Low back pain: From crippled to 100% in 10 days

One of the interesting things about rehabilitation is that it helps as a Physical Therapist to have some sort of experience of what your patients go through. Unfortunately, I found this one out the hard way with crippling low back pain that was re-aggravated from a climbing incident.

Cover image from http://centralchiro.ca.

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Background

Over the summer I tweaked my back when I was squatting down (in the asian squat position) and lifting some rocks. It manifested as a bit of shocking/shooting pain around the mid-low back and radiated slightly down into my right leg. I got out of position and did some quick mobility with standing marching movements and some transverse abdominus exercises and just moved around more and was generally fine. It was pretty stiff the next few days, and I did some reverse hyperextensions to fix it the rest of the way. I had no more problem with it from then on.

Thankfully, I did not need any advanced concepts like you may need if you have chronic low back pain. I also have an article about understanding pain when dealing with injuries which may be useful in learn about how to deal with pain during the injury process. So you hurt your lower back also gives somewhat of an overview on different types of back injuries.

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Incident

About 2-3 months later, I was climbing indoors at the climbing gym. There was one climb where you had to pull really hard on a side pull while facing toward it, so the back ending up rounding a bit during the pulling motion. I think this was the trigger to cause the pain. I finished the climb, and thought nothing of it because was no pain.

I sat down for about 5 minutes to relax for the next climb, and when I went to get up my back seized up. I started to stand up, and intense shooting pain hit my back like a sledgehammer. 9/10 pain on the right side, and about 7/10 on the left. Around mid-low back so about L3-L4 lumbar vertebrae if you’re familiar with the low back area.

For reference, 10/10 pain is can’t move and need to go to emergency room crying pain). I couldn’t stand up, and I couldn’t even move into a lunge position. It hurt so bad I was considering going to the ER, but I knew they would just give me pain killers and send me home so I knew it wasn’t really a good option.

I immediately knew that my back needed some light mobility and stability work. The transition to the quadruped position from sitting look a couple minutes to do because I couldn’t move without it sending shooting and pulsing pain in my back. I finally got into quadruped and did some cat-camel exercises which barely alleviated the pain any. Maybe .5-1 points at most (down to 8-8.5/10 on right and 6-6.5/10 on the left). I ditched that and tried to stand up multiple times over the course of the next 20-25 minutes, and I couldn’t do it. Things were looking grim so I called my wife to come get me, and I crawling my way slowly to the wall with climbing holds to help me stand up very slowly. I couldn’t even stand up straight and had to do a semi-hunching position. I couldn’t bend down to pick up my climbing gear, so my wife had to get it. It took me about 5 minutes to walk 50 feet out to the car. It was bad.

This incident and mechanism of injury is very similar to a bent over lifting injury where you throw out your back.

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Rehabilitation

Talk to your doctor and/or physical therapist about any type of rehabilitation methods before you try it.

Some general information:

• I did not take many painkillers such as NSAIDs or Tylenol. I only took 2 Ibuprofen per day for the first two days. You may be able to tolerate more to reduce the pain if necessary, consult your doc for that.
• I couldn’t really sit up or stand once I got home so all I could do was lie down.
• I had to take about 5-10 minutes to get up and use support of a chair to hobble to the toilet
• Log rolling is going to be your friend for getting out of bed.

Day 1

Overall, I started doing rehabilitation work about 2 hours after the incident. If you are not familiar with McKenzie exercises, they are useful for different types of back pain especially flexion injuries.

McKenzie Exercises – Image from linkedin

Lying on your back in bed is one way for the back to get very stiff and decrease overall mobility.

The first day I was able to about 4-5 different sessions of about 2-5 minutes of McKenzie exercises over the course of that night. Usually separated by about 30-60 minutes.

1. The one or two times I was only able to get into Exercise 1. The back was slightly to moderately painful when doing the exericise, but it did not get worse which was important. I terminated the exercises once it started aching and getting worse.
2. To transition from Exercise 1 to Exercise 2 without propping myself I put a pillow under my upper torso. This allowed me to put the back more into an arched position and passively mobilize it and increase the range of motion my back could handle. I terminated sets once the aching started getting worse again.
3. As the back slowly improved, I was able to almost get into position 2 by the end of the night. I did none of the other positions since I couldn’t get into them if I tried.

Sleeping is a huge issue with back pain. What I did for this is to sleeping on the side. Put a pillow between your legs to support it so the back doesn’t side bend into a weird position. Hug a pillow in your arms if necessary. Try not to roll or move too much.

Day 2

At the start of Day 2, I was unable to sit up and get out of bed without a lot of pain still. I still had to bend over and hobble to the bathroom after a long time.

I started doing McKenzie exercises every 30-90 minutes again, probably about 10 or so times throughout the day for anywhere from 2-10 minutes.

• I was able to progress to full exercise 2 at the end of the day, with partial press into exercise 3.
• I was able to get into a partial exercise 5

Those were the main exercises that I tried to do this day, and I stayed home during the entire day.

As the exercises improved from 2 to 3 in the arch, I was slowly able to stand up straighter when I needed to get out of the bed to go to the bathroom.

Day 3

At the start of Day 3, I was unable to sit up and get out of bed without pain, but it had decreased to a moderate amount instead of a lot. I could finally stand up straight to go to the bathroom with minimal pain.

I still did McKenzie exercises every 30-90 minutes again, probably about 10 or so times throughout the day for anywhere from 2-10 minutes.

• I was able to progress from a partial exercise 2 to about 75% of exercise 3 (arms were bent about 30 degrees).
• I was able to get mostly into exercise 5.
• If you can get into a hot bath or hot tub, this can be useful at this point. Since the pain is mostly starting to subside, the hot tub is very useful for decreasing the muscular tightness in the back.
• Get up and walk around as able to get the muscles working.
• I started working in some hook lying lumbar rotations. I limited the range of motion to non-painful or slightly painful. As the movements got better, I increased the range of motion as able.

Those were the main exercises that I tried to do this day.

Nearer the end of the day I was able to stand up straight with minimal pain, and walk with minimal to moderate pain depending on how long and how far.

Day 4

At the start of Day 4, I was unable to sit up and get out of bed without pain, but it had decreased to a minimal amount instead of moderate. I could walk without pain, but only for shorter periods of time.

I still did McKenzie exercises every 30-90 minutes again, probably about 10 or so times throughout the day for anywhere from 2-10 minutes.

• I was able to progress from 75% of exercise 3 (arms were bent about 30 degrees) to about 90% exercise 3.
• I was able to get mostly into exercise 5 without pain, but still sore.
• If you can get into a hot bath or hot tub, this can be useful at this point. Since the pain is mostly starting to subside, the hot tub is very useful for decreasing the muscular tightness in the back.
• Get up and walk around as able to get the muscles working.
• Work hooklying lumbar rotations and if you can also sit and/or stand and work trunk rotations.
• From here I was also able to add some bent leg reverse hyperextensions for 2-3 sets of about 10-15 reps.

I kept bent legs the entire time. I used my bed to do them, but you can also use a sturdy table, countertop, or block of some sort as seen above.

I love reverse hypers because they started to drastically reduce the pain and stabilize the intervertebral back muscles again which had gotten really stiff and inactivated in that time.

Day 5 and on

After I reintroduced the reverse hyperextensions, the next day I pretty much had no to minimal pain in all movements from getting up to walking to all of the exercises.

I slowly phased out a lot of the lying down exercises for:

• Started climbing lightly again. No bent back movements and highly submaximal
• Working up reverse hypers to 20-30 repetition range
• Started working in segmental rolling exercises to activate the small muscles of the back which helps reduce the spinal erector tightness
• Hot tub or hot bath to loosen up the back if it has gotten tight throughout the day. It is important to follow up with some supine hooklying rotations to stabilize the muscles.
• Worked in some pool exercises where I did the sitting and standing torso rotation with arms out to the side (video shows arms crossed in front of the body).

• Started working on arched back movements like McKenzie exercise 4 and improve the ability to arch back.
• Standing marching movements are useful to loosen up the hips and back muscles

Overall, the core of the program is reverse hypers and segmental rolling. The other exercises were excellent supplements to train the back to move well again rotating and arching. I didn’t work a lot of bent back movement until it was feeling 100% since that was the mechanism of injury.

• By Day 7, I was feeling 100% in normal everyday activities with no pain.
• By Day 10, I was feeling 100% back into climbing with no pain and no movement restrictions.

I still kept up the reverse hypers every other day for a month to ensure that I did not re-injure.

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Conclusions

Now, because I was previously athletic, it’s hard to say if my results were typical. Those who have poorer strength, mobility, and flexibility would generally take longer in healing. I also knew that early mobilization was very good instead of just lying down doing nothing and taking painkillers.

In general, if you were “just resting” it will generally heal and go away, but the results would not be as good as if you had rehabilitated it because the rehabilitation gets you back to being able to move effectively with less of re-injury faster. If I had done nothing, my injury probably would’ve taken at least 1-3 weeks to get back to normal activities without pain, and 2-4 weeks to get back to full athletic without pain. I was able to shorten it substantially.

Anyway, this is not meant to be “prescriptive” for anyone who has a low back injury like I had. This post is purely information content only. However, it should give you a general ideal of what the rehabilitation process is like if you have a rounded back strain type injury.

To re-iterate: I did not need any advanced concepts like you may need if you have chronic low back pain. I also have an article about understanding pain when dealing with injuries which may be useful in learn about how to deal with pain during the injury process.

If you want to talk to me about this article you can submit questions to the reddit or if you want me to help you specifically I also do injury consults.