Do You Think There is Hope, Part 2: Low back pain

Low back pain can be frustrating, overwhelming, and often complex. Diagnoses range from disc bulges and muscle strains to arthritis, nerve impingement, or the ever-common “non-specific low back pain.” For those dealing with chronic or recurring episodes, a common question arises: Is there hope for me? While there's no one-size-fits-all answer, I can confidently say—yes. Even in cases with a long history of pain or failed treatments, meaningful and lasting progress is possible. But healing requires a shift in mindset. Instead of focusing solely on injury and fear of movement, we must understand the role of pain psychology and the importance of restoring proper function in the surrounding joints and systems.

Your chronic low back pain has changed your brain

This is an exceptionally complex topic, but pain phycology is important here. When we have suffered from chronic pain, recurring pain, and failed treatment, the way our brain will process pain can change. We call this central-sensitization.  When pain lingers, or becomes chronic, we develop increased sensitivity at this region. Of course this complicates the treatment process, as pain is being used as a protective mechanism to reduce activity and motion in this region. Perfectly healthy, non “damaging” movement is interpreted as painful and dangerous. We must work through this stage in the rehab process and re-introduce movement in stages, working to train the brain and body to see and trust that the low back can work into new positions without creating “damage.”

Here are some example movements that help re-introduce movement to the lumbar spine that begin to help not only work through mobility restrictions, but also create movement wins or new pain free movements. You may not be 100% ready for each of these movements, and one or some might be better than others to start.

1.        McKenzie extensions

These are a staple movement in low back rehab. We will start with the McKenzie extension, which is typically more helpful than the flexion alternative. This movement can have a direct impact on reducing pain, as well as re-introduce maximal end range extension back to the lumbar spine.

2.        Supine cross-connect

This is a great movement to re-introduce subtle motion at the pelvis, flexion into the low back, and static tension and contraction at the glute and core. We hold this position and push it by creating longer and deep exhales.

3.        Heavy banded sit backs

This drill is fantastic for re-introducing lumbar flexion. Here we use the band to help us move slow through the movement while emphasizing as much lumbar flexion as possible. This forces the abdomen and core to work into lumbar flexion as opposed to letting ourselves fall into it. It is most often the case that people with chronic low back pain have chronically tight lumbar paraspinal muscles. These muscles do the exact opposite at the core muscles and glute muscles, pulling the low back into extension and fighting flexion. Now we can do the opposite, pull ourselves into lumbar flexion…

Chronic low back pain has limited your movement variability

We addressed this idea above as well. Re-introducing missing ranges of motion, typically flexion, into the lumbar spine can be a game changer for people suffering from chronic low back pain. The issue is that working these motions back in can take time if we don’t want to flare things up. Professional guidance is especially helpful here to help find the right movements at the right time. We combine the improved mobility with the movement “wins” that the brain and nervous system needs to restore pain free motion to the low back. Now we can spend the time to train and improve strength. Mobility at the surrounding joints, re-train core stability strategies that protect the low back, and work to improve your ability to create maximal force and speed between the lower and upper extremities (vital for golf performance). The movements listed above are great for improving lumbar spine mobility, here are a few more as well as some force producing movements that begin to challenge the low back once we have built up tolerance and confidence…

1.        FRC thoracic spine rotation PAILS/RAILS

This movement focuses on turning through the thoracic spine, but we still rely heavily on lumbar spine and core stability to allow the thoracic spine to rotate above it. This helps address a common area of mobility restriction (thoracic spine) while challenging the core and low back for stability.

2.        DNS low oblique sit

This is a fantastic movement for working to improve hip mobility under load. We are training the pelvis to rotate on a stable femur, effectively creating rotation at the hip joint like it is needed in the golf swing (in a closed chain). We also get flexion at the low back, extension at the hip, and challenge core stability.

3.        3d band split stance rotations

This is a great comprehensive movement that challenges rotation throughout the body and spine. We load into a single leg with our body weight while rotating the pelvis over that leg, maintaining a hinged and flexed low back position, and rotate the trunk and thoracic spine on top of it. We challenge thoracic spine rotation mobility AND strength/ motor control while doing the same for the hip and pelvis. The low back must work hard to mediate and these two things happening above and below it.

Conclusion

No matter how long you've been dealing with low back pain, there is always hope—hope that doesn't have to involve surgery or injections. While those interventions may have their place, they should never be considered without conservative care. Without addressing the root causes—like mobility restrictions, motor control deficits, or joint dysfunction—those procedures often leave the original problems unresolved. In fact, surgeries can worsen central sensitization by introducing more trauma, and injections don't restore movement or control in the areas that need it most, like the thoracic spine, hips, and pelvis. Fusing vertebrae doesn’t improve mobility, and numbing pain doesn’t re-train how your body moves. Real, lasting relief comes from restoring function—not just reducing symptoms. That’s where the real work—and real progress happens.

-Dr. Nick DC, MS, TPI, CSCS

If you would like to learn more about your body, pain, and performance, send Dr. Nick an email at contact@integratedrpc.com or call at (585)478-4379, or schedule a FREE discovery visit at Contact.

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