I was amazed at the response I got to my last blog post. It seems like back pain stories are like belly buttons; everybody has one. Over the past week I've had private messages on Facebook, comments and conversations with people about the post "Every now and then I fall apart" and how it resonated with them.
Usually the first question they ask is "So, how's your back doing?"
It's coming along well, thanks for asking!
So how did I get from having to sleep on the floor and having to pump myself up to put on my socks in the morning to reintroducing running and light weights in only a few days?
The answer is both simple, and complicated.
First, the simple answer. I refused to shut down and stop moving. I continued to do what movement was available IN AN INTELLIGENT WAY. And that's where things get a bit complicated. Because where is the line between rehabilitation movement and blindly trying to push through pain with the potential for longterm issues? I'm glad you asked...
First, the suggestions here apply to most back pain, but not all. If you suspect that you've injured an IVD (intervertebral disc) then you're best off to get assessed by a Chiropractor, Physiotherapist or reputable Osteopath first. You'll notice I didn't say Massage Therapist. That's because the variation in knowledge between Massage Therapists in unregulated provinces (like Alberta) can be...well...frightening, and I'd rather you get healthy than pump the tires of my profession.
If you have numbness or tingling through your buttocks, perineum and inner thigh, as though you were numb where a saddle would be (google "saddle parethesia") then go to an emergency room.
Otherwise, let's talk about reintroducing movement after a back "tweak". It's important to understand that synovial joints like the facet joints between our vertebrae or the sacroiliac joints between our sacrum and pelvis move on three planes; forward and backward (think bowing), side to side (think side bending) and rotational (think twisting). This is where somebody will say "well, technically joint A moves in a sagittal plane and joint B moves in a frontal plane blah blah blah...". That's not what I'm after in this post. Bear with me and see if this makes sense.
Most injuries in the back, especially in the low back happen when at least two of those three planes of movement are initiated at the same time. Think of the number of Canadians every year who hurt their back shovelling snow. They are flexing forward, slightly side bending, and twisting all at the same time.
It's important to understand that the facet joints in the low back DO NOT do all three types of movement equally well! They are good at flexion/extension, but they struggle with twisting; that movement SHOULD come from the ribs, hips and ankle/foot complex. Between those areas we have the low back and the knee! Wanna guess how many people complain of knee or low back pain? And of those people, care to guess how many have ankle, hip or rib cage limitations that they weren't aware of?
So if all this is true, how do we start to reintroduce movement? Here's a six pointers;
1. Expect to be scared. It can be frightening trying to move safely after a back injury. Every step you take, every move you make you seem to be watching it, wondering if this will be the movement that brings pain with it. Accept it, and treat it with respect, not fear.
2. Go slow. One does not simply rush into back movements, or back into movements as it is. Give yourself plenty of time to move, roll, maybe even swear.
3. Move away from pain. Usually when you hurt your back there are a few movements that really bring it on more than others, such as extension with left rotation. So avoid that movement. Start off first with what your body can do.
4. Single Plane movements. Start with movements in one direction at a time. Think cat/cow from yoga; it's a basic flexion/extension exercise. Or straight side bending as another. Introduce movement one direction at a time. Don't swing for the fences with a backhanding twist the first day.
5. Periperhal-Central-Peripheral. If your low back is where the pain is, let's call that the epicentre of the injury (although we all know know it might be more of the victim than the actual cause), start with joints further away. Stretch the feet, calves, neck and shoulders. All of these areas have an effect on the movement of the low back so you are still working towards a goal. Then move towards your quadriceps, hamstrings, adductors, abductors (upper leg), lats and rib cage (intercostals and erector spinae). Finally move into the muscles of your low back.
6. Get Help. Follow up with a physiotherapist, osteopath, chiropractor or massage therapist for treatment, but more importantly, for homecare recommendations. The biggest changes I see in my clients is if they take the stretches and exercises given at the end of a treatment seriously and apply them in their everyday life.
Finally, give it time. Don't think to yourself "I did a whole 30 minutes of rolling, why isn't it better?". It might take ten thirty minute sessions to slowly reintroduce the movement you're looking for into your back. Do this slowly, gradually, because more isn't always better. Less isn't always better. A Lagom is just right (a lagom is a Swedish word that translates to "just the right amount. Freakin' brilliant).
Treat the injury with the respect it deserves, but without the fear that any and all movement will be detrimental to recovery.