What do you do when your low back hurts so badly you can’t stand up straight?

What to do when your low back hurts so badly you can’t stand up straight

No 1– Don’t panic!  Our nervous system is really smart and when you panic, it makes everything way worse.  Trust me on this one.  I have been there many times.

No 2-Get into a position of comfort.  It may be sitting, lying down or any position that makes you feel good.  I had very bad back pain some years ago that I had to squat every block in NYC where I live, just to get to the bus stop.  Forget the subway, that was way too far!!  Trust your body on this one.

No 3-Know that the acute symptoms will calm down.  You will be left with lingering symptoms, which will need addressing from a good physical therapist.  The key here is:  knowing what NOT to do.  What positions to avoid rather than what exercises to do.  Knowledge is power and knowing what positions to avoid can be the difference in getting a good nights sleep or staying up all night due to your pain.

No 4-Ice, ice and ice.  I get a ton of questions about whether to use heat or ice.  I would use ice with any type of acute pain.  If you have a hot and swollen knee or ankle, then ice is your friend.  If your back hurts, I prefer ice.  But many of my patients say heat helps.  If there is an acute muscle spasm, I believe ice really works.  At the end of the day, use what makes you feel better!! There is no hard or fast rule, outside of swelling, which requires ice.

No 5-Stretching your back out by bending over, or stretching your hamstrings may not be wise choices if your back hurts when you sit or lean forward.  Hamstring stretching early on can aggravate a nerve and potentially flare you up again.   On the other hand, lying on your stomach and propping yourself on your elbows, the so-called “McKenzie Extension” may not be a good thing if you can’t stand up straight or have a problem bending backwards.   This varies from individual to individual and depends on what motion aggravates you.   Obviously this is for the acute stage and can change once the symptoms ease.

No 6-If you experience back pain with many different movements, like walking, sitting, getting up from a chair and just plain standing, then a lumbar support (belt) may help in the short term.



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Do old injuries matter? (Hint: They do!!)

Do past injuries matter? Remember that old shoulder issue you had?  Do you think it’s playing into your back pain which isn’t getting better?  I do.  Or that old ankle sprain?  I have had MANY of those!

Think about it…. you are a runner and your knee, hip or low back hurts. You rest, get some treatment to the local area of pain.  You go out for a run and BAM! you hurt again.  Why?  That is the ultimate in frustration.  Think about some old injuries you may have had.  Any foot issues?

Looking at your foot and seeing how you load your leg when you run can give you incredible insight here. Seeing a skilled physiotherapist who thinks out of the box will open your eyes to other potential sources to your current symptoms.

Simply put, you need effective push off from your foot when you run (and even walk!) and if you are not getting that propulsion, you will compensate somewhere else.

I suffered from chronic left hip pain for some time and it turns out that my old ankle sprain from years ago was causing me to run a certain way that was not really great for my hip. I compensated for a bit until I could not…

In my book “Why Do I Hurt” , I discuss a patient of mine who had chronic foot pain, but was not getting full relief of his symptoms.  His foot was a player for sure, but he had an issue in his mid back that was perpetuating his foot pain.  Go figure!!

Past injuries and old habits (aka “poor movement patterns”) play a BIG role in chronic pain.

Another example…

You’re into martial arts and all of a sudden that right jab causes you INTENSE low back pain. You are really sore to touch and have a hard time bending over. You rest, ice, and get some treatment. You return to your favorite sport and then your pain comes back.   Why?

True story-it’s because the low back is not the source of your problem.  It’s the poor victim.   When you have a sudden and intense injury like this, think about the mechanism of your injury. In this scenario, my patient was punching and jabbing, while her body was turned to the left.

We did not treat her low back; but we did treat her thorax. That is the part of the body in between the neck and abdomen (think rib cage).    When you have rotational injuries you must consider that area of your body as a potential source. 

Here is a free chapter of my book where I discuss common culprits to persistent pain issues.  Click here for the download.

If you’re starting something new or just living with an injury, please know that there is hope.  Looking at the body from a holistic standpoint can take you a long way!






Am I your last resort?

Thought I would add another glimpse into my podcast and how helping people with persistent pain is something I LOVE to do!!     Please click on the graphic above for a sneak peak.

Now, this is a CHALLENGING one! Ever have those patients who have been everywhere, had everything done to them (injections, surgeries, acupuncture) and nothing helped?  Well, this is your lucky day because this episode really takes us down the chain from head to toe with someone who had low back pain. Pretty standard, right?  But this was FAR from standard. Hint: her low back was not the source of her problem.

We owe it to our patients to perform a whole body assessment, educate them and above all, LISTEN to them. When you have persistent pain and no one has been able to help you,  you want a solution and you want to be heard.

I have been down that route myself with many injuries over the years and the quality I value most in a health care practitioner, is their ability to listen and look me in the eye.

I hope you enjoy this episode!

Subscribe at Itunes or Spotify! Tough to Treat.



living with pain

Pain, happiness, habits and productivity

“The Relationship of Our Body to Our Mind Is More than Just a Tagline. It’s a Real Thing.”

I am so honored to have been interviewed by Gretchen Rubin upon the launch of my new book, Why Do I Hurt? Discover the Surprising Connections That Cause Physical Pain and What To Do About Them”.

Here is the link to the interview.


We discuss pain, habits, happiness and productivity.  You may not be surprised that these all can relate to each other in very interesting ways.  Movement in whatever form is good for your body, mind and soul. And when you make that a habit, even better!

In the interview, I talk about how the delivery of a diagnosis to someone is the most important interaction we have with our patients.  Health care professional’s words matter. The way it is delivered can have a placebo effect or it can be a nocebo.  Read the interview for more on that.

It is extremely compelling when you tell a patient that they have a choice versus telling them that they must do something or they will never get better.  Really different words with an enormous effect on how we process pain.


hip pain

Post-op hip pain. Is it really the hip?

Many people have labral tears in their hip but is surgery the only solution? More often than not, there are secondary issues causing the labral tear in the first place, especially when someone still has lingering issues that the surgery did not address. Does a lack of control in the foot cause a hip labral tear? An overactive pelvic floor? Join the Tough To Treat podcast and find out!


Low back pain exercises

Do You Have Back Pain With Sitting?

What to do when you have back pain with sitting? How do you get to a seated position? You squat of course!!

Low back pain with sitting is extremely common. I had it for years when I worked on a trading floor. Thankfully, I had an extension cord for my headset and was able to get up and move while talking to clients.

The key to “good posture” is to vary it. Plain and simple! There is no right or wrong way to sit and thinking otherwise is misguided. Just get up and move!

When you do have back pain with long periods of sitting, think about your bias. What I mean is, how are you sitting? Are you sitting all day turned to the right looking at your computer, or are you writing and taking notes while on a conference call, leaning on your desk at the same time?

This may seem trivial but if you do them day and day out, for weeks, months, years, it adds up and could potentiate a back problem. If you do suffer from back pain with prolonged sitting, look at the ergonomics of your office and notice what you do all day-it could be quite revealing! And furthermore, look at your squat, that may be even more telling!

Have a torn labrum in your hip? Is it really the cause of your hip pain?

Did you know that the source of your persistent hip pain may come from your foot or even your pelvis? One of my patients found this out after a surgical procedure to repair a torn labrum in her hip. Just because you are looking down the barrel of an MRI saying that you have a torn labrum, does not mean that it is necessarily the original cause of your problem. It certainly became the victim in this case. Ultimately, you need to find the source of your problem and then change your strategy around it. Enjoy!



Really? The Cause Of My Knee Pain Is Not My Knee?

This is a short one on why the source of your knee pain may not be your knee. One of my patients who is a competitive golfer had chronic unresolved knee pain. Watch this short two minute video and find out the source of his knee pain. You do not have to be a golfer to watch, trust me!!



My Philosophy on Healing the Whole Person

Say hello to yourself and goodbye to pain!  I explain in this short (less than 2 mins! ) video on my unique problem solving approach to help you get rid of persistent pain!





physical therapy or wall street

How I successfully transitioned from Wall Street to Physical Therapy

People often ask me how I made the transition to Physical Therapy after a successful career on Wall Street.  After all, they say, “Isn’t bond trading different than treating patients?”   Not really. It is all about problem solving.   You have had persistent knee pain and want it gone, yesterday.  That is a problem that needs solving.  Chances are it’s not your knee, especially if your symptom is a chronic one.

My clients on Wall St were the institutional kind, think central banks, hedge funds etc. They wanted to figure out how to strategize to maximize return or minimize loss.

After all, isn’t that what you want,  to be able to squat in the gym without knee pain, for example? Maximum potential, minimum loss?

I was asked to give a speech this past November at our inaugural Women In PT Summit here in NYC on how I used my experience on Wall Street to grow my PT career and practice. Excerpts are below. It’s short, I promise!!

I really took charge of my mindset when I started on the trading floor and how I viewed myself in a very male dominated profession.   The second thing I did was identify my strengths. One of them is that I am a Learner and I love problem-solving !   The third is that I became a educator both for myself, my clients and patients.

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