Have you ever bent over to pick up a dropped item from off the floor, and suddenly—BAM!—a wave of back pain hit you?
Chances are, after that happened, you may not have been able to stand back up again without significantly increasing your pain. You may have needed to take anti-inflammatory medicines, or maybe you were even considering a trip to the ER if your pain was that substantial.
If this sounds like a familiar scenario, you are not alone. This type of low back pain – known as “lumbar derangement” by many physical therapists – is estimated to be typical of 80-90% of low back pain cases. This initial episode of back pain is called the acute phase. It can last anywhere from a few days to a few weeks, depending on the severity of the derangement. This is what I call the “un-cute” phase… No one looks pretty when they are in that much pain!
The good news is – if managed properly – you can prevent this acute derangement from progressing to a chronic, recurrent situation. Often times, simple movements can literally reverse the mechanical deformation that occurs at the vertebral level.
A physical therapist trained in a particular method of evaluating back pain – known as the McKenzie Method – can help determine if your lumbar derangement has a directional preference. This refers to the behavior of your pain in relationship to spinal movements. A directional preference is seen when pain consistently increases and moves away from your spine (ie., down the buttocks or leg) with certain movements and conversely, decreases and moves centrally towards the spine with other movements. Not always, but most often, if you hurt your back bending forward (called flexion), moving your spine in the opposite direction – backward bending or extension – will decrease and centralize your back pain. Studies have shown that this centralization phenomenon is a 100% accurate indication of a reduction of the lumbar derangement.
So, what does this mean for you when you can’t stand up again after picking that dropped item off the floor? Since the mechanism of injury is bending forward, chances are that bending your spine backward will help.
The first step you should take is to assess where exactly your pain is located: right in the center of your back, or off to one side, or perhaps down one leg to the back of your knee? After you’ve identified where your pain is located, try moving your spine in the opposite direction of bending forwards. The safest way to do this is to lie flat on your stomach.
Monitor the behavior of your symptoms. If there is no change in the intensity or location of your pain, or if it is moving closer towards the center of your back and perhaps lessening, then try propping yourself up on your elbows. Try maintaining this position for 3-5 minutes (Hint: have someone bring you an ice pack to lie on your back while in this position to keep muscle spasms down).
Again, if symptoms are not worsening, that is, becoming more intense or moving further away from the spine, then next try performing a “press up” or cobra stretch as it is called in yoga. Position your hands directly under your shoulders while lying flat, then use your arms to lift your chest up as high as you can, with the goal of straightening your elbows. If this relieves your pain to some extent, repeat up to 10 repetitions or so. You should notice that you are able to move farther in to extension as your pain moves centrally, and your pain may be subsiding. If so, it is recommend that you repeat this entire process at least every 2 hours to manage your acute symptoms.
Avoid sitting as much as possible, but if you must sit, keep your lower spine in a position of extension by using a lumbar roll in the small of your back at all times. And most importantly, do everything in your power to avoid bending forward for 10-14 days until that derangement is fully healed!
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