What do you do when your patient's acute low back pain patient is so irritable it flares with any lumbar exercises or manual therapy?
What If your patient can't perform even your usual gentle targeted low back exercises?
We often get stuck asking ourselves what the "right" low back exercise is for this patient that'll calm their pain.
Here's a different question you can ask yourself.... "Where can I exercise that still influences the back?"
When the low back won't tolerate targeted input or exercises, you can focus on moving it's neighbours instead - the hips and thoracic spine.
Or give them, as Dr David Toomey (NZ Titled Musculoskeletal Physio, PhD) calls it.....
"A non-low back pain program."
You could think of it like going on holidays to get away from a grumpy neighbour - you feel good and your neighbour gets a bit of a chance to calm down while you're moving around on holiday.
In this case, you keep your patient moving, stop them getting stiff in other areas as well, and even take advantage of some exercise-induced hypoalgesia (EIH) and distraction.
All without flaring up their pain and losing their trust before you've even started.
"It's a way of providing exercises for the low back, without doing low back exercises." Dr David Toomey
Here's one exercise you can use: the Knight's hip flexor stretch.
Half-kneeling, tuck the tailbone under (posterior pelvic tilt), then give them this image — imagine a rollerblade under each leg, front leg pulls back, back knee slides forward. The stretch deepens beautifully, you get a nice isometric contraction around the hips and hamstrings (once again getting some EIH), and the back doesn't have to do a thing.
You can describe it to your patient something like this...
Here are some exercises around the back that will get us in a position where we can do some specific exercises a little further down."
Learn more about this approach
Discover how to target acute low back pain with a "Low back pain movement flow", or a "Non-low back pain movement flow" for those really irritable patient presentations in Dr David Toomey's latest Clinical Edge member presentations.
Find out what's in this presentation and how it'll help you below.
Both of these presentations are available now with Clinical Edge membership. Click here for your access.
Clinical Edge members can login here to watch this new presentation now.
In this practical presentation, David Toomey reveals his “non low back pain” movement flow, a simple but highly effective approach that uses movement in adjacent regions such as the hips and thoracic spine to keep patients active, reduce fear around movement, and maintain exercise engagement during acute or highly irritable phases of low back pain.
Rather than abandoning exercise altogether, you’ll discover how to use gentle movement, mobility work and patient-friendly exercise progressions to de-threaten movement, promote confidence and encourage comfortable movement around the painful area.
Using practical demonstrations and real-world clinical reasoning, David walks you through a complete movement flow that can be performed in the clinic, at home or throughout the workday, with minimal or no equipment required.
In this presentation you’ll discover:
- Why direct low back exercises are not always appropriate during acute or highly irritable low back pain presentations.
- How movement in adjacent regions such as the hips and thoracic spine can help maintain movement confidence and reduce stiffness.
- Strategies to keep patients engaged with exercise when lumbar movement is poorly tolerated.
- How to introduce exercise without provoking unnecessary pain, fear or guarding.
- Practical hip mobility exercises including hip flexor stretches, glute stretches and hip internal rotation mobility drills.
- How to use simple imagery and cueing strategies to improve patient relaxation and movement quality.
- Thoracic extension exercises using foam rollers, couches, benches or kitchen counters.
- Thoracic rotation exercises that improve movement confidence while minimising lumbar irritation.
- How to encourage relaxed, intuitive movement rather than over-cueing or rigid movement patterns.
- Why “greasing the groove” with frequent comfortable movement can be more effective than rigid sets and repetitions during acute pain.
- How to adapt exercises based on patient comfort, irritability, mobility restrictions and previous injuries.
- Ways to integrate movement opportunities throughout the day to improve confidence and reduce fear avoidance.
- You’ll leave with practical movement flows, adaptable exercise options and useful clinical strategies to help highly irritable low back pain patients stay moving, stay engaged and regain confidence with exercise earlier in rehabilitation.
Click here for your access, or login here if you're a Clinical Edge member.