What to Do When Your Back Pain Flares Up

As you return to exercise or increase movement, some soreness or small, short-lived increases in pain are normal and not a sign of damage or further injury. What we want to watch out for is sharp pain during a movement or any of the red flag symptoms listed above. Pain from a movement that subsides quickly is not generally a concern and can be addressed with activity modification. If this occurs, please see the regression suggestions for each exercise in the exercise library.

In general, if your back pain flares up, do your best to keep gently moving in ways that do not clearly provoke your pain further. Resting from heavier activity other than walking is often helpful for a couple of days, but try to keep some comfortable walking with frequent short breaks or decompression positions so that you do not become completely inactive.

If your back pain flares up, here's what to do:

1. Don't panic

2. Evaluate the situation.

• Mild pain/soreness (no red flags)
  • Continue with the program and exercises
• Moderate pain (no red flags)
  • Find what you can do that isn't painful and eliminate the rest for 2-3 days. Make sure to keep walking. Take breaks if you must, but keep walking. Movement is crucial.
  • If pain settles after 48-72 hours or does not escalate, return to exercise.
• Severe pain (no red flags)
  • Maintaining movement is very important. Walking is the best way to do this.
  • Move with stability, not rigidity.
  • Focus on your well-being and ensure that your daily needs are met.
  • If you cannot perform daily tasks, and your pain intensity is not subsiding within 1-2 weeks, seek medical care.
• Red flag symptoms
  • Seek medical care immediately if you experience
    • New bladder or bowel problems
    • Numbness around the saddle/groin area
    • Rapidly worsening leg weakness
    • Feeling unsafe physically

The Traffic Light Rule

A useful framework used for judging pain experienced during the performance of exercises is the "Traffic Light" rule, where:

• Green (0-3/10 pain): is safe to continue
• Yellow (4-5/10 pain): acceptable if the pain subsides soon after completion
• Red (6+/10 pain): stop and modify the exercise

Please note that this educational content does not constitute medical advice. For diagnosis or medical treatment, please consult with a clinician.

As always, thank you for your attention, and have a great weekend!

Best,

Mitch