Back pain in constantly in the headlines – why? Because according to the National Institute of health 80% of adults experience back pain at some point in their lifetime. Here at BASE we see patients of all ages and all activity levels struggling with back pain. So today we're going to answer the question – what's happening when 'your back goes out?'
We've all heard or experienced the story – "I bent over to pick up a pencil and threw my back out" or "I got up too quickly and my back seized up". With these scenarios it's rarely one isolated event that creates the injury. Rather, it's usually months or years of damage under the surface that culminates in one final small stress that tips the scale. For example:
1) You might have had a damaged disc from years of bad posture or poor lifting technique.
2) You might have a series of stiff vertebrae that don't slide and glide like they should.
3) Maybe you have weak muscles around the spine that don't support it well.
In any case you're starting out with a back that's not functioning optimally – this leaves all of those components (the disc, the vertebrae, the nerves etc.) vulnerable to damage caused by a seemingly innocuous event. Whatever the damage, once you hit the tipping point the injury begins an inflammatory response in your body and a release of chemicals alert your brain that damage to your tissues has occurred. As a response, your body sends out pain signals and seizes up in effort to stabilize and protect the injured area.
So when your back seizes up it's actually your body going into protection mode. The muscles around the damaged joint, disc, nerve or the damaged muscle itself tighten up and prevent movement. You begin to move abnormally to reduce your pain, until eventually things calm down and pensively return to you regular activities hoping that it doesn't flare up again.
How do I prevent re-injury?
So what should you do when this happens to you? And how can you prevent it from happening over and over? The good news is that there's a better strategy than crossing your fingers and hoping for the best.
The best thing to do in the early stages of this kind of injury is to do what feels right. Spend time in positions that are comfortable, apply heat or ice, or maybe take some muscle relaxants if it's okay with your doctor. This can often get you feeling 50 to 90% better and many people stop here because they feel like they've gotten themselves out of immediate danger. Unfortunately, stopping here puts your back at risk for re-injury because you haven't identified and corrected the cause of the pain incident.
The key to preventing injury is to find the source of your pain and correcting the problem. The most common injuries are a) tears in the disc, b) pinched nerves and c) damaged vertebral joints.
Tears in the disc: Forward bending and rotation movement are known to be the most damaging to discs. You might be putting your discs at risk by sitting in a slouched posture all day at work, or by using improper lifting technique – or both. If bad posture is the cause of your pain you can have your sitting posture evaluated and learn how to fix it. All too often I find my patients using a military style shoulders back – sit up straight approach. Not only is this approach exhausting (try hold it for more than 2 minutes), it's incorrect! Good posture actually starts with the position of your pelvis and a strong core. A better chair or work set up can be a helpful nudge in the right direction too. You might also have muscle weakness or movement impairments that place undue stress on your discs during everyday movements.
Pinched nerve: If your disc is in really bad shape and it tears, the jelly-like center can bulge out and pinch the nerve. Compression on a nerve is painful right away. If that compression is not relieved things get worse because swelling builds up and the nerve gets glued down, inhibiting its movement. Without a mobile nerve you can have radiating pain down the leg or restricted movement in the back itself. Fortunately, nerve-sliding exercises have been developed and they've been shown to be effective at decreasing swelling and improving nerve mobility.
Damaged facet joint: Facet joints are the connectors between vertebrae that allow smooth movement throughout the spine. If you have a section of facet joints that are too stiff you inevitably have one segment where there is too much movement. Instead of each level of the spine contributing to a nice smooth curve, you end up with a hinge at one point. And that hinge-like point is enough to cause that twinge after a quick movement that eventually causes your whole back to seize up. The good news is that hands on treatment can loosen up the rest of the spine, and take the pressure of the "hinge".
Finally, once you've treated the culprit at the root of the problem you want to build the strength and control around your spine. It'll start with a series of 'physical therapy exercises' but if you keep at it you can quickly build up to 'gym exercises' that will keep you strong in the long term.
"Throwing out your back" may seem like it comes out of nowhere but the truth is that there are always problems below the surface that cause this injury to happen. The seizing up part of things is your body's way of protecting itself. The good news is that there is something you can do about it! One of the easiest things to do is get up and get moving. Movement is what keeps joints and discs healthy. For more complex situations a physical therapist is one of the best trained professionals to help you assess and treat your problem.
Hope that sheds a little light on what happens when your back goes out. Send us your comments and let us know what else you want to hear about!