It is estimated that up to 70% of the adult population will experience non specific low back pain at some point in their lifetime. It is the leading cause of activity limitation and work absence in the world, yet it is generally very preventable and treatable.
Basic Anatomy of the lower back:
Your back is made up of 5 bones called vertebrae and they have discs, ligaments and facet joints connecting them together. Injury to the joints, discs or muscles
are common and can often be a source of back pain.
The spinal cord is protected within these vertebral bones and nerves branch out through gaps between the bones to the rest of your body. These gaps can be narrowed by bulging discs or bony formations. Pushing on the nerves can cause nerve type symptoms such as pins and needles, numbness or sharp shooting pain.
Facet joint injuries – generally but not always facet joint injuries will be worse when bending backwards and twisting. The back will actually feel locked so you just can’t push any further into that movement. Facet joint injuries can also limit you bending backwards.
Disc injuries eg: irritation/ inflammation or bulges – generally a little more serious and can take a fair while longer to settle depending on if the nerve has been affected or not. Disc injuries are usually worse with bending movements, but can also be very restricted going backwards into extension.
Sacro-iliac joints/ pelvic instability – these injuries are generally worse with asymmetrical activities eg running, steps etc. SIJ injuries can often be relieved when sitting in a slouched position, in contrast to a disc injury which can be worse in a slouched position.
Muscular strains are the least serious pathology and usually the quickest to resolve. Depending on which muscle is injured will depend on which movement hurts the most. Most soft tissue injuries will be fully resolved within 6 weeks.
One of the factors which can assist in diagnosis for both a treating practitioner and a personal trainer is knowing which movements or activities make your back pain worse and which movements make it better. For example bending or sitting is more likely to be associated with flexion injury whilst walking or standing is usually an extension based injury. Similarly if a disc is involved then your shock absorption will be worse so running, jumping, skipping etc will usually make your symptoms worse. It’s important to remember that you won’t always get pain at the time of exercising but it can be as late as the next morning when you wake up.
Usually during a back injury you can continue training to a degree unless you have nerve symptoms. These include:
– Pins and needles/ numbness down an arm or leg
– Pain radiating down an arm or leg
These symptoms don’t have to be going all the way down your arm or leg, they can just be referred to your buttocks or hamstrings for example.
After any injury ice is usually applied immediately in a wet towel to help limit any inflammation and swelling. As the joints in the back don’t tend to swell as much as other joints, heat can be used as an alternative to ice in helping to decrease muscle spasm.
Use the ice or heat for 10-15 mins as often as is required for pain relief. Remember you don’t have to be sitting down to apply ice or heat, if you’re short on time any treatment is better than nothing.
Comfortable sleeping positions:
– Sleeping on your side with a pillow in between your knees to limit rotation of your back
– Sleeping on your back with a pillow under your knees
One of the most important things that can contribute to low back pain is your mattress. Ensure you have a good quality mattress that supports your back so that you don’t wake up stiff or sore. When you go shopping for a new mattress it’s a good idea to go when your back is a little stiff or sore, so you can see which mattress supports you best.
Things to avoid with a back injury:
– Movements that cause an increase in pain i.e. twisting and bending movements
– heavy lifting
– sitting for longer than 30 mins, especially in a slouched position or in an unsupported chair
– picking up children, putting them in car seats etc
Stretches are really important to loosen up your back joints and muscles in the morning and before exercise. If you wake up and your back is stiff it’s important to loosen it up so that your range of movement isn’t limited.
Over the counter anti-inflammatories include: nurofen or voltaren tablets. Generally these should be taken the day after the injury for at least 3 days in a row to reduce inflammation. They must be taken with food to avoid stomach complications. It is generally advisable to take panadol for the first 24 hours after an injury, however if this isn’t strong enough to assist with your pain seek further medical advice. If you’re not sure if you can take these medications talk to your doctor or pharmacist first.
Preventing back injuries:
It’s common to re-injure your back and there are ways to protect your spine with exercise and correct lifting techniques.
With lifting make sure you bend your knees, keep your back straight, and the load close to your body. This includes when lifting or carrying children.
Avoid twisting your back with lifting and always move your feet to turn. If you have a desk job, make sure you have a chair with a supported back or lumbar roll, and every half an hour to get up from your desk and stretch your back.
How to get back to exercise quickly?
It’s important to get treatment for your injury as soon as possible to allow for it to heal quicker. You also need to strengthen your muscles before returning to sport, so if you are unsure about what exercise to do, speak to your treating practitioner.
Gentle stretching is always recommended no matter how sore your back is
Lie on your back and rolls your knees gently from side to side x 10 -15 each side
Lumbar flexion – brings one of 2 knees up to your chest and hold for 15-20 seconds.
Gluts stretches – can be done in lying or standing. If you are lying down bend your knees up to 90 degrees but keep both feet on the ground. Bend one leg so that your foot rests on your opposite knee. Then pull your legs up towards you. Hold for 20-30 seconds.
Swimming is also another activity that you can often perform when you can’t do your normal cardio workout. Sometimes you may need to use a pool buoy between your legs if kicking hurts but generally swimming will help strengthen your muscles and help maintain your fitness.
Even when your back is better and you are back training it is important to always monitor your flexibility and add in a gluts stretch as part of your warm up routine. You can also use equipment like foam rollers and spikey balls to loosen the gluts.
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