Throw Back Thursday

  I am going to talk about something that I'm not supposed to talk about as a personal trainer.  I am going to tell you what to do when you have acute back pain.  Personal trainers are 'allowed' to talk about a myriad of fitness-y things, but injuries and spines, no siree.  This is because some cases of back pain are related to disk issues and disk issues are a subject reserved for doctors.  However, most back pain is muscular, non-serious, and does not require medical attention.  Almost everyone will experience it at some point.  You need to know what to do to prevent acute muscular back pain and heal yourself if you do have a run-in with it.
   I am not a doctor, I am not giving medical advice.  I am a person on the internets, do not substitute my advice for medical attention if that is what you need.  I do have a lot of experience with clients who have/had acute back pain.  The kind of pain I refer to in this post is pin-pointed back pain after a single isolated incident, such as lifting something.  I am not referring to chronic, radiating or tingling pain.

Spinal

  Although acute back pain can feel like you've broken your back, you've most likely just strained or spasmed a muscle.  Lumbar vertebrae are meant to extend (bend back, arching your back) and slightly flex.  The mechanics of lumbar vertebrae are not made to withstand shearing or lateral forces.  In order to protect your vertebrae, your back muscles 'prefer' not to flex or bend laterally, especially under load.  

  When spinal muscles are made to do things they don't want to do, either over time (sitting in a slouch, running with poor form), or all at once (deadlifting with crappy form), they aggressively contract, or spasm.  This spasm stops your muscles from being stretched under load and stops the shearing force on your spine.  In a way, throwing your back out is actually less terrible than what might have happened if your body didn't stop you.  The actual contraction of the spasm is incredibly painful, your muscles have basically just used all of their strength on you.  

  For the next week or two after a 'throw back,' your muscles will still be in slight spasm, this causes residual pain.  The steps to alleviating this pain include gently releasing these muscles with self myofascial release and being in better positions so that your back feels safe, strong and mechanically stable.  One of the paradoxes of back spasms is: healing them involves loosing up your tissues, but tightening up your muscles.  Muscles can have a gamy, locked-up quality to them and still be over stretched.  NEVER STRETCH YOUR LOWER BACK AFTER A SPASM.

Please refer to my previous posts for information on pain and good positioning.

Immediately after the incident

You feel like your life is flashing before your eyes, like things will never be the same again.  Everything is going to be fine in a week or two.  Here is what you have to do now, for the next hour or so:

• Lie on your stomach.  You just stretched your back muscles under load, which they do not like.  Lying down on your stomach will allow your back muscles to contract slightly, which makes them feel safe.
• Breathe into the floor.  Take deep breaths, feel your stomach push into the ground on your inhales and shy away on your exhales.  This will help to relax you and to slightly stretch your hip muscles, taking pressure off your back.
• Practice bracing your spine (while lying on your stomach) by squeezing your glutes and abs.  This will also make your back feel supported and help to get blood flow to the area.
• Apply ice to your back.  Only do this up to 1 hour after the incident.  Right after the incident, ice will help to prevent inflammation from setting in.  
• Take an OTC pain medication of your choice.  This will help to reduce inflammation and pain.
• After an hour or two you should be able to stand and walk with manageable pain.  If your movement capacity is still extremely limited, or if your pain is worse, radiating, or tingling, you should seek medical help.  If you do seek medical attention, the practitioner determines the advice you will receive.  If you go to a surgeon, you will get advice on pain and surgery, if you go to a physical therapist, you will get advice about pain, movement and mobility.  

Several hours after the incident

By this time, you've gotten home and are starting to feel slightly better.  Some positions or movements, like sitting up, may still be very painful.

• Take an Epsom salt bath.  This will further reduce pain and inflammation.
• Continue deep breathing and lying on stomach when possible.
• Apply heat to your back for comfort and to increase blood flow (which decreases inflammation in the long run).
• Sleep in whatever position is most comfortable, where you can get the most sleep.

The next day

You may feel stiff and very sore when you wake up.  Moving around will ultimately make you feel better than being a couch potato.

• Roll to one side instead of sitting straight up.
• Sit as little as possible, go for a walk.  Sitting compresses your back, walking will further help to ease inflammation.
• Gently move around, discover what positions are most comfortable and which cause the most pain.  Spend as much time as possible in the positions that feel best.

Several days after the incident

At this point, only the positions that cause you the most pain still hurt.  You don't feel like yourself quite yet, but there's been a big improvement.  It's time to release a few muscles that tightened up to protect your back.  

• If your back spasmed in flexion (bending over with a rounded back), it is likely that your spinal erectors are inflamed and your hip flexors, hamstrings and quads need rolling out.
• If your back spasmed in rotation (this is more common) or while side bending (hiking one hip while lifting, side bending to pick something up, doing what you thought was an oblique exercise), it is likely that your quadratus lumborum is inflamed on one (usually left) side and obliques (usually the right side) and glutes need rolling out.

Spinal erectors referred to are the ones located in the lower back.

Here is Jill Miller explaining how to roll out your obliques:

You may use a foam roller or lacrosse balls instead of the balls she is using if you like.

Here are Jill Miller and Kelly Starrett explaining how to release your psoas and diaphragm:

Skip ahead to around 1:38

Here is Kelly Starrett explaining how to release your glutes:

When you feel ready to workout

  Go ahead, do anything that doesn't cause you pain.  'Busy work' with a low eccentric component, like sled pushes, or kettlebell carries is usually a good place to start.  Slowly add in exercises and increase weights as long as your positioning is sound and your spine is braced.  The exercise or activity that coincided with your injury did not cause it.  Your positioning in your daily life, anatomy and poor form caused the injury.  More on this here.  Do not fear exercises or activities, fear slouching, sitting and bad, careless form.

  If you do not understand why you got injured performing a specific exercise, it is time to get a trainer for a few sessions to explain how to brace and perform movements correctly.

Walk the line

  Don't be afraid of getting back into your exercise routine, don't be careless either.  Throwing your back out does not have to be a repeat occurrence, but it does mean that you are prone to back injury.  These factors increase your risk for back injury 100 fold more than specific exercises or movements:

• Sitting in general or working in a slouched position.
• Slouched posture.
• Tight hips, ankles, upper back.
• Not knowing how to bend at your hips or lift with your legs.
• Not knowing how to brace your spine.
• Not understanding how to exercise or perform activities of daily living in good positions.

  All of these factors are within your control.  You do not have a bad back, but if you don't change your positioning and educate yourself, a bad back will have you.