We’ve all been there.
That nagging low back pain by your waistline burning into your upper buttock area. We go to bed at night with Advil, Aleve or Tylenol, we get an “ok” night’s sleep and wake up the next morning hoping that the back pain is gone. The first move, a guarded roll to our side, no pain, so far so good. Then a “core stabilized” side-lying to sit move just like the therapist taught. Maybe this is the day. And then you stand and – POW – that dang low back pain is still there! Now the second-guessing and questions: we are doing everything everybody is telling us, we went to therapy three times last week, we followed our doctor’s orders, we are walking more, we are losing weight, we are watching our body mechanics, we take frequent breaks from sitting, we stopped heavy lifting, we are swinging the golf club easier, we stopped taking prescription pain pills and the pain is still there. As a physical therapist who suffers from back pain, this pain sucks!
Maybe you had surgery and still have lower back pain?
If you have severe back pain, chances are you might have had an epidural or spoke to someone about getting one. You may have been to therapy a dozen times, twice in two years and there is still a little pain. Maybe you’ve lost hope. Is there any cure for this nagging injury?
Here is my story.
In 2015 I was training for a ½ marathon, running daily through a little bit of low back pain over the final few weeks. I ran and had a personal record of course, it was my 1st race. The next day I was bent over fixing a sprinkler in my backyard. I had been on my knees, bent forward for about 20 minutes when I went to stand up and BANG! A hot poker in the right side of my lower back. Hot, burning, stabbing and shooting pain that just dropped me back down onto my stomach in the middle of the yard. After the initial symptoms, I was laughing because I knew exactly what I had done. The tingling in the numbness started into my 4th and 5th toes of my right foot and the pain was so intense that I could just laugh. My wife and kids were gone for the day, no cell phone, stuck face-down in a sprinkler-soaked part of the yard with my golden retriever licking my face. What the heck am I going to do?
After 15-20 minutes the 10/10 pain was down 8/10, moveable and no ambulance needed. Then my PT brain kicked in and I knew I had to regain a neutral to slightly extended lumbar spine as soon as possible. This technique is 1 to 4 approaches in the McKenzie Method and emphasizes getting into a neutral position quickly to allow for more controlled healing in what I suspected as a disc derangement issue. Once I got to tall kneeling, I crawled up the wall to standing. I went inside, took some medication and remained standing. Lying down on my back with my feet up ( which is what we all want to do) can be one of the worst things to do for a suspected disc type injury. Lying on the stomach, in neutral with slight extension for short amounts of time is recommended. I also remembered no bending, lifting, carrying, reaching or long term sitting for up to 7 to 10 days. This was the immediate first aid 101 and 2nd victory.
So now what? Knowledge.
After my MRI and consulting with a trusted colleague, we received the diagnosis: congenital foraminal stenosis with a moderate disc herniation on the right side at L4/5. What in the world is that? As a PT, I have seen this diagnosis on paperwork and never wanted to see my name attached to is as my diagnosis. My central canal where the spinal cord goes is smaller than it should be for a guy my size. I have a medium disc herniation that’s blocking the side opening of the spine where the nerves go out to my leg.
If you have an MRI that you don’t understand, then chat with your local PT and get an explanation that makes sense to you. Medical jargon is for medical professionals, not patients, and I believe that PTs have the education, time and ability to convey and convert the medical diagnosis into “normal jargon.”
Commit to Treatment.
For me, it was physical therapy (it better be, I am a physical therapist), epidurals, reduction in heavy lifting and impact activities (running) and I stopped golfing for a short period of time. For medication, Advil/Aleve and patience was key. If you want to get better faster, consistency is key.
Think of the tissue in your lumbar spine as ligaments around an ankle. Ankle sprains hurt, they swell, they turn black and blue and we can’t walk on them right away, sometimes for weeks. Why do we expect more from the spine? Injuries to the spine are painful, it swells, tissues may not turn black and blue, but tissues do tear and bleed and we can’t walk. So now we have reduced this terrible, miserable, debilitating back pain to a common grade three ankle sprain.
Should we expect to go running on a severely sprained ankle in just a couple of weeks? A bad ankle sprain could require surgery, but most require a commitment to a 3-6 month regiment of First Aid, early conservative movements, progressive strengthening and conditioning, and a slow return to stressful activities. Of course, there are more serious injuries that can occur in the lumbar spine that will require more time, treatment and/or surgery and can be debilitating, but let’s assume that common things happen commonly and keep the focus on that annoying, but functional lower back pain.
Its been 4-years, what are my symptoms today? I still have local daily low back pain. At best, I have days with no lower back pain. At worse, it’s a 2-3/10. If I do stressful activities, it’s a little worse. If I follow all the rules and my home program, it’s better. I chose not to do surgery although it was suggested. I actively manage it every day. I understand the limitations and I choose to be active with some discomfort. Where is your mindset? What help do you need? Do you have a plan?
Get with an experienced local PT and find the answers that fit you and your lifestyle the best. Know that your small victories are important, and you too can BEAT lower back pain today! Come into a Foothills location near you!