Dr. Nathan Kadlecek, PT
Is a physical therapist committed to providing high quality health information, largely focused on lower back pain and the gross overuse of diagnostic imaging, medication, surgery, low quality treatment methods, and the over-diagnosis of pain conditions. He's also a powerlifter, pain nerd, macro-scale thinker, and wants to help you think differently about pain, healthcare, and life.
1. Take 10 deep breaths if possible
2. Find a couple movements that feel good. Find a direction of movement that feels okay.
3. If cleared by your doctor, NSAIDs can help. (tylenol) (this is not advice telling you to take medication)
5. Recognize that usually when your back seizes up, it's not due to anything seriously dangerous occuring like cancer, a fracture, or anything like that. If you've had recent trauma then yes, you should get that checked out.
6. Red Flags would include worsening numbness, tingling, weakness, and bowel and bladder changes. This would indicate a need to see your physician ASAP.
If you need help from a back pain expert, join our facebook group and ask a question!
Does it hurt? Then no, you shouldn't squat in the MANNER in which you're doing it.
You should still try to change a few things up though...
1. Decrease the weight
2. Change your stance width
3. Change from low bar to high bar or vice versa.
4. Try front squats or goblet squats
5. Shorten your range of motion (don't go down as deep)
6. Change your tempo. 3 seconds down, 3 seconds up. This will also force you to reduce the weight, too.
Those are my most practical tips to stay squatting while you're dealing with back pain.
Whether or not someone needs to change their mattress is one of the most common questions I get.
The short answer is, probably not (although it's possible).
I'm going to share a few things that you should be addressing before you decide to go buy a $2,000 mattress that may or may not help you.
1. Movement. Are you moving? Are you exercising? If not, why not? If it's because it hurts, you'll need to find a way or some different movements that don't hurt as much. Working with a professional can be very helpful in this regard.
2. Mindset. Are you deathly afraid of your current condition? This fear can sometimes lead to lack of movement and perseveration on the problem which in turn leads to worse outcomes and often times more pain.
3. Stress. Are you managing your stress well? If not, this can contribute to pain levels, too.
There's more, however I've covered those in other videos that I will link in the cards and end screen :)
What is the best treatment for degenerative disc disease?
Now, DDD is actually really common and it's just a normal part of aging. The imaging findings that lead to this diagnosis of DDD is going to be highly prevalent in populations 50 and older. It progressively changes as we get older.
DDD really isn't a disease, and I wish that the medical terminology was changed on this.
Yes, it is true that people with more "findings" on imaging tend to have more pain, however it doesn't mean that one specific thing (that we can identify), is the pain driver itself.
Pain itself is complex and there are many factors that go into this including, sleep, physical activity levels, stress, social engagement, etc.
Short answer: For some yes, for some no.
As with most medication, it depends on you. This is a conversation to have with your doctor, especially if you're having negative side effects.
Side effects of gabapentin can include fatigue, brain-fog, and balance disturbances. Make sure you consult with your physician if you have any serious side effects or if your pain gets worse!
Step 1: Improve your activity levels. It's important to find movement that you enjoy, and, that doesn't flare symptoms up too much. Degenerative discs can be symptomatic or asymptomatic, and the treatment is the same, find movement that works.
Step 2: Update your understanding of what degenerative disc disease actually is. If you don't understand what's going on, that can cause confusion and fear. When we are confused and fearful, we make poor decisions. Educate yourself. You're already doing that by reading this and watching this video :)
Step 3: Be consistent with your movement patterns. Movement is a lifestyle and you can't get around it if you truly want to be healthy. If you're hurting a TON and can't find something that does work for you and you've tried a bunch of stuff already --> we'd love to chat with you and see if there is anything we can do to help.
Click this link to get our "success guide," and to book an appointment to speak with us.
Quick answer is NO. I scoured the internet to see what the research had to say, and the only thing I found about paralysis was an osteophyte, or a piece of extra bone growth that compressed the vocal cords, and that was only one person.
Personally, i've never seen some become paralyzed from degenerative disc disease, and most people who have back pain and are symptomatic tend to do really well with a movement program in addition to improving their beliefs around their spine.
If you have a herniated disc and you have progressive numbness, tingling, bowel and bladder changes, and weakness, that you don't take care of, yes, that could lead to paralysis, but that's about it
What do you think? Are you still afraid about becoming paralyzed?
Have you ever used muscle relaxers for lower back pain or sciatica? In this video I dive into when they may be appropriate to use, when they are not appropriate to use, and what to look out for. This video is going over a systematic review (a review of many research papers) of the proper use-cases of muscle relaxers.
"Skeletal muscle relaxants are effective agents used for the management of acute nonspecific low back pain. However, the risk of adverse drug events raises concern for their safety in routine use. In the past decade, the overuse of some agents has grown drastically, with an increased incidence of adverse effects. In addition to sedation, patients may experience headache, dizziness, blurred vision, nausea, and vomiting.
The potential for abuse and dependency seen with carisoprodol resulted in its reclassification as a controlled substance in 2012 by the DEA. Ideally, this agent should be used with caution due to lack of efficacy, abuse potential, and risk for active metabolite accumulation.
The medications in this class are commonly used to treat acute musculoskeletal back pain, but they are often taken in higher quantities and for longer durations than recommended. Since evidence supports their use only for acute low back pain, they should be used temporarily for pain relief. This also prevents the extended masking of any underlying condition causing the back pain.
There are no set guidelines as to which agents are preferred; therefore, clinical judgment with proper understanding of the drug characteristics and patient-specific parameters should guide appropriate drug selection.6 Health care providers must use their judgment to weigh the pros and cons of prescribing a muscle relaxant while tailoring therapy to the individual needs of each patient. As evidence improves, recommendations can be modified, allowing patients to achieve safe and effective relief of their acute low back pain."
Witenko C, Moorman-Li R, Motycka C, et al. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. P T. 2014;39(6):427-435.
This video is focused on long term solutions to solve lower back pain.
Solving might not be what you think though.
It might not be "fixing" a positional fault, or really fixing a biomechanical issue at all.
While there are certainly some biological drivers of pain (there always is), what's even more important is to look at the context around pain.
How is it impacting your life, what activities are you trying to get back to, and ultimately what is the best way to go about improving your current situation?
There are a few key steps:
1. Determine whether you're causing more damage or not. Once you've determined that it's safe to move and that you aren't causing more damage, it's much easier to develop the confidence in your body that movement is okay, and safe.
2. Find movement that you enjoy. Ideally rehabbing an injury or improving pain should be done by finding movements that you enjoy and that you can be consistent with. There is no sesnse in slogging away at things you hate, particularly if you won't be consistent with it. The process is always easier if you can enjoy part of it.
3. Stay consistent and adjust as needed. It's tremendously improtant that you stay consistent witih your rehab program AND adjust as necessary. It doesn't make sense to keep doing the same stuff over and over again if it's not improving your overall quality of life and bringing you closer to your ultimate goal and outcome.
What do you think of those steps, anything I missed? Comment below, i'd love to hear from you.
There are a few “conditions” that i’ll share below that are complete nonsense. You’re not “stupid” for believing these, a multitude of practitioners still peddle in falsehoods (unknowingly) and outdated treatment paradigms. I’m not going to go into full detail into each of the conditions in this article as it would likely become a books length, but i’m going to keep it short and to the point. (at some point I may update this article to become more exhaustive)
Bulging discs and degenerative disc disease
These are normal findings. Let me repeat, these are normal findings in most adults. (insert disc degeneration findings)
Please refer to my first sentence saying “I’m not saying these things never contribute to pain.”
As you can see from this graphic, in people who have NO PAIN whatsoever, these findings are present.
You might be saying, “well, I have pain, and I have those findings, so those don’t apply to me.” Absolutely. I think the disconnect between the statement above is that providers will tell people “oh hey, good news, that’s normal,” but then the patient, or you, thinks, “okay… well if that’s normal, then WHY DO I HURT?”
Sadly the conversation often stops right there and everyone is just as confused as when they first walked into the appointment.
There are several reasons “why you hurt,” which we are going to discuss later on in this article/video.
Disc herniations (pinched nerve)
Large disc herniations can certainly be a direct cause of symptoms as they may compress spinal nerve roots to a large degree causing decreased blood flow to the nerve root, resulting in metabolite build up, leading to more “danger signals,” being sent up to the brain, resulting in a painful sensation down the leg. The challenge with this though, is that not everyone who has compression of a nerve root actually has severe symptoms. This is why it’s important to do a clinical exam prior to getting an X-ray, or an MRI. Additionally, the larger the disc herniation, the higher the likelihood that it will resorb (heal) naturally, with time.
Again, this can cause some cord compression or if it’s foraminal stenosis can cause compression of nerve roots. But, as we discussed above, this can cause symptoms or people can have little to no symptoms.
While it’s certainly true that some people who have scoliosis have more back pain, it’s also true that most people will be able to improve their symptoms even if they have scoliosis. In more severe cases of scoliosis where the curve is excessive and causing breathing issues, surgery can sometimes be indicated. In the majority of cases a small degree of scoliosis is actually pretty normal, and by making some lifestyle improvements you can actually reduce a lot of the symptoms.
Lots of people experience these. They are incredibly painful and often times they come out of the blue from movements as simple as picking up a sock off the floor, sometimes bending and twisting, etc. The interesting thing is, that it’s not always from lifting heavy objects. Often times people will experience back spasms in their lower back from doing simple, low effort activities. Causes of back spasms, again, goes back to our body trying to protect itself, even if it doesn’t necessarily have to.
Subluxations or bones going out of alignment.
This is complete and utter nonsense that needs to die a fiery death. (can you see how much I disagree with this teaching from so many practitioners). It’s simply not true, it’s not supported by the research, we can’t reliably find differences in bone positioning or bony landmarks between different providers, it’s useless.
I’m going to link to a few different articles you can read about this.
Pelvis is rotated or twisted
This is complete nonsense. The only way for this to happen is with severe trauma, or potentially ligamentous laxity with childbirth. So… this doesn’t happen, it can’t be correct by muscle energy techniques, or massage, or a hammer and chisel… it just doesn’t happen and you can’t correct something that is imaginary. I expect to get a lot of hate from this one even though I clearly articulated in the beginning of this video of what the true nature of pain is.
I’m going to link to a few different articles you can read about this.
Leg length discrepancy (hips are off)
Complete BS and utter nonsense.
Subluxations, bones out of alignment, and leg length discrepancies or rotations all make a critical error, that our body isn’t adaptable to various positioning of our bones and joints. And, there aren’t even reliable measurements to show these things happening under randomized controlled trials.
Why people feel better after getting these things corrected has an explanation too, which put simply… is because people trust the provider and believe that it will help. If there is nothing to correct, but you believe there is something to correct, and then that person “corrects it,” and you immediately feel better, wala, problem solved.