Making Sense of Your Back Pain

“I bent over to pick up a garbage bag and I felt a strain/pop/grabbing sensation in my back. Immediately after, I felt my lower back seize up to the point of paralyzing me with agony. I could barely walk and needed to lay down immediately. But when I tried to lay down, I could barely turn my trunk to find a comfortable position. I was at the point where I was going to call 911 because I was in so much pain. I really thought I did some serious damage.”

This is a common mock subjective history of a patient who sustained an acute low back injury. In this article, you will learn about different types of low back pain that can present from an injury like the one stated above. You will also learn specific questions to ask yourself prior to making a decision on which healthcare provider you should seek out first.

Common Non-Specific Low Back Pain

There are several common symptoms that can be experienced post a lumbar strain. The most common profile of pain is diffuse, achy low back discomfort localized directly above and/or below the pelvis. This pain is usually exacerbated by reaching towards your toes and picking up objects from the ground. You may also experience symptoms of pinching discomfort with arching your low back into extension or rotation of your spine. The common theme is that you don’t feel any radiating symptoms or numbness/tingling down into your lower extremities with spinal movement. Another tendency of generalized low back pain is that there are positions that make the pain improve. For these types of symptoms, it makes sense to reach out to a physical therapist to help you better understand your pain patterns and get you back to doing what you love without pain.

Lumbar Radiculopathy

The lumbar (lower portion) of your spinal cord is responsible for conducting sensory information and motor function to the lower extremities. If your back injury results in compression of the peripheral nerve roots (the nerves coming off the spinal cord) in that area, you will typically have a loss of control over specific movements of lower extremity joints. You may also experience unilateral radiating/burning sensations or numbness/ tingling along the sensory distribution of the nerve that is compressed. This type of symptom profile, though irritating and limiting to your function, does not need emergency room attention. Reaching out to your trusted physician or physical therapist will help guide your care back to full function. 

Emergent Situations

The more sinister situation is when the spinal cord is the source of compression. This can result in bilateral lower leg numbness and tingling, saddle anesthesia (inner groin numbness), bowel and bladder dysfunction, significant difficulty moving your toes, and ataxia (difficulty with balance when walking). These symptoms are associated with conditions called “conus medullaris or cauda equina syndrome.” These conditions warrant immediate emergency room attention because sustained pressure on the spinal cord, or the cauda equina, can result in permanent paralysis.

Summary

In most cases, as daunting as the acute symptoms of a back strain are, the majority of people will be able to fully recover from the injury without ever needing a surgical operation nor injection. The keys to managing acute symptoms are to use modalities such as heat, ice, or soft tissue massage to help reduce pain and manage symptoms of muscle spasming. Choose the modality that your body responds best to. Anecdotally, patients respond better to heat and soft tissue massage because of its effect on relieving muscle spasms. The majority of the initial pain response is secondary to intense muscle spasms. You may also use over-the-counter anti-inflammatory medications, as prescribed, during the first 48-72 hours. These medications can help modulate pain sensitivity from the excessive, acute biochemical response that naturally occurs in response to the tissue trauma sustained. 

The major key to expediting your return to full function is to find a way to introduce spinal movement and walking, as tolerated. Pain-free movement is the best way to communicate safety to the nervous system. When the body appreciates that movement can be restored safely, muscle spasms, and the pain associated with them, will decrease substantially. The key to avoiding a re-injury of your low back is to complete a progressive exercise program that will prepare your body to safely, and consistently, conquer the demands of your desired and required activities of daily living. 

If you have any questions, or would like guidance on how to safely return back to exercise and an active lifestyle, don’t hesitate to connect with Resilience Performance Physical Therapy. Submit your insurance info today!