Chiropractic care for patients with low back pain (LBP) not only includes spinal manipulation or adjustments but also patient education in regards to heat/ice, performing daily activities, and exercise.
Heat vs. Ice: This topic is controversial, as often patients will be told by their friends and family to use the opposite of what a doctor of chiropractic may recommend to his/her patients. In general, when pain is present, there is inflammation… so use ice to reduce swelling and pain. When heat is inappropriately utilized during this inflammatory phase of healing, vasodilation (an increase in blood supply to the already swollen injured area) often results in an increase in pain. Heat may be safely applied later in the healing process during the reparative phase of healing, but as long as pain is present, using ice is usually safer and more effective.
Daily Activities: Improper technique for sitting, bending, pulling, pushing, and lifting can perpetuate the inflammatory phase, slow down the healing process, and interfere/prevent people from returning to their desired activities of daily living, especially work. Improperly performing these routine activities is similar to picking at scab since you’re delaying the healing process and you can even make things worse for yourself.
Exercise: There are many exercises available for patients with low back pain. When deciding on the type of exercise, the position the patient feels best or at least finds less irritating is usually the direction to emphasize.
More specifically, for those who feel a reduction in pain when bending forward (referred to as “flexion-biased”), flexion exercises are usually indicated. Examples of these include raising a single knee to chest, double knee to chest, posterior pelvic tilts, sitting forward flexion, and hamstring stretches.
When bending backwards results in pain reduction (referred to as “extension-biased”), standing and bending backwards, performing a sagging type of push-up (“prone press-up”), and laying backwards on large pillows or on a gym-ball are good exercises.
The dosage or duration exercises must be determined individually and it is typically safer to start with 1 or 2 exercises and gradually increase the number as well as repetition and/or hold-times. If sharp/”bad” pain is noted, the patient is warned to discontinue that exercise and report this for further discussion with their chiropractor. It is normal and often a good sign when stretching/”good” pain is obtained at the end range of the exercise.