Help! My back went "OUT"
Have you ever had back pain, weakness or tension so intense you are unable to function for a period of time? My back is “out” you may tell your spouse, kids or colleagues. What is actually happening to the spine when this occurs? How can we shorten the duration of an episode and most importantly, prevent it from happening again? Low back pain (LBP) is the most common musculoskeletal problem and the leading cause of disability globally.
The spine is a highly complex structure whose challenge is to keep us upright and highly mobile, yet protect our spinal cord and provide a stable base from which our limbs can move. It is made up of:
24 vertebral bones
48 facet joints
Ligaments that hold the joints together
23 discs between each vertebra to provide cushioning
The spinal cord that runs through the vertebra and the nerves that extend from it through the spaces between the vertebrae
Tendons that attach muscles to vertebra
20 muscle pairs that support the spine and allow for movement
Each of these structures works together to achieve pain-free functional movement and static posture. However a disruption in one of these areas can result in pain and sometimes it is debilitating. The most common causes of acute low back pain are mechanical in nature, meaning a change in the way the components of the spine function. A change in mechanics can be caused by a muscle strain, ligament sprain, disc herniation or tear(s), arthritic changes and inflammation of the joints and compression or inflammation of the nerve roots that emerge from the spinal column, through the vertebrae, and down the leg. These causes can occur in isolation or in combination. Of course, there are other reasons acute pain can occur including the presence of a tumor, infection, kidney stone, endometriosis and pregnancy to name a few.
When acute LBP occurs (i.e. your back “goes out”) there are steps you can take to lessen the pain and the duration of the episode. Initially, get off your feet. With most mechanical issues, decreasing compressive forces on your spine will help. Sitting will not necessarily achieve this and, in many cases, will make it worse. Lie down on your bed. If your mattress is very old and saggy it may feel best to lie on a carpeted floor, however, sometimes the act of getting on and off the floor can also make it worse so be careful.
Use good body mechanics. To get in and out of bed first, sit down by bending the knees and hips. Then lower yourself to your side bringing your feet up and your head and shoulders lower down. From there, with your knees bent to your back.
Lie with the back flat and pillows under the knees/feet. Play around with the number of pillows under your knees and do what feels best. Place a soft gel ice pack across the lower back or anywhere you feel pain. You can also alternate with a warm (not too hot) heating pad. Alternate 20 minutes of ice, nothing for 20 minutes, 20 minutes heat, nothing for 20 minutes and so on, always starting and ending with ice.
Change position every 20 minutes, alternate rest and gentle movement.
If you need to change your resting position, try lying on your side with a pillow between your knees.
Make an appointment to see a doc and/or a physical therapist, it usually takes at least a few days or weeks to get in, if you don’t need the appointment by the time it comes up, you can cancel! This is also a good time to ask what over-the-counter medications you can take. Aleve Liquigels are my go-to, check with your doctor to be sure there is nothing else you're taking that is contraindicated. Your doctor may prescribe some muscle relaxants. These are best taken at night before bed as they will make you sleepy. But if you are home from work and in spasm, don't wait to take them!
Other things to try are an Epsom salt bath, gentle movement or standing in a swimming pool, magnesium glycinate, turmeric, l-theanine.
Consult an MD and a PT to discuss further course of evaluation/treatment and to establish a regular exercise program. A program incorporating stretching, strengthening, mobility and stability performed regularly along with good posture and body mechanics can help prevent these episodes from repeating themselves.