| By: Julie Eibensteiner PT, DPT, CSCS “Throwing out backs” or “slipping discs”….how this PT handles an episode of intense back pain. On December 28, I was seeing an immediate post-op knee surgery patient at 7am. I reached across the table to examine the patient’s knee (didn’t even lift it) and WHAM! it was as if an ice pick got shoved right into my lower back. First thought: Ruh roh. Second thought: Here comes the tightness and muscle spasm. This isn’t going to be fun. Fortunately, my post-op patient was actually an orthopedic PT herself so when I told her what I felt we had similar lines of thinking: Keep moving. It will be OK. Prioritize extension (straightening up)… …and we were going to get this PT session in! (and we did). Other good items: I’ve experienced this once before – over 15 years ago. I know enough professionally, to not be afraid of this situation – the bark is much worse than the bite. Spoiler Alert: I was back to lifting and running in 4 days. I was back to work the next work day with only minimal stiffness. Here’s how I did it – no special equipment or pain meds needed. |
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| Day 0: Within minutes: 1. Kept calm 2. Prioritized regaining ability to extend / straighten up. 3. Recognized back was going to get really tight and muscle spasm was a guarantee. Later that morning: 1. Kept calm – especially when sitting in a car and getting out of the car after I had to drive 30 min to take Buddy to vet later that morning. Took my time, didn’t let the extreme tightness scare me. I had no symptoms going down my legs which was a good sign. It hurt like the dickens after sitting in a chair for 15 min at the vet though! 2. Prioritized easy movement / walking – took Buddy for a 15 min walk when got home. Noted it felt better after we got moving, knew it would tighten back up again once we got home. 3. Prioritized laying (extension) on the couch over sitting in a chair (flexion) during down time. Thought about popping two Advil but didn’t. Later that day: 1. Kept calm and patient 2. Prioritized easy movement – made a pointed effort to get up and move that afternoon and do light vacuuming. Although it was pretty uncomfortable and I and to avoid some movements altogether (limiting holding anything away from my body) it improved in the short term- even though I knew it likely wouldn’t stay that way. That night: 1. Prioritized good sleep and just finding a position that was comfortable at the time. Knew and expected that this would change during the night. 2. Kept calm when I woke up in the morning and walking was really uncomfortable. Expected it to get better as I reasonably moved more. Day 1 after injury: Kept moving – tried to do as many regular activities as possible and modified away from extreme pain. Noted that pain was less awful when getting up to move and took less time to improve once I got moving – that was a win. Day 2 after injury: 1. Worked a full day – prioritized standing over sitting during work day. 2. Kept moving again – tried to do as many regular activities as possible and modified away from extreme pain. Noted that there were less total activities I had to avoid from the day before. Day 3: after injury: 1. Worked a full day as much to normal as possible. Didn’t avoid lifting heavier things but eased back in as tolerated. Generally felt my back was 85-90% resolved. 2. Thought about getting a lifting session in myself as it was part of my New Year’s resolution, but decided to hold off one more day. Day 4: after injury: Completed a regular day which also included my own strength training (DB bench press, DB seated shoulder press, TRX hanging hamstring curls, and calf raises) and ran a mile on the treadmill. All tolerated pretty well! 1 Week after the injury: What injury? Back to full go. Even put deadlifts, RDLs, and bent over row back into my workout. 5/5 on workouts and running since the New Year! TAKE HOME POINTS 1. Keep calm. 2. Keep moving and get moving early and often after the injury. Walking is a super weapon! 3. Recognize the small improvements as you make them and progress slowly as able! Backs really don’t get “thrown out”- your body is much more resilient than that. That description of anatomy is a myth, so are “slipping discs”. If backs got thrown out and discs slipped – NFL and NHL players would never make it through a game. The greater majority of the time, back pain is coming from muscle spasms. If you want to break the cycle of myuscle spasm your most powerful weapon is moderate amounts of moderate activity, in a variety of ways, and don’t let your mind go right toward thinking you need a back surgery! |
| Disclaimer: When is it time to get it checked out more? Symptoms into arms or legs – you have shooting pains into arms or legs, you are experiencing numbness or tingling or your arms or legs, you are having bowel/bladder dysfunction, or a limb feels noticeably weak without explanation. Pain along the spine (especially lower back) that has become sharper with time, more pin-pointed with time, and is reproducible with extension (standing straighter, running, or arching backwards). Persistent, Unchanging Pain – no matter what you do, it isn’t changing a bit and getting worse over 5-7 days. Especially important to get checked if you have a history of cancer and/or it’s accompanied by unexplained weight loss or pain that wakes you up a night. |
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