Even though lower back pain can be the result of a trauma like a fall or car accident, the most common reason is no reason at all. For most people the pain just shows up one day and gradually worsens to the point it is time to seek professional help. In these cases the answer to everything we need to know is right there in front of us. A good whole body exam should be able to identify what went wrong and what changes are needed.
Lumbar sprains and strains can often result from sudden or forceful movements like a fall, twist, lift, push, pull, direct blow, or quickly straightening up from a seated, crouched, or bent position. Most commonly, sprains and strains are not the result of any single event, but rather from repeated overloading.
The spine is very good at being able to manage small isolated stressors, but repetitive challenges often can lead to injury in much the same way that constantly bending a piece of copper wire will cause it to break. Examples of stress that can cause lower back pain include bad postures, sedentary lifestyles, poor-fitting workstations, repetitive movements, improper lifting, or being overweight.
If your pain was the result of a trauma, allowing healing to take place in an optimal fashion is job one. Once several weeks have gone by healing is essentially complete. Any pain continuing beyond that time frame is not related to a lack of healing but altered movement patterns, muscle guarding, fear/perception of movement as threatening, scar tissue restrictions, etc. It should be treatable with manual therapy, activity modification and purposeful movement/exercise.
The good news is that most back pain is not as hard to treat as you think. Expect that you will begin to improve and ramp back to full activity regardless of your MRI findings.
Also, MRI is often not that helpful, at least at first. The problem is that 60% of people with no back pain history have disc bulges evident on MRI. So, if people who feel fine have disc bulges what does it mean if I hurt and I have a disc bulge? It means the disc bulge may not be the source of your pain. Just because it’s there doesn’t mean it’s a problem.
If you want to learn more about recovery from lower back pain I encourage you to read the book, “Gift of Injury” by Brian Carroll and Stu McGill. Brian was a world record power lifter who’s squatted over 1000 pounds but suffered severe back pain from his training and wanted to avoid surgery and Stu was the PhD researcher who guided his amazing recovery. Dr McGill has influenced and trained many clinicians in spinal rehab worldwide including our physical therapist, Dan Swinscoe.
If your pain doesn’t begin to resolve quickly with more conservative measures, an MRI can be essential at ruling out sinister pathology and to facilitate more aggressive treatment options such as an epidural steroid injection if needed.
However, most of the time with lower back pain we have simple solutions. Walk more, sit less, sit smarter. Breathe better. Learn how to move so you can handle loads safely. Get stronger in smart ways. Get your thoracic area and hips to move better so the lumbar region is exposed to less loads. Become strong in all three planes of motion. If you need help getting comfortable to sleep we recommend Proze "Nerve." This is a topical cream that works great. Our patients can get it at a discount using this link.
Our expectation is daily improvement what is yours?