Your Back Pain Self-Assessment: A Simplified Guide

Goal: To find your personal pain triggers—the specific postures, movements, and loads that cause your pain—so you can avoid them and start healing.

Step 1: Essential Precaution – Rule Out Sinister Causes

Before you begin, it is crucial to rule out serious medical conditions. See your doctor to discuss:

• Unexplained weight loss

• History of cancer

• Fever with back pain

• Loss of bowel or bladder control

• Numbness in the saddle area (inner thighs, groin)

• Constant, severe night pain

• Significant trauma (e.g., car accident, fall)

If your pain is unrelenting and doesn't change with different postures or movements, you must seek medical advice.

Step 2: Create Your Pain Profile Lists

Get a notebook. Create two lists:

• List A: Painful Activities

o *What makes your pain worse? (e.g., sitting 15+ minutes, bending to tie shoes, driving)*

• List B: Pain-Free Activities

o What can you do without pain? (e.g., walking, lying down)

Compare the Lists: Look for a common theme in your painful activities. Do they all involve bending? Sitting? Twisting? This is your first clue.

Step 3: Answer the Essential Diagnostic Questions

Answer these questions in your notebook. They provide vital clues.

1. Does your pain intensity change? Do you have any pain-free moments?

2. Do you get sharp, stabbing pains when you move or roll over in bed? (A sign of instability)

3. What specific activity makes your pain worse?

4. Was the onset sudden (trauma) or gradual?

5. Do you have a history of osteoporosis? (This changes exercise choices)

6. Is your pain worst first thing in the morning? (Points to mattress/sleep posture)

7. Does your pain increase throughout the day? (Points to cumulative loading)

8. Is the pain concentrated in your middle back?

9. Does pain radiate into your buttocks, legs, or feet? (Indicates nerve involvement)

10. Does fast walking make your pain better or worse?

Step 4: Perform the Pain Provocation & Relief Tests

⚠️ Caution: The goal is to gently provoke pain to identify it. Stop immediately if pain is severe.

Test 1: Posture & Compression (Sitting on a Stool)

• Sit tall (Neutral), grab the seat, and pull up gently. Note pain.

• Sit in a Slouch, pull up again. Note pain.

• Sit with a slight arch (Extension), pull up again. Note pain.

• What it means: The posture that caused the most pain is a primary trigger.

Test 2: Dynamic Load (Heel Drop)

• Stand and gently rise onto your toes, then drop onto your heels.

• What it means: If this causes pain, your spine is currently intolerant to dynamic loads (e.g., running, stairs).

Test 3: Finding "Feel-Good" Postures

• Tummy Lie: Lie face down for 2-3 minutes. Did this reduce your pain?

o If YES: Spinal FLEXION (slouching) is a major trigger. Gentle extension helps.

• Standing Extension: Stand and arch your back. Does this cause pain?

o If YES: Spinal EXTENSION is a trigger for you.

• Wall Plank: Lean on your forearms against a wall. Adjust your hip and back position until you find the most comfortable posture.

o This is your "neutral" or "feel-good" posture. Try to maintain this during the day.

Test 4: Load Intolerance

• Hold a light weight (e.g., 5 lbs) at your belt buckle. Note pain.

• Hold the weight with arms outstretched. Note pain.

• What it means: If pain increases, your spine is load-intolerant. Avoid lifting and carrying.

Test 5: Motion Intolerance

• Place a light bar on your shoulders. Gently roll your pelvis forward and backward (creating spine flexion and extension).

• What it means: Does this motion trigger pain? If so, you must learn to stabilize your spine and move from your hips.

Step 5: Identify Your Primary Pain Category

Based on your answers and tests, find the pattern that best describes your pain.

• Category: Flexion Intolerance

o Key Features: Pain with sitting, bending, tying shoes.

o Probable Cause: Disc Bulge.

o Do This: Lie on your stomach. Use a "hip hinge" to bend.

o Avoid This: Slouching, sit-ups, and knee-to-chest stretches.

• Category: Extension Intolerance

o Key Features: Pain when arching your back or twisting.

o Probable Cause: Facet Joint issues or Arthritis.

o Do This: Find and maintain a neutral spine posture.

o Avoid This: Overhead reaches and exercises like the "cobra" pose in yoga.

• Category: Load Intolerance

o Key Features: Pain with lifting, carrying, or the heel drop test.

o Probable Cause: Vertebral Endplate irritation.

o Do This: Hold loads close to your body. Use gentle abdominal bracing.

o Avoid This: Heavy lifting, running, and jumping.

• Category: Nerve Pain

o Key Features: Pain radiates down your leg. Worse when you bend your neck forward.

o Probable Cause: Nerve Compression or irritation.

o Do This: Look into "nerve flossing" techniques. Work on reducing the disc bulge.

o Avoid This: Aggressive stretching and prolonged sitting.

• Category: Episodic Pain

o Key Features: You have good days and bad days with sudden flare-ups.

o Probable Cause: Disc Sensitivity.

o Do This: Keep a detailed daily log to find your hidden triggers.

o Avoid This: The specific activity that caused your last flare-up.

• Category: Walking Pain

o Key Features: Pain starts after walking a specific distance.

o Probable Cause: Arthritic Joints or Spinal Stenosis.

o Do This: Break walking into shorter, manageable intervals.

o Avoid This: Walking until you feel pain.

Step 6: Assess Your Recovery Personality

Be honest with yourself. Your mindset is critical to recovery.

• Type A (The Over-Doer): You push through pain and often do more exercises than prescribed.

o Your Task: Give yourself permission to rest. Recovery requires patience, not force.

• Type B (The Under-Doer): You find excuses to skip your rehab exercises.

o Your Task: Commit to consistency. Your recovery depends on diligent daily effort.

Step 7: What to Do Next

• If You Found Your Triggers: Your main job is to remove them from your life. Replace painful movements with pain-free ones. This is the core of recovery.

• If You Are Unsure or Have Complex Pain: Keep a detailed Daily Log Book for 1-2 weeks. Record your activities, postures, and pain levels. Patterns will emerge.

• If You Need Professional Help: Use your notes from this assessment and bring them with you on your first appointment. We will:

o Perform provocative tests to find your triggers.

o Give you a clear diagnosis and recovery plan.

o Not just give you pain pills or a generic list of exercises.

Your Key Takeaway: You are the best expert on your pain. By systematically identifying what hurts and what helps, you can take control of your recovery.