5 Exercises for Acute Lower Back Pain


Earlier this week I posted about some myths and lower back pain. Here is a link.

Acute back pain is recent pain. Pain that is less than a couple months old. A takeaways I like people to understand about acute lower back pain are: it is very common and usually will go away fairly quickly, the amount of pain you have doesn’t always correlate to the severity of the injury, feeling some pain after an injury is quite normal and doesn’t mean you are harming it further, and moving and staying as normal as possible is generally the best course of action.

That is where exercise and activity come in to play. Many people are understandably fearful or worry about hurting themselves more. And, the message we commonly hear is if you lift wrong you will damage yourself, bad posture will wreck your back, be careful you will hurt yourself, or don’t do too much. In truth staying as normal as possible and moving is helpful. This doesn’t mean you should ignore your pain and do everything full on. But it does mean you can continue to do some things even if there is some manageable pain or discomfort.

Many people will find movement is more comfortable than being sedentary. They will find sitting or first thing in the morning is worse and walking and changing posture is better. With acute pain the goal is to get your spine moving all the directions it needs to move without aggravating things. Sometimes specific movements will reduce symptoms. If this is the case then focus on doing that movement frequently through your day. Sometimes a specific movement will aggravate things. If that happens, wait to do it a bit longer and reduce activities in your day that are similar. Sometimes just general movement will help. All of these motions are safe. So try them. If they help keep doing them. If something doesn’t feel right back off or wait a bit on that exercise.

Press ups: These exercises extend your spine or back bend. Many people find these can reduce pain, especially if you find sitting or bending over forward is painful or difficult. If they do reduce pain try to do them 10 times every hour or 2.


Prayer: This stretch flexes or fully bends your spine. It does it in a position with less weight on your back and can also provide a bit of traction. prayer-stretch-02

Open Book: This stretch rotates your spine. It focuses on your mid back, but can be a good early comfortable way to begin some easy twisting.


Cat and Camel: This exercise works flexing and extending your spine in an easy position. It also allows you to begin active control work with your pelvis, hips, and core with not too much load on your back.


Walking: If you are comfortable walking, it is a great activity to help your recovery. It gives you overall body movement, can get you outdoors, and get your cardiovascular system going. Sometimes you can only tolerate short distances. Its Ok. Do what you can and build it up.


These are exercises for new back pain or injury, although many people can use them at any stage of recovery. They won’t cure you, but they can keep your spine moving, and in some cases give people some relief. Ultimately, pain resolves as we heal and our nervous system feels we are safe. Moving can help this happen. I will do some future posts on other exercises for other stages of back pain.

As always post questions or comments here. Give us a call at 970-949-9966 if you have questions or ascent-pt.com.






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5 Myths About Back Pain


Last week I put up a poll in the Eagle County Mountain Sports Injury Group about things people wanted to know about.  Here’s a link to the group if you are interested.

The most answered topic was back pain, and a couple of people asked about exercise for back pain. That can be a tricky question, because there are lots of different reasons for back pain, and they can call for different strategies.  I will answer that in an upcoming post. But, today I wanted to talk about some of the myths and misconceptions about back pain. Back pain is very common. And there is a lot of fear and uncertainty for people about. When you see some of these misconceptions it may help you understand why exercise might be so variable. So here are 5 common myths about back pain.

  1. Your back needs special protection in regards to posture and specific exercises or it can get damaged because it is so weak and fragile: This is the biggest myth I see in people’s understanding of their back and the messages they get from culture and the medical system. Yes low back pain is common, and it can be serious and very limiting when it happens. But, your spine is actually very strong and resilient and is designed to tolerate all kinds of heavy loads and various postures. Do we need to be careful and limit things when we have an injury? Yes. Does sitting “wrong” or lifting “wrong” cause us severe problems? Probably not. If we are lifting high loads we should be aware of good posture. If we are sitting or sedentary a lot moving can help. But good general exercise has been shown to be as effective as any specific kinds to help your back pain.
  2. If you have back pain you need x-rays or an MRI for safe treatment or return to activity: Yes there are sometimes serious injuries or situations called “red flags” that require these tests. Examples are trauma that might cause a fracture, significant or progressive neurological changes, and severe intractable pain. But, most low back pain is not these things. Conservative management does not generally require these for safe effective treatment.
  3. If you have a disk issue you will have problems for ever and need to change how you live: This relates to the above issue. Many people get tests done with back pain. Those tests frequently show bulging, herniated, or degenerative disks. What people don’t understand is many people without pain would also have those findings too. Changes in our spine are quite normal as we age, and they aren’t always the sole cause of our pain. You can treat things conservatively, feel better, and the tests would not change.
  4. When you have back pain you need to stop doing everything until the pain stops: Pain is disconcerting. When we have it we are understandably concerned that we are hurting ourselves when we feel it. But, many times our system has become sensitized, and you are not causing harm, your body is just saying be aware or careful. Feeling some pain with activity is OK. Keeping active and as normal as possible, within reason, has been shown to be helpful in recovering from back pain. Try to keep up as many activities as you can and modify what you need to.
  5. Back pain is only about the damage to tissues and physical things I do to my back: Of course tissue injury and physical loads we place on our back affect back pain. But pain is seldom single cause, although that’s what we are all looking for, a cause to fix. Pain can have contributions from our biology, which includes tissue and structure but also things like stress biology, psychology, and sociology. So if you have persisting back pain it can help to also evaluate things like sleep, stress, nutrition, worry, and fear. Also understanding how the pain is affecting your life. Things like how it affects your job, family life and recreational activities. Many people get focused on what part they can fix, and miss other important contributing things.

As you can see, there can be a lot to back pain. Many people get it, and it may just be a normal part of our lives that we have to deal with time to time. If you have any questions about back pain, post a comment, call us at 970-949-9966 or go to ascent-pt.com.

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Patient Question Friday: Does _______ Work?


This isn’t one question I get from any particular person. Its a form of a question I get from almost every person. Does something work for my problem? The something can be a wide variety of options medications, surgery, creams or rubs, braces, straps, ice, heat, massage, acupuncture, taping, and others.

There are a couple of layers to this question. The first is what does the person mean by works? Do you mean fix my problem? Or more along the lines of will it help my pain to some extent? What I think some people mean is am I going to be spending my time and money wisely to try this.

The truth is the answer to the first question is frequently, no its not going to fix your problem. The body will fix most problems by healing. We can help that along with proper management of the injury. Rest when needed. Protect what needs protecting. Restoring movement, strength, and function at an appropriate level. Time is a factor. Now some of those techniques and products may help in that situation. Taping or bracing may protect something for example.

The answer to the second question, will it help my pain to some extent?, is usually maybe, or it might, or it could. But, everyone is different and we never know for sure. So, does that mean you should try these things?

I like to ask a few questions when assessing whether a technique or product could be useful.

  1. Is it scientifically plausible?
  2. Can it be harmful?
  3. Is it affordable for you?

The 1st question is probably the most important. There are many things out there that just make no sense from a scientific perspective. But, some people swear by them. Why is that? Its also sometimes difficult as a consumer to ferret out the evidence. Testimonials in ads are powerful and we don’t really have time or access to do research. The first thing to know is many products “work” in the sense of reducing pain. The issue is sometimes the scientific reasoning is backfilled in after someone discovers something helps pain. They design a new product or technique. They want to market it. They know it needs an explanation to convince people. So they come up with a seemingly plausible reason that it might work, it puts you back in alignment, it changes blood flow, it releases energy. They usually don’t have much science behind it.

There are some reasons that many things “work” in many people. And there is science behind it. Pain from tissues is driven by your nervous system as a protective response. You have an injury and nerve endings send signals detecting mechanical stress, temperature, or inflammation up to the brain. The brain processes these signals and determines what to do. This can be pain. Many of the things I listed above alter the signals the nerve endings send up to your brain. Heat and ice affect temperature. Manual therapies and taping affect mechanical stresses. If we get a different input from the nerve endings, we can get a different out put from the brain. We may experience less pain. We aren’t really changing the tissues, we are influencing the nervous system.

Two other plausible reasons things “work” from a scientific reason are treatment alliance and placebo/treatment effect. Treatment alliance has to do with your relationship to the person giving you advice or helping you. We know that if you have confidence and trust in the person you are getting advice from or working with you will have an improved response. Placebo and treatment effect also play a part. Knowing we are doing something has a powerful effect on our nervous system. Even if the treatment isn’t doing a lot biologically, it can affect pain perception and biological systems.

So if we determine that there frequently is at least some plausibility, what should we do? I then assess the nest 2 questions safety and cost. If we know something is really safe and very affordable. There is no reason not to give it a go. Most conservative things are pretty safe. Many are free to try at home or minimal cost. Go for it. It may give you relief, it may not. But no harm done. Things like surgeries or other major procedures are where the questions come in. Their is a lot more risk when we get involved with these. That’s when we really need to focus on why someone is having pain, and if these procedures really will “work”.

If you have questions about something, post in the comments or call us at 970-949-9966 or ascent-pt.com


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Concepts of Pain

conceptsof pain

Last time I talked a bit about “pain science” Here is a graphic that talks about some of the core concepts of pain. Some of these concepts are becoming more well known in the medical world and to the average person. But, when I talk to people, many don’t really understand them, or in the medical world treatment and language don’t reflect that. Many people still think and believe that pain always means damage. The amount of pain reflects the amount of damage. Persisting pain means increasing severity of your physical or structural condition. And, pain must be reduced or eradicated before you can continue to move forward with your life. These beliefs are well-ingrained not only into our culture, but also our medical system. People will continue to search for a “fix” and there are plenty of people willing to offer them “the fix”.

Now, of course, sometimes damage and pain correlate quite well. You break your leg, cut yourself, or sprain your ankle and their is structural damage to bones, skin, ligaments, muscles, or tendons. In a normal situation they are painful at first, as they should be. Then as time goes by you heal and the pain steadily resolves and you feel better. You assume you healed so your  pain went away. This is acute pain. But, sometimes normal healing times pass and the pain is still there. Sometimes even worse than it was when it was new. This is persistent or chronic pain. You assume you have pain because something is not right in your structure. Something hasn’t healed right or is out of place or is not working right. And sometimes that is true, but sometimes something else my be going on. You might be having a pain problem.

Over the next couple weeks I will go in detail about the 6 core concepts of pain mentioned above. There are lots of other important things. But, these concepts are a good place to start. So keep an eye out.

If you have pain issues, and aren’t sure what to do give us a ring at 970-949-9966 or our website at ascent-pt.com.

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What Is Pain Science?


On or facebook group last week I was asking what people might be interested in for content. Someone responded more about pain science. Here is a link to the group if you are interested in checking it out.  Eagle County Sports Injury Group

The person asking was a physical therapist. So, to the average person the term pain science may not mean a lot. So over the next few weeks I will intersperse some posts about pain and “pain science” here. Today I will try to define it, although it may mean different things to different people. I will say what it means to me.

Most simply pain science is the science of pain. You might think how much science is there about pain? You damage something or injure it and it hurts. When it heals or I get straightened out then the pain goes away.

Well it turns out there is more to it than that. The International Association for the Study of Pain defines it this way. “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

A couple of things to note. One is that pain can occur with actual or potential damage. So it is not as straight forward as damage equals pain. The other thing to notice is that pain is an unpleasant sensory and emotional experience. That brings in a lot. It means we are dealing with biological, psychological, and social processes. That means we have lots of areas of science that are contributing to pain science.

When I think of trying to understand pain science it takes understanding in things like biology, structure and mechanics, neuroscience, psychology, kinesiology, sociology and communicating with people. Lots of stuff. Pain science isn’t a thing you do to fix people. It is a way to understand pain and to help people understand how to move forward with their pain.

So to me pain science involves:

  • Knowing when to push something and when to rest
  • Understanding all the complex factors that affect your pain other than an injury
  • Understanding how pain can change a person’s life
  • How to communicate with people so they are heard and can work toward their goals
  • Knowing how getting back to life despite pain can sometimes be helpful
  • Helping people understand what they can do to manage their own pain
  • Understanding the pros and cons of various orthopedic procedures in relation to pain
  • And knowing that as much as we think we know about pain, its just the tip of the iceberg.

When we think about pain science, what we are really talking about his how we work as humans. We are dealing with every part of our system. Our muscles, bones, ligaments, tendons and joints, yes. But also our nervous system, brain, and identity. We are trying to understand how humanity works in a nutshell.

I hope this helps, and over the next few weeks we will talk a bit more about how pain works as far as we know now. It will keep changing. Its always interesting and exciting, at least to me.

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Natural Medicine.


When people are recovering from pain or an injury, most people want to know what to do to make things move a bit faster. I like to touch on all aspects of the biopsychosocial aspects of health when we talk about this. Of course things like the right amount of rest, doing your exercises, not doing things to soon, using ice etc.. are all helpful.  But, people don’t often consider the other things, their mental health and social life. When people are in pain or injured, lots of things change. You might be in bed or sitting around the house a lot recovering. Maybe you are off work. You can’t get outside and do your favorite activity here in the mountains. Social hour with your friends doesn’t happen. You aren’t being you. All these things are healthy activities that we use to cope with the difficulties and stresses of life and renew and refresh ourselves mentally and physically.

In relation to this, here is a link to an article about doctors in the UK prescribing nature to help with various health issues. We are more and more recognizing how needed activity and being out in the world are important to health, just as world puts us indoors with more difficult access. So weather you are healthy now, or recovering from an injury or in pain, finds ways to add some nature to your life, even if its different than normal.

Nature prescriptions

If you have any questions about exercise and health, give us a call at 970-949-9966, or drop by our website ascent-pt.com.

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How Bad Is Not Exercising?


sylvan.jpgAn interesting article about research into exercise. We know that exercise helps us mentally and physically in all kinds of ways. This research shows how harmful not exercising regularly can be on your heart. Long term issues at higher rates than smoking and diabetes among others. So keep on being active.

Here is the link to the article.

If you are having difficulty beginning or maintaining your exercise program because of pain or injury, a physical therapist can help. Call us at 970-949-9966 or go to our website.


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Non-Physical Load Tolerance And A Full Cup


A while back, I posted on load tolerance.

Load tolerance is the capacity our body has to handle a certain amount of force without breaking down or having pain. How much can you lift. How far can you run. How long can you go. How much stress a tissue can handle before it breaks in a trauma. No matter our fitness or pain situation we have a load tolerance, where if we go past it, we can have issues. This can be a maximum level of force on our body, or too much force for too long without enough time to recover. People with better conditioning and training will just be able to go longer, harder or heavier than someone who is less trained. Someone with pain sensitivity issues has to be more careful. We deal with load tolerance in preventing injury, recovering from pain and injury, and in safe training for performance.

One thing about load tolerance that sometimes gives people trouble, is when they have a pain reaction although they continued on a sensible plan. Especially during injury recovery. You thought you did everything right. You found out what a current safe limit is. You worked at that level. You steadily brought up your level of activity. Then, BAM!!! even though you didn’t increase that much you had a flare. You go over what you did in your training or rehab program and can’t find any mistakes. This can set people off. Wondering what you did wrong. Or what else is wrong with your body. Did somebody miss something? Will you be able to recover? This can spiral and cause people to give up on their program and go for more drastic measures which may not be warranted.

In this situation I like to use the full cup metaphor that I learned from Greg Lehman.


If we look at a cup that has liquid in it, when the liquid overflows we run into trouble. In our cup, the main thing we recognize is the health of the tissues we are dealing with. If we obviously go over our tissues’ load tolerance then the cup overflows. We can see this. But, we still don’t understand why when we exercised today the same as yesterday it hurts more today.

One reason, could be still physical. We could have stressed our tissues in ways that weren’t related to our exercise program. We used more stressful postures. We did more loading at home or work, just not in our exercise program. Our tissues register load all day, not just when doing formal exercise.

The other reason may not be physical. When the cup overflows, it may be a sign that our nervous system is becoming more protective. Lots of things can load our nervous system and sensitize it. Look at the cup picture above. Stress. Poor sleep. Nutrition. Worry. Fear. Anxiety all can play a role. Its different for everyone as we are all different in how we process things. But, if you do flare up, and you have sorted through all the physical things you can, check the other things. If life has been stressful. If you are not sleeping well. If you are more anxious about your injury, or other things. You may have an answer. Your tissues may not be worse or something else isn’t wrong. Your body may just be more sensitized that day. Knowing this can help. We can be more confident we are on the right path, and just having a harder day. If it continues to be an issue, it gives us a chance to figure out how to deal with some of the other issues that may be affecting our rehab or training.

Working with a physical therapist knowledgeable in pain can help. We can help sort through some of these things and help keep you on track in your training. If you have any questions post them in the comments, give us a ring at 970-949-9966 or go tohttp://www.ascent-pt.com/

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Hip Pain, culture, words and fragility


Last week I wrote a post about exercise after 50, which was inspired by a poor article by Reader’s Digest about how not to exercise and their correction. This week an article was published in Runner’s World about hip pain which also was disturbing and full of many myths.

This post was inspired by Ellie Somers. She is a PT in Seattle, who specializes in working with female athletes. I had the fortune to meet her last year at the San Diego Pain Summit. She wrote a great response to the article. I was disturbed by the article before I saw Ellie’s letter and had started writing in my head then saw it, but decided to write anyway. But here’s her letter.

I wanted to write about it because it is important for people to understand the myths that culture, health media, and even our medical system are spreading. Its also important to understand how words can affect us and our thoughts and beliefs about our bodies and our health. The old adage “sticks and stones can break your bones, but words can never hurt you” isn’t really true. There now is a body of research that shows that what we hear, see, and believe actually can affect us…A lot. We may fear doing things or trying things we love because a doctor tells us its harmful. If we have an injury or feel pain, we may worry over it and wonder if we really should be doing it. When we constantly hear messages in the culture or from medical professionals that we have to be careful, or if we do it wrong we will get injured, it changes our view of our body and what we should or should not be doing.

With the internet we have more access to information than ever before. But, we need to know what we are hearing is true. This is made harder because even among medical professionals information on pain and injury is outdated and sometimes biased. Its still common to hear that running is bad for your knees, structural changes from “normal” are always harmful or will eventually cause problems, you shouldn’t do x sport after a certain age, and many other messages. Many health providers and the media don’t even understand the power of these words on people, and many don’t even understand that the information is incorrect in the first place.

The basic message I took away from the article is because women have become more active they are hurting themselves. The reason for increased hip pain and surgery is exercise and sport. I think this is incorrect and a terrible message. We know that exercise is beneficial for health and wellness in untold numbers of ways physically, psychologically, and socially. To have a message that they might be hurting themselves is harmful. Exercise should be promoting fitness and strength. Not weakness and fragility. Sport should be a symbol of resilience and achievement, not fear.

Some reasons behind increased hip pain and surgery may be harder to deal with. Improvements in technology are allowing us to find structural “defects” that we didn’t know about previously. People have invented surgical techniques to deal with these “defects”. I am all for surgery that can help people. But the research now coming out on many of these imaging results and surgeries show they are not what we originally thought. Many “defects” are actually prevalent in people without problems. Outcomes on these repairs are not fantastic in many cases. Knowledge of “defects” even if they are common again begin to change our thoughts and beliefs about our body and may affect how we experience pain. People want quick fixes, and our system rewards those who offer them.

Pain is complex. People are complicated. The more we learn, sometimes the less we know. Deciding how to handle pain and injuries can be very complex. There aren’t always easy answers. But we need to ask the questions with every person. But we do know bodies heal really well. People are strong, resilient, and amazing. No matter what “they” say.


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Patient Question Friday. Knee Pain



I am going to start a regular patient question answer thing here on Fridays. I will take any questions if you have them, just post in the comments or email them in. Or I will take questions from people I see here in the clinic.

Jen from Edwards asked me ” I have knee pain when hiking, especially down hill, and riding my mountain bike uphill. What should I do?”

When I asked Jen a bit more about her pain, she described it as pain under her knee cap. In addition to hiking downhill and biking up hill, she notices it with squats and kneeling too.

This type of pain is often called anterior knee pain, or sometimes patellofemoral pain. There are different reasons we get it. But generally the surface of the patella or the femur where they contact each other becomes sensitized. All the things Jen describes her pain with increase load in this area.


To help the pain we need to figure out ways to decrease loads on this joint, at least for a while. Then we need to build up loads gradually to allow return to the activities that are an issue.

The first way is to look at activity management. Sometimes the issue is we ramp up activities to fast. We don’t do something much for a while then we jump in and do too much too fast. This gets things irritated and then we keep them irritated by trying to push our way through. Or we are sensitive enough that things like walking and stairs keep it going. The solution in these cases is to back down on the offending activities, as you feel better then gradually build them up. In Jen’s case we talked about hikes with less vertical descent and mountain bike rides with less steep climbs. As she is able to do this easily she can build up.

The second way to reduce load is to look at how your knee is loading biomechanically. The knee is caught between the hip and the ankle. Sometimes things happening above and below the knee can increase loads on the knee. By altering things you can make changes. A few examples are:

  • A stiff ankle may increase load on the knee. Improving ankle flexibility may help your knee.
  • Poor hip strength or endurance may cause increased rotation at the knee with downhill activities. Working on strength and endurance in our hips can alter these mechanics.
  • Poor balance can add stress at the knee every time we are in single leg stance. Improving dynamic balance can reduce these loads.

There are others also, but you can see there are different issues which load the knee. Changing these loads combined with progressive loading of the knee will work very well in reducing pain.

If you have tried dealing with your knee pain and are stuck, getting a physical therapist to look at your management plan and mechanics can be helpful getting you on the right track. If you have any questions about your knee or anything else, post it in the comments call me at 970-949-9966 or ascent-pt.com.

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