10 Do’s and Don’ts for Active Individuals With Low Back Pain

While low back pain is very common, most people are unaware of the Do's and Don'ts for active individuals with low back pain.
Person with lower back pain at a desk
Dr. Alexander Elahi
April 8, 2024

Low Back Pain is unfortunately very common. However, the good news is that the vast majority of low back pain can be treated conservatively without the use of rest, pills, injections, or surgery. In today’s blog we discuss five Do’s and five Don’ts for active individuals with low back pain.

5 Do's:

1. Do understand your pain is very real

Oftentimes, persistent pain involving the lower back is quite complex. This can be caused with or without the presence of tissue damage. Since our tissues might not incur any new damage, this can lead many people suffering from back pain to feel as if their pain isn't real. Persistent low back pain should be viewed through the same lens as other complex conditions such as diabetes, where many factors are constantly involved - not just one single influence. We now know factors including sleep, nutrition, hydration, and stress (both emotional and social) all play a part in low back health in addition to physical activity and fitness.

Regardless of which factor "ticked off" your lower back, your pain is REAL.

2. Do Remain Physically Active

One of the toughest bits of advice we give to our patients with acute low back pain is to continue to stay active. It sounds contradictory to standard medical advice of "rest and recover" but bear with me for a minute.

While there is no "hack" or "curative" exercise for low back pain, there are dozens of strategies to effectively mitigate long-lasting pain. One of those strategies is to continue to simply move. How frequently, how intense, how long is entirely up to you, but know this: there is no amount of exercise that is too little. (Griffin, O'Sullivan)

"Small strokes fell great oaks" is a favorite quote around the office. We appreciate the little roots of effort which have yet to bear fruit. But much like a plant slowly grows and eventually bears much fruit, your movement should also be slow and progressive. Our job at Key Spine Care is to make sure you are placed in the right soil.

3. Do Sit, Stand, and Slouch in Various Positions

We are not the posture police. Oftentimes, patients preemptively defend their posture and depict seated, driving, and standing postures they believe we are going to tell them they "need" to be like. 

Controversial Statement #1: We believe that movement is dynamic and variable, and so is posture.

We view posture to have many positions, including slouching, bending, and arching. Common healthcare and fitness warnings to avoid a specific movement of the spine are void of any currently published evidence. Additionally, this propagates fear of otherwise normal, everyday motions, such as bending forward to touch your toes.

4. Do Continue to Enjoy Meaningful Activities

Suffering with low back pain can be overwhelming. Focusing on anything other than the painful experience can be quite a challenge (I have had a few personal experiences with "hot" low back episodes in recent years, and it was difficult to focus on much else during those intense days).

Our advice is to focus on the tasks or activities that add value to your life. For me, it was going on a family walk with my wife. My pain was lost while focused on the conversation with my wife. 

An important take-home message about meaningful activities and low back pain is this: It is possible to do both. You can have pain AND enjoy meaningful activities & experiences. We had a patient at our office with an acute episode of low back pain AND he was still able to participate in a family trip at the same time. The family trip took priority over the pain. 

I am writing this today to publicly give you, your family, and your enjoyable life priority over your pain.

5. Do Maintain Your Social Life

Oftentimes, people experiencing low back issues feel secluded. They avoid going out with friends and they frequently miss social interactions at work if they are forced to stay home. As mentioned earlier, this feeling of seclusion can add additional layers to the multifactorial components of pain, such as stress or lack of sleep. This "loop" can only lengthen the time it takes for recovery.

One of our favorite treatment plan ideas is to have patients nurture meaningful relationships. Getting lunch with a close friend, coffee with a spouse, or a phone call to an old friend are all ways we can connect with other people and share memories. Frequently, it's within these close relationships that we can be honest with ourselves, and receive valuable insights, as well as much-needed encouragement.

5 Don’ts:

1. Don't Fight it - It is NOT a Sign of Weakness

Pain affects people of all ages, so it is important to note that you and I are not exempt and shouldn't attempt to fight it. This can create a "Vicious Cycle" in which a hyper-vigilant person attempts to fight the pain, which can lead to more regular "flare-ups", which can yield less physical activity, low mood, sleep disruptions, frustrations, and more intense reliance on pain medications and over the counter.

Rather than focusing on defeating pain, we (I say "we" because I need to hear this too!) should focus our energy and minds on what we CAN control. We can control our attitudes about our pain and our decisions around our lives, such as whether to exercise or not to exercise. Once a decision has been made, reward yourself for taking steps in the right direction - regardless of whether they were successful.

2. Don't Assume Persistent Pain is Due to Tissue Damage

Pain is an effective protector. Therefore, if you've injured an area before, pain is an accurate protective sensation warning of potential or worsening damage. Just like if the fire alarm goes off in the house, one doesn't know where the fire is or, more importantly, the severity of the fire. Did someone just cook on the stovetop with olive oil again and the whole kitchen is smoky? That's not the same intensity as if there were an actual fire coming from the stove. 

And yet, it’s the same fire alarm that goes off in both situations... 

The alarm doesn't tell us where the fire is, nor how severe it is. Pain is the same. 

3. Don't Rush If You Flare-Up

The journey to recover from pain is full of peaks and valleys. Patients frequently describe "good days" and "bad days". This is completely normal.

Rather than viewing painful flare-ups as a re-injury or a "setback", we can take this time to evaluate specific triggers and situations which provoked them. Factors such as a poor night's sleep, a stressful week at work, or a fight with your spouse can all provoke flare-ups.. The point is not to feel guilty about WHAT played a part in the flare-up but to observe it, address it, and learn from it.

Healthy Low Back Tip: Place a sticky note on your refrigerator that states, "A flare-up will come. I will be OK."

4. Don't Believe Everything You Hear, Read, or See (especially on social media!)

When pain reaches a certain point, most people are willing to try just about ANYTHING. 

With the rapid increase in online influencers, it has become increasingly challenging for patients suffering from low back pain to sift through the vast amount of opinions, myths, and information online. Unfortunately, there are snake-oil salesmen out there selling their remedies, so be on the lookout! When listening, reading, or watching someone discuss ways to treat low back pain, it is best to be extremely cautious and wary of anyone who claims to "cure" low back pain. Whether that is a chiropractor claiming to cure low back pain with a specific adjustment or technique, or a physical therapist claiming to cure it with a specific manual therapy method. Be wary, very wary. (This coming from a chiropractic physician!) 

Therefore, before choosing a particular provider, treatment, or approach it is important to research, discuss and investigate your options. What we do in our office is sit down with patients (or stand if that's more comfortable 🙂)  and we go through what is called Informed Consent, which we map out for them using the acronym "BRAN":

  • B: Benefits, as in, "Here's the benefit of exercises for low back pain." 
  • R: Risks, as in "Here are the inherent and potential risks of each method we prescribe." 
  • A: Alternative Options, as in, "In addition to chiropractic & physical therapy, another option is..." (which also includes benefits and risk for EACH option. Most providers RARELY disclose these and it proves to be quite costly for both time and effort.)
  • N: Nothing, as in, "Here's what you expect if you do nothing for your low back."  

5. Don't Rely on X-rays or MRIs

While medical images, such as X-rays, MRIs, and CTs are helpful in certain clinical situations, only a small number of people actually need them. A thorough patient history and physical examination will effectively dictate the medical necessity for an image. Providers who over-prescribe MRIs and X-rays for every low back patient are going against the current clinical practice guidelines! These clinical practice guidelines were put together by leading experts in chiropractic, physical therapy, neurosurgery, and medical research... So, basically, the authority figures on the topic and NONE of them recommend obtaining an X-ray on every low back pain patient! If you are in a medical office and X-rays are recommended, without explanation, as part of the practice’s Standard Operating Procedures (SOPs), you have my permission to quietly walk out of the appointment. 

Here's why the reliance on medical imaging has become problematic. One study showed that 40% of people over the age of 30 and 50% of people over the age of 40 have lumbar spine (low back) disc bulges on MRI. These people were asymptomatic!

So, it is important we don't equate what we see on the X-ray or MRI to the relevance of the person.

If you’re an athlete or an active individual who is also experiencing low back pain, then don’t wait any longer. Give us a call at (240) 206-0655 to book your Low Back Pain Assessment today with Frederick’s only Certified Primary Spine Practitioner!

Do this next!

  1. Share this article with a friend or family member who has been dealing with constant back, neck, shoulder, hip, or knee pain that we could help!
  2. Call our office TODAY at (240) 206-0655 to book your Low Back Pain Assessment today.
  3. Keep an eye out for our next article!


Derek Griffin, PhD, and Professor Peter O'Sullivan (Two of the world's leaders in managing and treating low back conditions and pain research.) 



Derek Griffin, PhD, and Professor Peter O'Sullivan (Two of the world's leaders in managing and treating low back conditions and pain research.) 


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