What is Wrong?
Acute back pain is incredibly common. In fact, the vast majority of people will experience a few episodes of acute back pain throughout their life. Sometimes there is an incident that precedes the back pain. It comes on suddenly when moving a table or reaching to get something out of the car. Other times it just comes on for no apparent reason, either suddenly or more gradually.
Most of the time the injury is not serious and you can expect to make a full recovery. The low back consists of five lumbar vertebrae with intervertebral discs in between them. Each vertebra is joined to the one above and below via the disc and some joints called the facet joints. Surrounding these structures are lots of ligaments and muscles to keep it all together.
Your pain could be coming from any one of the structures mentioned above. The pain will feel very similar regardless of which structure is injured. It’s generally a dull ache across the low back that can be extremely intense or very mild indeed. It can sometimes radiate into one of the legs. The pain comes on when one of those structures mentioned above become irritated in some way. There may or may not be inflammation and tissue disruption associated with the irritation.
How Long Will it Last?
Usually about four to six weeks. Although this can vary significantly depending on the nature of the injury. Sometimes the symptoms persist for a long time – we’re going to get to that later.
Why did this Happen?
People often feel like they did something to bring this on. “I lifted something that was too heavy,” or “I must have moved in the wrong way.” The evidence suggests that this is not really the case. These episodes of low back pain just come on sometimes. You didn’t do anything “wrong.” It just happened. As for why it happened, can be very difficult to say. All we know is that right now one of the structures in your back has been irritated and it’s going to take a while to calm down.
Do I need an x-ray or MRI?
Not usually. Since this is a short term problem in the vast majority of cases, there is usually no need to get any type of scan. Actually, there have been some studies showing that getting scans like this done within the first couple of months results in a slower recovery. The theory is that people become “too careful” with their activities and slow their recovery.
There are a few exceptions though. Sometimes there can be more serious problems that cause back pain. If you have any of the following you should consult with a medical professional immediately.
- Numbness in one or both legs
- Loss of muscle power in your legs or feet
- Incontinence (losing control of your bladder)
- Saddle anaesthesia (numbness around your pelvic area)
- A history of Cancer (you have had cancer before)
Is it Sciatica?
Sciatica is a general term that has been used for a long time to refer to a variety of conditions. Unfortunately it is often mis-used and has become quite unhelpful. The sciatic nerve is a large nerve that connects your spinal cord to your leg. The sciatic nerve divides into smaller branches as it goes down the leg much like tree roots.
Sometimes the sciatic nerve gets irritated or inflamed somewhere along its path. This can often be right near the spinal cord where those facet joints or intervertebral discs we mentioned earlier can press on the nerve roots and cause inflammation. This causes extreme nerve pain roaring down the back of the leg. It is often described as burning, electric or lancinating pain. The inflammation of the sciatic nerve can also cause tingling, numbness and even muscle weakness. This condition is known as Radiculopathy. If you have any of these symptoms, you should seek immediate medical attention.
Radiculopathy occurs in about 3-5% of the population. Low back pain occurs in about 60-70% of the population. So the vast majority of cases are not true “sciatica” (Radiculopathy) . However, something that is very common in low back pain is for the pain to radiate into one of the legs. It can radiate quite far down, even as far as the foot sometimes. We call this referred pain and it is different from radiculopathy.
What is Referred Pain?
Referred pain is when the low back pain radiates down one of the legs. This has nothing to do with the sciatic nerve so to call it “sciatica” is misleading. What is actually happening is that the pain is coming from one of the structures in the low back (lumbar spine) that we mentioned earlier (intervertebral discs, facet joints, ligaments, muscles). The brain confuses signals from the low back with signals from the leg and so your brain perceives the problem to be in the leg. However, the problem is actually in the low back.
This is quite confusing and it’s difficult to explain without getting into detail about how the nervous system is organized. For now, we’ll just say that sometimes low back pain radiates down the leg and we call it referred pain.
Is it a Slipped Disc?
Discs don’t slip. Ever.
The intervertebral disc is a shock absorbing cushion that sits in between each vertebra. They are joined to each vertebra by an extremely strong bond through something called an end plate. The disc can not slip in any direction, it is physically impossible.
Imagine you had two small pieces of wood. You glue them together with the strongest adhesive you can find. Then you hammer 10 nails through them. Then you wrap them in duct tape. Now try and get them to “slip”. They won’t. That’s just how your discs are, they can’t slip. So “slipped disc” is another inaccurate and very unhelpful term that has become very popular.
However, sometimes the disc can irritate one of those nerve roots we mentioned earlier. When this happens, you get the roaring leg pain and numbness due to the irritation of the nerve – that’s the radiculopathy condition we mentioned earlier. The disc can do this by bulging onto the nerve root.
The discs can and do bulge all the time. In fact, even people with absolutely no pain usually have disc bulges at multiple levels in their spine. The disc is a shock absorber, it’s supposed to bulge. Unfortunately, sometimes these bulges can irritate the nerve roots and cause radiculopathy. When that happens you will experience roaring leg pain, numbness, and even weakness. If you have any of these symptoms, you should absolutely consult a medical professional immediately.
Chronic Back Pain
We all know someone who has had really bad back pain for many years. If you’re reading this, that may even be you. Chronic back pain is a very serious problem. It’s very difficult to treat and people who develop chronic pain suffer immensely. Chronic back pain is quite different from acute back pain. “Chronic” actually just means long-standing and we usually define that as more than 3 months. However, many people have acute back pain that takes 5 or 6 months to resolve. So the term is more of a guide.
Chronic pain is a very large and complicated topic. The pain persists and becomes more intense over time due to changes in the nervous system. If you have had your back pain for a long time then you would likely benefit from learning more about what is happening. Since this article is more for acute back pain I’d like to recommend some other resources that I’m sure you would find helpful.
What should I do?
There are lots of things you can do to make this less unpleasant and speed up the resolution of your back pain. What you ultimately decide to do will depend on your circumstances. If the pain isn’t very intense, you can certainly just wait it out and carry on as normal. If the pain is very intense, then you will probably want some help.
Consult a Professional
This would certainly be my top pick. While the other things on this list will definitely be helpful, there really is no substitute for the guidance and expertise of a professional. It’s like doing your tax return, you can certainly do it yourself, but it would be much easier and more effective to consult an accountant. So the first question is which type of professional? This is where I’m going to show my own bias a little. As a physiotherapist, I honestly feel like a rehabilitation professional such as a Physio, Athletic Therapist or Chiropractor would be the best person to see first.
These professionals can do a full assessment and provide a clinical diagnosis. They can refer you to the appropriate doctors or surgeons for scans and further testing if they feel it is needed. They can also help you understand the problem and design a rehabilitation program that will help you recover as fast as possible.
We have all of these professionals available here at Collegiate Sports Medicine. If you would like to have a chat with us about how we might be able to help, we’d love to hear from you. Just give us a call.
This may sound like a strange term. The idea is to stay active but only to the degree that you feel able. I like to use a green light, orange light and red light system. Green is no pain, orange is mild pain and red is severe pain. Generally speaking, you can do whatever you want as long as you feel no pain or mild pain. If the pain becomes severe, you have to stop. Over time, you will find you are able to be more and more active.
In this sense, no activity is “off limits.” You can go to work, do housework, go for a run, lift weights, go swimming, go camping … whatever you like. Your only restriction is that you must try to avoid that severe “red light” pain. If doing any of these causes severe pain, then leave it till next week and try again!
As long as it doesn’t cause severe “red light” pain, then a daily walk really helps you to recover more quickly. It need only be 5 minutes if that’s all you can manage. However, you can go for an hour or more as long as you only have mild “orange light” pain. If you can only manage a few minutes, I’d encourage you to try and do it a few times a day.
People usually find their back doesn’t like doing any one thing for a long time. Sitting, standing, walking, running, bending etc. Whatever it is, usually you will need to take a break from it at least every 20-30 minutes. So just try and apply this to whatever you are doing. If you’re at work, get up from your desk regularly. If you’re doing housework, just do one room at a time. If you’re on the road, take pit stops as often as you can.
As the saying goes, “motion is lotion.” We want to keep your back moving, and including some regular stretching and mobility exercises will really help keep you going. There are no “right” or “wrong” exercises here as long as you follow the green, orange and red light system. If an exercise causes severe “red light” pain, then just leave it for now and try again in a few days.
These are a couple of exercises I recommend often. Feel free to try them and see if they help.
Manual Therapy includes treatments like soft tissue massage and joint mobilisations. There are many different kinds of therapy and different therapists who will have different skills.This is certainly something you may discuss with your therapist should you decide to work with a professional. There are a few things you can do at home such as using a tennis or lacrosse ball to help loosen up the muscles. Again, the traffic light rules apply. There should be no severe “red light” pain. If there is, you need to go more gently.
Just press the ball up against the low back between you and a wall or the floor. Move around to work the ball as if the ball is giving you a massage. You can do this for as long as you like but I would suggest starting with about 3 minutes and then see how you feel afterwards.
Low back pain is very common and usually resolves within four to six weeks. It’s best to stay active but avoid severe “red light” pain. Medical professionals can help you get through this as quickly as possible. If you would like some help, give us a call.