Has this happened to you? You've bent down to pick something up, or maybe you're combining lifting and twisting and "ping". Your back "goes". Sudden onset of lower back pain which is pretty severe and makes moving around difficult.
You've slipped a disc right?
WRONG!
No. As Prof. Peter O'Sullivan said on the radio recently, "discs don't slip". The phrase "slipped disc" tends to conjure up an image of a disc having popped out sideways between two vertebrae. This can't happen, there's plenty of connective tissue keeping the disc in place.
Great, so what did happen?
We call these injuries a lower back sprain or a lower back strain. Essentially they're like a sprained ankle in your back. Joints in your lower back have the same sorts of connective tissues (muscles, tendons, fascia, joint capsule, cartilage etc) as joints like your ankles and you can tear the fibers that make up these structures. If it is the disc that is injured, you get a tear through some of the fibers of the disc that causes a "disc bulge" where the fluid inside the disc pushes into where the tear is causing a bulge.
Will it heal?
Yes. These structures have a decent blood supply and they'll heal themselves. The healing process will take up to three months, though the vast majority of the time you're symptom free well before the three month mark.
You might have heard of people requiring surgery on these sorts of injuries. While this does some time happen, the vast majority of these injuries resolve without any need for surgery.
So what can I do about it?
Like a sprained ankle, you need to take it relatively easy for particularly the first 3-7 days. This doesn't mean spend the day in bed, but just potter around, changing positions regularly between lying, sitting, standing and some gentle walking. In the early stages try to avoid activities such as gardening, vacuuming, mopping, stacking and unstacking dishwashers which load your back into flexion.
You might find using ice packs helps to reduce pain and inflammation. it can also be worth discussing with your doctor or a pharmacist the short-term use of painkillers or anti-inflams. your physio will be able to help with pain relief with some joint mobilisations, gentle massage etc.
As you get out of the acute, inflammatory stage of healing your pain will begin to settle and you'll be able to gradually introduce more and more normal daily activities. Some strengthening, stretching and proprioceptive exercises are useful to make you able to perform functional tasks more easily and reduce your risk of re-injury.
These injuries don't sound very nice. How can I prevent them from happening?
- Maintaining a good level of physical fitness will help reduce your risk of back injury. An unfit person who decides to spend the day in the garden is at a greater risk of hurting their back than someone who spends a lot of time lifting weights at the gym.
-Use good lifting technique. Keeping the object close to you, bending from the knees and hips as well as the back and avoiding combining lifting with twisting movements will reduce your risk of injuring your back.
- Pilates and yoga type exercise is helpful for improving your proprioception of your lower back and pelvis, as well as strengthening muscles that help to stabilise through your lower back.