So you just “tweaked” your back, or perhaps you “threw your back out” or even worse, “slipped a disc”. Whatever you are self diagnosing with Dr. Google’s help, be sure to keep in mind the vast majority of sudden onset, and recurrent low back pain, is due to muscular strain, and here is what you can do significantly improve your recovery time. First, I must state the obvious; getting a proper diagnosis by a well-trusted health practitioner, is always the best practice. Here are some general recommendations if the injury is a minor muscle strain.

The first 48 hours to 5 days is very critical for muscular back pain. Correctly and quickly addressing the injured muscles will stop the “lock up” and quick sharp pain which is the hallmark of the majority of low back pain. Following even a very mild strain of any of the numerous small muscles of the back, there is an increasing muscular guarding, which occurs in order slow movement. This muscular guarding can lead to very painful chronic spasms. This presentation is the typical pain-spasm cycle we must break in order to restore normal, non-painful, movement. The goal in the first week is to avoid allowing the larger back muscles to join in on the painful spasming. Often this spasming feels like sharp, gripping tension with positional changes such as rolling over in bed or getting up after a prolonged sitting or driving trip. Decreasing pain by relaxing and stretching the spasming muscles is the main goal of the first week after the strain so it doesn’t progressively damage tissue. Once again, strains like this are very common, in fact, the most common back pain. These initial days are critical in recovering maximally in the shortest time possible. Muscles require a significant amount of the body’s resources to contract, and these resources are brought to the muscles by an increased blood flow. When the muscles are tight from prolonged spasms, blood cannot adequately penetrate the depth of the rigid muscles. Blood therefore cannot bring adequate resources such as oxygen, nutrients and inflammatory cellular mediators for damaged tissue repair. Also, when the muscle is locked and ridged, the metabolic waste by-products due to the prolonged contracting cannot be adequately flushed which causes a local acidic pH change. This environment within the muscles leads to prolonged and increased muscle spasms and pain due to this acid irritating the nearby tissues and nerve endings. Think of muscles as sponges for blood. If a sponge is squeezed tightly in a fist in a bucket of water, no water can get in or out. However, if we repeatedly squeeze and release the sponge, we will flush out all the dirt and debris out of the sponge into the water of the bucket. Forcing the muscles to stretch, contract, then relax is how we rinse them with oxygen and nutrient rich blood. This is also why lying in bed or on the couch and hoping for a speedy recovery never works adequately. There are many studies demonstrating the dangers of prolonged bed rest with back pain. So we have established after we hurt the back, we should not stay in bed and let the muscles lock up, but what should be done to decrease pain? We must correct spasm to speed healthy recovery. Here is the answer explained in the form of a how to help your back injury at home guide.

I felt something in my back pull, now what?

STEP 1.

MOVEMENT, not bed rest. Yes, it will be uncomfortable, but moving in the safe and specific manor, listed here, will help interrupt the pain spasm cycle and bring highly needed blood flow to the damaged tissue, thus delivering the needed nutrients, oxygen and repair cells/enzymes to speed recovery. Blood flow to muscles is variable; blood doesn’t penetrate deep into the large muscle and tendons unless the muscles are active. The key to getting this right is to gently and progressively bring increased blood flow to the specific low back and accessory muscles which are injured. First, slowly increase the major multi-joint muscles range of motion through elongation (stretching) and relaxation, and then mild to moderate load is needed through the muscle. It is key to do this without compressing and straining the joints. Simple body weight movements with an emphasis on slow full range of motion spinal movement is perfect for this goal. Cat/ camels (Figure 1), open books (Fig. 2) and knee rolls (Fig. 3) are both safe and highly effective to accomplish this task. Once again, I would like to emphasize that these motions may feel uncomfortable, but are done with the specific a physiological reason; to bring much needed blood flow to heal damaged tissue. These movements, used to increase blood flow, are of primary importance, and the rest of the recommendations, in this guide revolve around this primary objective, as adjuncts to offer as much pain relief as possible to help allow these movements to be accomplished multiple times per day, every day, and always before and after any activity you feel may aggravate it the pain. The anticipated activity might be a sport practice , but it could also be a prolonged drive.

STEP 2: HEAT, STIM AND EPSOME SALT HOT TUB

HEAT, HOME STIM and HOT TUB. I will repeat, we want blood flow and heat helps that as well as acting as a low level analgesic. Heat can be accomplished through hot bath, a hot tub or even heating pad (plug in, or heated in microwave). The ideal cycle of a heating pad is 20 minutes on/ 20 minutes off. It will reduce pain by decreasing nerve nociception and the on off cycling will create a pump like effect for blood. The pain reduction is the same physiological theory the home stim units (TENS… Dr. Ho style units) work on. There is also a local release of something called enkephalins, these are local endorphins. Endorphins, and enkephalins, decrease the sensation of pain. This is a temporary decrease in pain (2-12hrs) and this produces the perfect time to move. Do the movements in the figures above.

Get in the tub! Hot water decreases muscular tension and put EPSOME SALT in the tub. Magnesium (Epsom salt) helps muscles relax by its roll as a calcium blocker in muscle cells. Calcium gets dumped into muscle cells to initiate contraction. Magnesium is effective in moderating this excessive spasm excitation contraction. And throw away those oral magnesium pills; we absorb magnesium far better through our skin in a bath. Dump a ½ kg of Epsom salt in a hot bathtub. Epsom salt is magnesium, not salt. You need more in a hot tub. Soak for 15 minutes.

For the home stim unit, called the TENS unit (Transcutaneous Electrical Nerve Stimulator) the stim pads should be placed on the area of tension, generally on the meaty area of the low back. Always at least a finger width apart, never touching. Crank it as high as you can handle without tensing up, watch the muscles twitch in the mirror. Keep on for 20 minutes, up to three times a day. Once again, to help you move. The decreased sensation of pain can last 2-12 hours.

Heat, hot tub, home stim. Adding these as soon as possible after a suspected low back muscle pull should decrease the sensation of pain to allow significantly less discomfort during movements to break the pain spasm cycle.

STEP 3:BRACE ABS DURING POSITION CHANGES

Be sure to brace for impact. Tightening the front core muscles, by flexing them will stop the low back and lumbar spine from moving during challenging spinal tasks such as getting in and out of the car, a chair and even bed. Also brace for rolling over in bed and getting up from the toilet. The tightening of the stomach muscles (think of the instinct to tighten the core if someone faked a punched into your stomach) allows our muscular corset of the front muscles to take the work away from the injured back muscles. The stronger and more active we have our front core muscles the less work and strain our backs incur. Keeping these muscles tight and active during movement is a powerful spinal sparing technique. It is also like having a large weight belt of our own muscles to support and protect the injured back. The less we continually tax the back, by adding help from the muscles of the abdominals during difficult tasks, the quicker the damaged muscles will heal and the less pain these movements will cause. Decrease the healing time and pain by using and practicing the abdominal brace as much as possible. During any challenging everyday movement, protect your back with your front. A weakness in the abdominal muscles may have led to the muscular strain in the back and this abdominal brace technique will have the added benefits of strengthening the abdominals and also groove a proper core first muscle movement plan by the motor cortex for full body movement. Ab brace first, then move.

I have been careful to emphasize throughout this minor low back injury recovery guide that all the steps are designed to allow the most comfort possible to return to normal movement. As stated, the pain and dysfunction from the muscular strain is prolonged and worsened due to the persistence of muscular spasm in the back. Extreme pain during this acute initial phase may also be lessened by a simple over the counter muscle relaxer such as Robaxicet Platinum. These drugs do nothing to heal the injury, that’s what the movements are for. These muscle relaxers will often make movements a little less restrictive. Once again, these are taken to assist you to be able to do the healing movements (cat/camel, knee rolls and open book).

Using these recommendations, as a substitute for proper diagnosing is ill advised, and if the pain persists longer than a week or if the pain radiates into the glutes or down the leg, seek a well-trained health practitioner for advice and a proper assessment. There are very few injuries of the back these recommendations will worsen, but if this occurs also be sure to seek proper diagnosis for your specific injury. This guide is one tool that can be implemented immediately after injury to drastically speed recovery, if followed properly the muscular pain in the back should improve each day. Preventing future occurrences of these kinds of injuries can be corrected with spinal movements training. These minor muscle pulls are usually due too poor core muscular balance, and we can identify this and improve it at High Performance Health, so let us assess your spinal health to avoid this situation all together or show you how to improve your overall spinal health after injury. As always, we are here to help, and feel free to forward this guide and any questions or comments you have to Dr. Brad Murray @info@hphealth.ca. And, if you found this article helpful, please click the “Like” acknowledgment below. Have a High Performance day!