What’s the best thing to do when you put your back out? I’m describing that episode that most of the population will experience at some point in their life that involves paralysing pain in the lower back weakening your legs. In this article I will give you best practice to resolve this horrible experience as quickly as possible.
First of all what is really happening?
Many of you reading this will know exactly what I am talking about. In fact I have experienced this myself.
What is really happening in the majority of cases is that some of the important structure in your lower back (disc or joint) has experienced damage or simply strain and has decided to ‘shut down’ for repair. So despite the acute spasms, crippling pain and weakness in the legs that makes you think you will be wheelchair-bound permanently, what you are most likely experiencing is a protective healing response that will resolve.
An example…
This week I saw a patient on Friday who had experienced this on the Monday prior. Let’s call her ‘Mrs Robinson’. Mrs Robinson did not get to me til Friday because she couldn’t move until then. On the Sunday afternoon she lifted some heavy boxes but felt ok. Then on the Monday morning she woke up, got out of bed and then twisting ever so slightly in the shower Mrs Robinson experienced crippling pain as her back spasmed. She could not support herself and was bedridden for three days, describing the pain as ‘worse than childbirth’.
What really happened?
On Sunday afternoon when Mrs Robinson lifted those boxes she loaded one of her spinal joints or discs on an angle that sprained or damaged it. Now she may have caused some permanent injury to a disc or she may have simply sprained the joint in the same way that you can sprain an ankle, except in this case it’s a spinal joint.
When Mrs Robinson went to bed that night after reading her Woman’s Day, her body went to work on repairing that spinal joint. The first thing her body did was it sent inflammation to that joint. The inflammation carries in it all sorts of healing goodies that help disc and joint to repair, however it also deliberately creates pain and sensitivity.
Then Mrs Robinson gets up in the morning, blissfully ignorant of what is going on in her lower back.
Standing … okay.
Walking to the bathroom … okay. The back can handle that.
Shower on … and as she rotates her spine and bends a little to reach for the Garnier, she unwittingly places load on that disc that is busy doing some important repair work. The back simply ‘shuts down’. And here is the ‘childbirth pain’. How does your body insist that you don’t move your spine at all. It causes the spinal muscles to spasm causing extreme pain. It seems as though any movement, even moving your arm causes excruciating pain in the back!
Even if one has the mental fortitude to ignore the pain and insist on trying to walk, the body simply overrides. The legs go weak and you’re on the floor.
Why the violent overreaction?
Simple.
Your body knows that any significant permanent injury to these structures may be irreversible. Irreversible means permanent nerve compression or permanent paralysis. So, an overreaction? I don’t think so. I think that by giving you excruciating pain and immobilising you, your body actually has your best interests in mind.
So what is the best things to do in this scenario?
Remember that in 90 per cent of cases all this pain is in fact a severe protective reaction. The pain is usually not the actual injury but the body’s secondary healing process. So the best advice is: work with the body to help it get the job done as efficiently as possible.
Rule 1: Don’t use a heat pack.
For many of us this sounds counterintuitive. I say this because the spasming muscles that are causing much of the pain love heat and will feel better with a heat pack … BUT … what’s really happening is the inflammation underneath the muscles is the real trigger for the spasms and inflammation will be prolonged with heat. So although the heat may feel good it will prolong the whole process!
Rule 2: Avoid sitting.
Sitting places your vertebral discs in a posture that is inefficient and stressful. In other words when you sit you are putting an already injured joint under stress. This makes it even angrier. So if you sit, sit well; not in a deep lounge (you won’t get out) but on an upright chair like a dining chair. Even then, don’t sit for long. I normally suggest a 10 minute rule – don’t sit for more than 10 minutes without moving. Patients usually figure this out because they find that if they sit for more than 10 minutes they can’t get up anyway.
Rule 3: Move.
As soon as pain will allow it, start to walk around. Walking puts your spine in a very efficient posture and movement helps relax the spasming muscles. Most people figure this out anyway and say that once they ‘get going’ they get some relief. Again the 10 minute rule. Walk for 5-10 minutes often. Like every hour. Having said this, note that walking for 50 minutes is not better. Walking for long periods will end up irritating the inflammation, making it worse so short walks often for the first seven days.
Rule 4: If you want to rest lie down flat.
If you want to rest for a long period of time don’t sit, lie down.
Rule 5: Observe these rules for 10 days.
If you stick to what you have read here for 10 days then you should be moving really well and feeling heaps better in five to 10 days. But… if you decide to break these rules then your symptoms may last for weeks and weeks.
Your back won’t be back to full duties for six weeks.
Know this! When the worst of the pain has subsided, if you still have some stiffness or some pain in the back or even in your leg this is a gentle indicator that your back is not fully better. There will some residual inflammation. In other words trying to move that box that you didn’t get to last Sunday may just trigger the whole process again. So don’t trust your back to do heavy work even if it feels good for at least six weeks. After the first two weeks, you want to be walking 20 minutes every day for four weeks without symptoms before you are all clear.
Medication?
In the first few days strong painkillers may be necessary to survive (chat to your GP), but note that painkillers are not ‘fixing’ anything. Secondly anti-inflammatory medication will speed up the process and they are actually addressing the primary trigger for all of your symptoms, that is the inflammation around the spine. Ignoring the damage anti-inflammatories do to your stomach lining, for short bursts (10 days) they are very helpful. Just know that your body will ‘work the process’ and heal in its own time and using anti-inflamatories to speed up the process will give you a ‘false reading’ of just how much healing has taken place.
Do I need treatment from a Myotherapist?
Receiving some treatment and some tailored exercises inside the first 10 days from your Myotherapist will help even further but this is not critical.
What IS critical is getting a treatment or two from your Myotherapist once you are feeling better. YES once you are feeling better.
This is because unbeknown to you, once your terrible pain has gone the body will most likely continue with some subtle restrictions that simply ‘lay in wait’ and predispose your back to ‘going again’ more easily than it should. I see people all the time with reoccurring back pain because they have ‘just had a bad back’ ever since that episode way back when. I have lost count of the number of patients whose ‘forever’ bad back I have FIXED.
A couple of treatments to identify and resolve the subtle restrictions that your body has adopted – and intends to live with – gives your body the best chance to resume full function with little chance of reoccurrence.
I hope you don’t ever need to refer to this article BUT if this article was helpful punch your name and email into the sidebar and you will receive new posts as I write them.
– Tim
