The most common acute injury I see is when a client lifts or moves a certain way (fill-in the blank from deadlifting to picking up a piece of paper on the floor) and *POW* back pain so intense it can bring you to your knees. And sometimes it does.
Let’s start with good news: MOST cases of spontaneous acute low back pain resolve without intervention in 4-6 weeks. Even with a herniated disc, “the majority of disk herniations resorb, and patients usually become asymptomatic within 8 weeks after symptom onset.” HOWEVER, reoccurrence rates are high if PT intervention is delayed.
And you are not alone! Most people - 80-85% - will have low back pain at some point in their lifetime. The prevalence for low back pain in any given 12-month period is 37% for the general population and 51% for all athletes with some sports being as high as 61% (rowers). Risk factors for the general population include: obesity, low socioeconomic status, smoking and lack of exercise. For the athletic population, risk factors include too much exercise, biomechanics of sport, fatigue and/or poor technique, and training errors usually falling into the “too much too soon” category. Do you check any of those boxes?
Let’s talk about back pain and imaging. If red flags are absent (i.e. unexplained weight loss or bowel/bladder incontinence/retention - found to be very rare ~.02 to 3% of cases), MRIs can actually increase disability and cost of care while delaying recovery time. MRIs are really good at finding “problems” with a poor correlation rate to symptoms. “MRI should be considered in patients with radiculopathy symptoms who do not respond to conservative management consisting of pain control, medical management and physical therapy after 4–6 weeks of symptom onset.” Research has shown folks who get imaging for low back pain have “prolonged disability, higher medical costs, and greater utilization of surgery.[14]”. Just. Get. PT. First.
There are lots of structures in the back including muscles, tendons, joints, ligaments, etc. and it is not feasible or even necessary to decipher the exact cause of the pain. That being said, physical therapists are trained to evaluate your signs and symptoms which will dictate treatment. If this injury just happened and you have a high level of pain and can barely walk, our goal is symptom modulation with treatment such as lumbar manipulation, movement within pain limits, and overall pain management - you want to gently KEEP MOVING. Once your symptoms start to get better, we begin working on motor control including core stabilization and flexibility training. Finally when you’re feeling pretty good, we optimize your function and get you back to work, sports, strength & conditioning and hitting those PRs.
Summary:
1. You are not alone and it’s going to get better.
2. MRIs are unnecessary and even harmful in most cases of low back pain.
3. The EXACT structure in your back and impairment to that structure is not known but isn’t necessary for effective treatment.
4. PTs treat based on tolerance and provide education, tools and exercises to prevent this from happening again.
5. Research-supported treatment includes: lumbar manipulation and soft tissue techniques, motor control with core stabilization and flexibility training, followed by strength & conditioning and gradually returning to full activity.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6118107/#!po=16.1017
Prevention and managing LBP in rowers: https://bjsm.bmj.com/content/55/16/893
Interventions for athletes with LBP: https://bjsm.bmj.com/content/55/12/656?ijkey=1e78a1461b4932faa8db099ebd13a9cea19f5ed3&keytype2=tf_ipsecsha
Photo by Sasun Bughdaryan on Unsplash
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