Top 5 Fridays: 5 Ways to Manage Acute Low Back Pain | Modern Manual Therapy Blog

Top 5 Fridays: 5 Ways to Manage Acute Low Back Pain

There are many ways to manage low back pain, some are easy, others less so. Some involve hands on techniques, some are completely hands off.

Much of it depends on the patient's beliefs, past experiences, how they present on movement, fear avoidance, and more. This list is not comprehensive, but it is how I went about it recently in 2 similar cases.

1) Threat reduction
  • case 1, a gym manager who performs a ton of resistance training, mid 20s, severe central LBP
    • first ever acute low back pain, central, could not walk upright
    • threat reduction was to assure him, since it was non-traumatic, that 80% resolve rapidly and often on their own (but we can speed that up)
  • case 2, a mother, mid 30s, who has very high fear avoidance with LBP only, severe right sided LBP, no radiation
    • some history of similar pain, but the fear avoidance comes from a DC who told her in her teens that should would be paralyzed if she did not get regular adjustments
    • her biggest fear now is not being able to take care of her children if this happens
    • threat reduction was to assure her
      • it has always been addressed and gone away in the past
      • you will be better day by day if you keep moving and doing the right things
2) OMPT to improve ability to tolerate load as neither could walk upright without mod-sev pain
  • Case 1
    • repeated extension in standing was rapidly regressed for case 1 as he could not even stand upright without severe 10/10 pain
    • lumbar rotational manipulation was performed bilaterally, which enabled him to lie prone on elbows
    • prone on elbows for 10 minutes enabled him to walk upright for about 10 steps instead of 0
    • IASTM to lumbar paraspinals to reduce tone followed by slow and progressive general P/A mobs right over lower lumbar spine for about 10 minutes enabled him to walk upright

  • Case 2
    • light QL release to decrease tone on right side
    • thrust manipulation followed by overpressure in modified hips offset rapidly improved her ability to perform REIS and REIL with hips offset
3) RockTape - or your preferred brand
  • regardless of research on non-specific effects, I'm just looking at threat reduction
  • Case 1
    • RockTape was applied to paraspinals to further reduce threat
    • this gave him "support" to be able to walk upright without having to bend over from pain
  • Case 2
    • RockTape applied to paraspinals and iliac crests (why? a bit more lateral pain, probably would have worked the same)
    • she described it as "giving me more stability" and also enabled her to walk around for much longer periods of time
  • keep in mind that in both cases, both were very guarded, but pain went from 9-10/10 to 4-5/10 on day 1, which is still significant reduction, especially when tolerance to load is returned
4) Home Exercises
  • Case 1
    • instruction on use of lumbar roll and repeated extension in standing if possible
    • if not, regress to prolonged prone on elbows, 5-10 minutes
    • followed by quadruped hip drop (less threatening to drop the hips and can be peformed more passively in cases of high lumbar extensor tone)
  • Case 2
    • instruction on rotation in flexion (loading right side in sidelying), this centralized her pain, and enabled her to perform REIL modified hips offset, or straight REIS or REIL
    • when having moderate end range pain at extension in lying, she was instructed to hold end range (elbows locked), and perform diaphragmatic breathing, which significantly reduced pain and enabled further end range through tone reduction
5) Persistence
  • keeping up with HEP, threat reduction, reassurance was paramount in both cases
  • while Case 1 has mostly resolved, he is hesitant at returning to heavy lifting, especially as he has several asymmetries and loss of ROM that may contribute to abnormal loading/unloading strategies, he is pain free
  • Case 2 is about 80-90% pain free, and her anxiety is still at occasional moderate levels, but after 3-4 days is doing much better
  • in many cases, all it takes is repeated loading/unloading strategies to restore the ability to perform ADLs in WB positions, pain science education, light OMPT, time, and reassurance
Keeping it Eclectic...


  1. All important points but I think 1 and 5 really ring true for me. Thanks for sharing.

  2. No problem! What else would you add to the list?

  3. I think I understand most of what you were talking about with this post, except for 1 thing. What does "rotation in flexion (loading right side in sidelying)" look like? Is this similar to an open book type of movement?