Back pain
As a physiotherapist I see lots of patients with back pain. It varies from chronic to acute, one sided, central, with neural pain or without.It’s always concerning for patients though and for some it takes over their life and they can become stuck in a seemingly never ending world of chronic pain. The CSP (Chartered Society of Physiotherapists) make a bold statement that most people across the world will have at least one episode of back pain in their lifetime and if you look at global statistics on back pain it’s not only a financial drain but also a drain on work hours and GP time. The Uk statistics suggest (http://www.paincommunitycentre.org/article/low-back-pain-problem)that £500 million of the NHS budget is spent each year on back pain so anything we; as health care professionals, can do to help patients understand and improve their own back pain is helping to reduce that cost. Over 95% of back pain is nothing serious and will clear up in a few days, to a couple of weeks. The CSP gives some great advice and guidance on dispelling the myths of managing back pain and one of the key messages is to keep moving and take your pain medication.
The ‘back’ is a strong, stable structure cleverly designed to allow for twisting, bending, lifting, climbing and carrying us around on two feet. If you look after it it really is an amazing structure. It has joints, ligaments, tendons and muscles around it so is susceptible to soft tissue injuries just like our wrists, ankle, knees or fingers.
I’ve always considered myself to be fit and strong and have at times pushed my body to the extreme. I’ve run into burning buildings, cut people out of cars, rowed, skied, swum, cycled and been pretty injury free. Most of the injuries I have had I can be fairly specific about the cause and with a bit of knowledge and patience I’ve recovered well. I think it makes me more empathetic to my patients, especially working with so many runners, as I understand the frustration of not being able to run. As a physio I’m also aware of the importance of allowing your body time to heal. I know that pain is complex and often isn’t a sign of any true damage, but I also know that it can have a devestating effect on people’s lives.
So last week I had a bit of a shock. I had, I suppose, what you would describe as a bit of stiffness in my lower back but could pin point the cause down to doing some gym ball roll outs. I’d avoided doing them again at the circuits class I go to on a Friday but had carried on run training and weight training.
Last Thursday I’d got up in the morning to get ready for my exam; my level 4 coaching qualification in S&C. I must admit I was a bit stressed as the exam was a full day of practical and theoretical assessments. I felt slightly under prepared and was quietly wondering if I was actually ready for it and wishing I had another few weeks to prepare. My other half was trying to reassure me and make sure I had breakfast and a cup of tea and we did have a few cross words, I think mainly around him trying to help (yes I’m an evil girlfriend from hell!!). As I bent down to feed my cat I suddenly had the most awful pain in my lower back that felt like someone had stabbed me with a knife. Now I’m not a crier or a drama queen, but I dropped to the floor and screamed out in pain. I genuinly couldn’t move as the pain was unbearable and I felt like someone was not only stabbing my back but ripping my insides out. I burst into tears and Steve came running into the kitchen to find me wedged against the cooker unable to move. I managed to get onto a chair and the pain was coming in waves that made me feel physically sick. I couldnt believe that this had happened, on my exam day of all days. There was almost a bitter sweet irony to it as it meant I couldnt attend my exam. I took as many pain killers and ibuprofens as was safe to do so and basically spent the day moving from lying to standing and pacing around the bedroom. In my head I knew it wasnt serious but boy did it hurt. Thursday night I didnt sleep well and Friday morning I had patients booked in from 8 till 1pm. I didnt want to let them down so hobbled in trying not to look like a really bad advert for a physio. Saturday I was supposed to be attending the running show as one of the specialist professionals working on the Sports Injury Fix stand giving advice to injured runners. I didnt want to risk making myself worse so was gutted to have to let them know I couldn’t attend. I was pretty miserable as the running show was bigger and better this year so I was looking forward to seeing what was on offer.
So Saturday was spent pottering around the house and I started to feel much better. The pain eased right off and I couldn’t believe how effective the pain meds were. Sunday morning I woke feeling pretty good and this was where the dilemma came in. I was due to take part in the 4th race of a 5 event cross country series. I have never done all 5 so was really keen to be there and finish. This is where my physio head and runners head collided. I knew I hadn’t hurt my back seriously and it felt much better, a bit stiff into extension but other than that pretty much pain free. I thought about what I would say if it was a patient of mine. I’d advise them to listen their body. I knew that today that wasn’t enough. My body was saying ‘I think I’m ok and I dont hurt but remember how much it hurt so you don’t want that to happen again’. I had to make a decision on based on facts. I knew I hadn’t done any damage to my back and in my head I likened it to stubbing a toe on the bed. We’ve all done that at some point in our lives and the pain is intense, but it soon subsides and we are left with a bit of a swollen toe and some stiffness when we move it. I knew I did have the potential to tweek the healing soft tissue and potentially make it sore again. I had to weigh up all these factors and make a decision based on my physio knowledge, my experience as a runner and how I felt on the day. I didn’t want to let my running club down but likewise I knew I had to put my needs first. I went for a run before hand to test out my back, and felt good. I had slight restriction in my back extension so I knew I did have to be sensible and pull up if anything felt wrong once I set off.
I set off at a pretty good pace at the start but the course was brutally hilly. I’m not particularly strong on hills but can usually hold my own, today though I felt I couldn’t get my hips into extension so really felt I was pushing a lot with my quads, even on the flat. I decided to walk the really steep ones and found I could still get some good speed on the flat and downhill sections. I finished with most of the girls I’m usually close to in this race series so was quite pleased. I got home had a warm shower and a bit of a stretch out and now, as I’m sitting typing this I feel ok. Slight bit of an ache into my left hip, almost deep inside towards my back but other than that no actual pain.
Finished with smiles
I wanted to write this just to reassure readers that pain in your back can be caused by many things; compression, twisting, bending, and is usually nothing serious. If you trap a finger in a door you squeal, it throbs but it gradually starts to feel better. Its the same with your back, if you move and some of the soft tissue gets compressed between the bones it can cause pain or if you stretch a muscle of a ligamant too far it’ll cause pain. It can happen to anyone and it can be very frightening.
If you do experience back pain don’t panic, get some pain killers and ibuprofen and seek advice from the pharmacist as they can advise on the best types of pain relief, and you don’t need an appointment to see them. Keep moving as much as you can, but in the first day you may find resting up helps. Try heat or ice, I used a heat pack as I found the warmth soothing. Get plenty of sleep as this plays an important role in healing. You only need to go to the GP if you have ongoing back pain for more than 6 weeks, feel very unwell or are losing weight, have pins and needles down both legs or have problems with your bladder or bowel.
I hope sharing my experience of back pain has given you some reassurance that it really can happen to anyone at anytime. Being fit and strong keeps your back healthy but it wont stop you getting back pain at some point in your life. If you are concerned about ongoing back pain you can book in for an assessment or phone the clinic to discuss your concerns.