Acute (Days 1-7)

• Ask yourself "what have I done and do I need someone else's help?"

• If you have had an accident or acute injury, it is best to seek help
• If you are concerned you may have broke something or need some medication to deal with intense pain: SEE YOUR DOCTOR
• If it is not an emergency, but you need help with pain, function and mobility: SEE YOUR PHYSIOTHERAPIST FIRST, not your doctor

• If you determine you don't need help just yet, but your back is acutely sore:

• Lie down on your back on a firm surface and ice your back for 15 minutes at a time every hour you are able to for the first 3 days
• Start doing gentle pelvic rock movements to help your back from seizing up
• Start doing gentle hip stretches on your back and pelvic rock movements on your hands and knees
• Avoid soft couches and beds for the first week
• Once the intensity of the pain has subsided start using heat and ice for days 3-5
• Shift to just heat when you feel your problem is more stiffness than acute pain
• Visit a physiotherapist if the pain has persisted more than a week

Sub- Acute (Days 8-90)

• Ask yourself "why did this happen and what am I doing to make it worse?"

• Seek to understand the root cause of your problem by referring to the Why Backs Hurt and discussing what you've learned with your physiotherapist

• Consider how repeated daily tasks like sitting, standing, breathing, walking and lifting may be contributing factors

• Consider what type of treatment is most appropriate for you:

• Physiotherapy, IMS, Acupuncture, Manual Therapy, Prescriptive Exercise

• Massage Therapy, Osteopathy, Visceral Release, Craniosacral

• Chiropractic, Active Release Technique, Spinal Decompression

• Pilates, Yoga, Basic Fitness, Strength & Conditioning

• Start to create more body awareness about how you may have been compensating for the pain you have been experiencing for the past week to month

• Look at your posture and alignment in a mirror
• Pay attention to how you are breathing

• Try to note your pain patterns (i.e. what hurts when and how does it feel)

• Start Working on the WTH Step 1 exercises to create body awareness and mobility

• Start making your own health record.  Don't just leave it to your doctor and physio

• Writing things down all in the same place will help you get through your pain now and be a helpful record in the future

Chronic (Days 90+)

• Come to terms with the fact that you may not be able to wait this one out and not everything just gets better with time, in fact some things get worse with time unless you change your behaviour.

• If the pain gradually developed or seemed to arise for no apparent reason, don't get caught up on trying to find the one thing you did to cause the pain.

• Many times back pain is a case of "the straw that breaks the camel's back"

• Your long standing posture and movement patterns are likely to blame

• You are a product of everything you have done and experienced up to this point

• Find the right healthcare practitioner to help you follow a path of:

• Release: loosen tight, problematic tissues and joints

• Re-Educate: create body awareness and improve movement patterns

• Rebuild: build strength around new, improved movement patterns

• Suggested order of care if things don't seem to be working:

• Physiotherapist for IMS, postural awareness and spinal adjustments

• Massage Therapist/Osteopath for fascial and visceral release

• Physiotherapist for movement and strengthening exercises

• One-on-One Pilates progressing to group classes

• Family Doctor for X-Rays, CT scan or MRI
• Read some books to learn about the mental factors involved

• Chiropractor for manipulation and A.R.T.

• Highly trained Kinesiologist or personal trainer

• Spinal Decompression treatment if spine is quite degenerated

• Pelvic Floor Physiotherapist for internal exam and real time ultrasound

• Naturopath for prolotherapy injections

• Family Doctor referral to a back surgeon or specialist

• Physician performs nerve block injection

• Back surgery if all else fails

• Acknowledge your physical limitations, but carry on with your life as you work to improve your body e.g.:

• Tweak your golf swing and take a cart for now

• Drop down to a walk-run program for now

• Play doubles instead of singles for now

• Find a way to engage in active rest for your body that keeps you moving in ways you enjoy, but gives you a rest from the exercise you may be limited from

• Think about your body in terms of Pain, Prevention and Performance

• Don't stop paying attention to your body when the pain stops

• Find someone or something to help you work on your posture and mobility beyond your pain

• Find someone to push you to improve your body for the activities you love

Make your body a continual work in progress and you will get way more out of it throughout life

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