Listen on Soundcloud.
"Why did my back go out?". This is a common question from people who've ever happened to hobble painfully into my office before. This type of back pain is very acute (within 24 hours) and very painful. In today's blog post, I share my thoughts and insight about this problem.
How This Type of Back Pain Usually Presents Itself
Leaning or shifting of the torso sideways relative to the hips
Inability to stand up straight
Difficulty transitioning between positions or moving quickly
Ability to bend forward severely limited (difficult to sit and tie shoes, etc.)
Pain in the lower parts of the back or upper gluteal region
What Sets It Off?
Research hasn't been able to answer this question well. Especially for this type of back pain because it would be difficult for researchers to create a study where they are on stand-by waiting for people to throw their backs out. It would also be unethical to make subjects do things to try to set off their back pain.
What studies have been able to investigate are people who've had the back pain linger for a longer period of time. Read more about this type of low back pain here. While many research studies have suggested many risk factors, they don't usually discuss the mechanism of injury much. One paper I located surveyed doctors in Australia on what typically brings their patients in for this type of back pain. Here were the top five reasons:
My Experience and Opinion on What is Causing It
Patients I have seen that have "thrown" their back tend to do it with very ordinary and everyday activities.
Picking up a small item from the ground
Stooping or squatting for a couple hours doing yard work on a nice day
Picking up a child or moving items <50 lbs from one place to another
Leaning forward to look at something
This list coincides with at least four out of the five top reasons for coming in with back pain.
Patients sometimes think they may have blown or slipped a disc which is not an unreasonable first guess, especially when lifting something is what set off the pain. However, disc injuries usually make up a small percentage of patients that come through the door. Another reason it usually isn't a disc is that there isn't accompanying shooting pain, numbness, tingling, or weakness into the leg and foot which tends to be more characteristic of a blown disc (but not always).
While it could be a strained muscle, strains usually tend to happen in fast and ballistic type situations such as in sports and exercise, or a car accident. The activities that patients report to me require elongation of the muscles in the lower back at relatively slow(er) speeds or are sustained for a long periods of time.
Another reason that I don't think it's a disc injury or strain is that these patients can often have significant improvement with a week or two with rest, ice/heat, and pain relievers because this is what they have always done to manage episodes in the past, but for this particular time they needed to get better ASAP. Of course, this is not to say you should never get checked out by someone- because you should.
So if I don't think it's a disc or a strained muscle, what the heck is it? I believe it's due to muscle spasms set off from poor flexibility. Many of these patients that have their back go out will often have at least two of the following findings in their history and examination:
A past history of having a frequently tight and sore low back, perhaps after a prior injury (but not always)
Very dense and tight low back muscles with palpation (almost rock-like)
Very limited ability to bend forward in the lumbar spine (the actual low back)
The common theme with all the offending activities that I listed is that they usually require bending or rounding in the low back. Because these patients may have a history of low back pain already, I find that they tend to guard the area more, which keeps the low back muscles tight, and making them less compliant to elongation.
Compare the two people bending over in the picture. Whose back do you think might be unhappier after a couple hours of gardening over the weekend? For the sharp observer, you might also notice that the upper back of the individual on the right has taken on additional mobility to make up for what the low back lacks.
My opinion is when that extra bit of motion is needed to accomplish a task, too much is being asked of the muscle, and the body sensing possible danger, goes into spasm to guard and protect the region which leads to pain. Another theory floating around out there is that this "loosening" of the muscle in the offending activity may make the area unstable, and the body sensing this instability spasms and guards the muscle to protect itself.
What Can You Do to Help It?
While core strengthening exercises have become synonymous with low back pain, I don't believe that core strengthening is necessarily the route to go when you have this type of low back pain- not yet at least. Because in strengthening the core out the gate, you promote more stability and tension that is already disproportionate in the low back that doesn't want to bend. And while low back extension exercises are typically given out for those with disc related low back pain, they actually may help in the short-term for muscle spasms because they help to put the muscle into a shortened position where it might not be as irritated. But I don't believe this will be beneficial long-term because it will only serve to perpetuate your low back tension as well. What is necessary to help improve the situation long-term is to gradually and gently increase mobility and motor control in the low back once you are out of pain (I write about the importance of mobility here) This is where good chiropractic, physical therapy, massage, or yoga treatment can help you get there.
If you find yourself with a tweaked or thrown out back right now or find it happening to you often, don't go it alone and get checked out. To experience a different type of chiropractic clinic in Kirkland, come see me at Integrity Chiropractic.
Steffens D, Maher C, Ferreira M, Hancock M, Glass T, Latimer J. Clinicians' views on factors that trigger a sudden onset of low back pain. European Spine Journal: Official Publication Of The European Spine Society, The European Spinal Deformity Society, And The European Section Of The Cervical Spine Research Society [serial online]. March 2014;23(3):512-519.