faster!

Second, it tells us that despite the pain and dysfunction, we need to look at ways we can improve our mechanics in order to return to functional activities faster. Resting for too long is not the best option to regain our activities that we’ve lost due to the pain.

And third, it tells us that we need to figure out a way to still respect the pain while not being fearful of it. Simply listening to your pain, being brave, and trying things out gently is a key part in progressing as tolerated. 

Fundamental 2: Coordinated Movements

This is where my expertise as a doctor of physical therapy comes into play. I am an expert at understanding movement. Both functional and dysfunctional movement patterns come into my clinic every day, and it is my job to ensure that even with the pain that your back is experiencing, you are still able to do things as tolerated to best get you back on your feet.

​So how do I do that?

I ensure that your coordination at remaining in neutral spine position is solid before anything else.
Try the “bird dog” or “dead bug” exercises to see if you have reasonable spine coordination. If your spine moves significantly from its normal resting position during these movements, you definitely have a coordination deficit. 

Bird Dog:


Dead Bug:


Of course there are many more tests I use to assess for appropriate lumbar coordination; however, these are just two that are tried-and-true in my practice. 

Fundamental 3: Strength

Once you have gained a reasonable amount of coordination in keeping in neutral, we add some intensity. Longer holds, more variance, more load… all are options depending on the goals of the client. 

Aim for two minutes of great coordination with dead bugs and bird dogs to understand what a strength requirement standard should feel like.

The key variable is the coordination. Once coordination falters, you have to work harder or regress to something easier.

Once these three fundamentals are working at a reasonable level, your function should definitely be improving. If you’re still having difficulty after working on your day to day activities, your coordination, and your strength, you may need more guidance from a physical therapist. 

My job is to guide you through low back pain that isn’t responding to basic exercises. If you think that you’ve tried all you can, feel free to reach out to receive some more specific guidance to you and your situation. We’re here to help!

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​Look out for Part 2: The Hip’s Role in Low Back Function - coming soon!

Thanks for reading,

Dr. Marcus Rein, PT, DPT, CF-L2

  1. Malmivaara A, Häkkinen U, Aro T, Heinrichs ML, Koskenniemi L, Kuosma E, Lappi S, Paloheimo R, Servo C, Vaaranen V, et al. The treatment of acute low back pain--bed rest, exercises, or ordinary activity? N Engl J Med. 1995 Feb 9;332(6):351-5. doi: 10.1056/NEJM199502093320602. PMID: 7823996.

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