February 18, 2022
By Mary Rose Strickland, PT, DPT, OCS
For over 10 years, I have been specializing in seeing individuals with all orthopedic conditions, the most common of which is low back pain. I have attended top low back pain courses and conferences in the world learning how to evaluate and treat low back pain. For years, patients have called me directly, before their primary care doctor or other provider; for advice, peace of mind, guidance in how to handle especially those first few days. And for years, I have guided numerous patients through full plan of cares successfully improving or resolving their symptoms. But I personally had never experienced acute low back pain…until now.
Acute pain is pain that comes on immediately and has only been present for a short period of time. It could be the result of trauma or a specific event of some kind, or could show up for no specific reason or cause. It often brings with it extreme concern “I was fine yesterday, today I woke up and can’t walk, can’t straighten up, have this extreme pain in my back or numbness/tingling down my leg; something must be wrong!”
While I have experienced low back and SI joint pain and soreness associated with my pregnancies, I never had that immediate onset “feels like I threw my back out” type of experience. Until I decided that it was time to try and knock out a weekend’s worth of spring cleaning in a few hours timeframe while my kids were napping. I was running all over the house, on my hands and knees scrubbing floors (which by the way I do all of the time) and suddenly realized I couldn’t straighten up. I had immediate, very sharp pain in my low back. Here I am, a 33-year-old, hunched over and off to the side, unable to straighten up, bend over further, lift/carry much more than a cup of water, and sleep or even rest comfortably for more than 45 min at a time. Needless to say, it was an exhausting few days at the start.
For all of the phone calls, telehealth visits, and “treat your own back” instructions I have given to patients over the years, it was time to put it to use myself. I started through the evaluation process, developed some movement hypotheses and tested them out. I followed the advice I had given my patients hundreds of times in the past. I am very happy to say that in 3 days I was feeling about 50% better and actually able to resume normal rest and sleep, in 7 days I had no pain at rest, and 2 weeks later was back to scrubbing floors again – yes the exact same activity that I think was responsible for my pain to begin with – along with other high level activities.
There are some very important key things to know and do when you experience low back pain, that I’d like to share with you today. No doubt it was important in my success.
Peace of Mind
When you suddenly hurt that bad, are “stuck” and can’t move, experiencing odd symptoms you have never had before, can’t sleep, it can be very unnerving. “Did I slip a disk?” “What does it mean to throw your back out…and is this it?” “I hurt so badly – there must be something serious going on.” But that’s just it. Low back pain is very common. 60-80% of Americans will experience it at some time throughout their life. 97% of it is not serious and will resolve in 6-8 weeks, often on its own. In the absence of trauma, with no personal history of cancer within the last 5 years, and other signs and symptoms we consider “red flags” that may indicate there may be something more serious going on, there is no need for x-rays, MRIs, blood work, or other tests. I knew these stats. My pain was related to my movement and activities – if I attempted to move or do certain items – it hurt worse. My pain was reproducible. I had confidence that it would be fine and I could find things to reduce it.
What Movements Do I Respond To?
This is key to determine in the presence of acute low back pain. Every person is different and this is going to be different for each person. Some may respond well to movements where they arch their back and go backwards, others it may be sitting and bending forwards. It could be a side to side movement or even twisting yourself up like a pretzel in gentle ways, of course. As low back and musculoskeletal experts, physical therapists are able to take you through these movement sequences and build a hypothesis of what movements you respond best to. The best part? We don’t even have to be in the same room let alone put our hands on you to determine that. I repeat these movements and if I get better – I know they are the right ones. If I am not seeing much change or getting worse – it’s time to go back to the drawing board.
When I had my episode of low back pain, I moved. I moved some more and then when that was done, I kept moving. In essence – I did not spend my initial 3 days on the bed or couch curled up because it was the only position I didn’t have pain and because I was feeling sorry for myself. I still had to work. Patients were relying on me. I still have 2 kids 2 ½ and under relying on mom to get dinner going, orchestrate baths, get laundry put away…and be present with them. I have a personal goal to participate in aerobic exercise 5 days per week. I didn’t want to let myself down. Did I do all of these things the way I had always done before? Of course not – I could barely stand straight and was constantly shifting positions. But I modified my activities, enlisted some additional help, wore my supportive running shoes for a few days, and made it through. I truly feel this was key in my recovery. Physically, mentally, and emotionally – being able to keep going, and continuing to accomplish things was so important for my “achiever” personality-type.
Other Alterations Along the Way
We teach that it is so important to work to handle your low back pain and not simply alter symptoms that we are experiencing. The two paragraphs above explain how we can “handle” it in finding the right movements and staying active, however when you are in acute pain, there is nothing wrong with also utilizing some alterations along the way – as long as you understand that is simply all they are and by themselves have very limited success. That being said other things I did:
Full Return to Activities
As I was feeling better, I am thankful that I knew which strengthening exercises I should enlist in my late-stage recovery. To help rebalance muscles that undoubtedly shut off during this experience, and call up ones that maybe weren’t quite as strong or responding at the times they needed to begin with. I also tuned in to my body a bit more and determined that some hip movement asymmetries were likely also contributing factors to my episode. I now have a list of things to continue working on, even after the pain is gone, to minimize my risk of future recurrence.
Most importantly – I have returned to the activity that I think started it all – on my hands and knees cleaning spilt milk from sippy cups that were tossed overboard at the dinner table, and muddy paw and little boot prints at the front door. Fear avoidance is the practice of avoiding certain activities for fear that it will cause a return of our pain or injuries. Addressing contributing factors and then gradually returning to those activities is an important physical and mental step.
What I did Learn
First and foremost, I do have a great deal more empathy for my patients. Also, the saying that doctors and therapists sometimes make bad patients – there is probably some truth to that as well. My biggest mistake was trying to jam a weekend’s worth of activities in to a few hours. A lot of activities I did for a longer period of time and back-to-back without taking appropriate movement breaks in between. That warrior “I just need to push through this” mentality ended up costing me a lot more time than if I would have just done the right movements during real quick and short breaks through my original spring cleaning block of time. Lesson definitely learned on that one.
What I Want You to Know
Do you have low back pain? Not ready to talk to one of our expert Physical Therapists? We are hosting our first ever Low Back and Sciatica Workshop Online! Follow us on Facebook or check our website for more details!