Eight out of ten people experience lower back pain in their lifetime. Fortunately, the vast majority of acute (new) injuries resolve without complications in 2-4 week timeframe. With that said, low back pain is the #1 cause of disability and days lost from work in the United States today.
When an injury occurs, ice should be used to control pain and inflammation. Inflammation is the body’s natural and necessary response to injury. Unfortunately, our body almost always over-responds with the inflammatory response which can lengthen the recovery process. By applying ice we reduce blood flow to the localized area and reduce the inflammatory phase of recovery. Ice should be applied for a maximum of twenty minutes every hour.
Following the ice application, muscles should be lightly stretched using a 10 second hold technique. Mild muscle massage with trigger point massage may be used to reduce muscular spasm. It is typical for the body to respond to inflammation and pain by “splinting” itself by muscle contraction. A muscle spasm will cause further pain and inflammation, so it is important to break the muscle spasm so the body can progress through the inflammatory response. Trigger point massage is the process of pinpointing very tight and tender areas of the muscle and holding moderate fingertip pressure on the spot for 20-30 seconds. This evokes a relaxation response to the muscle. Continue the light massage searching and triggering those tight muscle fibers until the entire muscle is relaxed.
Keep in mind, studies have shown a quicker recovery for persons who continue to ambulate and perform light work duties through the healing process. Bedrest will lengthen your pain and suffering. Stay within your mild discomfort range to help the muscles relax and begin to advance in the recovery process.
Most importantly, we need to discuss those instances when we need more emergent care than ice, stretching and massage. Red Flags are signs and symptoms of conditions which warrant an immediate emergency room visit. The Red Flags of lower back pain are listed below:
Red Flags of Back Pain
-Loss of bowel or bladder control
-Increasing numbness to groin/anus region
-Progressive weakness of the legs
The Red Flags are signs of a condition known as cauda equina syndrome. Cauda equina syndrome is a condition in which the nerves in the lower lumbar spine are compressed causing progressively worsening condition resulting in permanent paralysis without immediate surgical decompression. This is very rare, but very permanent without emergent intervention. Present yourself immediately to the emergency room if any Red Flags begin to develop.
Another group of signs and symptoms that I will label as Yellow Flags require consultation with a doctor for further evaluation. The Yellow Flags of low back pain are listed below.
Yellow Flags
-trauma-fall, auto accident, etc.
-change in color of urine/feces
-pain worse at night-time and rest
-pain running down leg
-weakness/giving out of leg
-pulsating pain in back and belly
-severe pain, unmanageable with ice/stretch/massage
-unremitting pain lasting longer than 5 days
Yellow Flag symptoms may be signs of intervertebral disc injury, aortic aneurysm, kidney/gallstones, fracture, tumor or infection. These conditions require an attentive examination and testing so that appropriate intervention and proper care are provided.
If you tend to fall into a cycle of repeat injuries or are having a difficult time managing the pain or functioning through the pain, chiropractic or physical therapy can be considered to improve your functional abilities and manage your pain through the healing process. During therapy, core stabilization exercises and posture recognition strategies can be taught to prevent re-injury. In addition, hands-on massage, joint manipulation and mobilization can be used to reduce the muscle spasm and improve the motion at the joints of the spine.
In summary, the vast majority of low back injuries resolve over time with a reduction of activity (not bed rest!) and limiting pain by using ice/stretching/massage. If red or yellow flags are evident further evaluation is necessary. And if in doubt, better to be safe than sorry, get it checked out.
Todd R. Custer, D.C., A.T. – Dr. Custer is a doctor of chiropractic and former certified athletic trainer with experience rehabilitating injured athletes at the high school, collegiate, and professional levels (Philadelphia Eagles Football Club) since 1994.
Dr. Custer graduated from Texas Chiropractic College summa cum laude, and is currently treating patients at Better Care Chiropractic & Physical Therapy.
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