Our lower back literally carries us around, the lumbar region plays a vital role in our body’s loading pattern. The lower back acts as the center of stability within the core in multiple movement patterns. Flexion, extension, rotational movements and even lateral flexion are all movement patterns that need a healthy back in order to move optimally.
And the key word here is healthy, because without a healthy back we quickly realize how much we depend on this region of our bodies. But unfortunately, our lumbar regions get injured far more often than we would like.
And that’s why common lower back injuries are either annoying or debilitating depending on your type of injury and the it’s specific pathophysiology. If you’re not too sure on the type of injury you have but do in fact have back pain, please go check out our previous articles on this series. We discuss and dissect the types of injuries, how they occur and how to differentiate between acute and chronic conditions.
That being said, if you have read our other articles in this series then you’re probably here because you do in fact suffer from some type of lower back pain or discomfort. This article will take a look at your timeline for recovery and the general steps you need to take in order to have the best shot at getting back to normal.
Most people that have lower back pain usually fall within two categories:
Yes, I am well aware that I am generalizing here, but if you do fall in the latter category then this article is for you. And if you fall within the former, then this article is also for you.
Regardless of which category you fall into, lower back pain and by extension lower back injuries are something you need to take seriously.
Now with that being said, this article is going to cover the prognosis of common back injuries. Prognosis simply means the way forward with regards to your recovery. Luckily for you there is a sort of “template” that you can follow in order to treat and if it is needed, rehabilitate your specific issue. If you implement the following steps you should see some form of improvement in your injury.
Okay, so now that we have the technicalities out of the way let’s get back to what we need to cover. To simplify things and avoid too many complexities we’re going to break down this process into 4 steps that you can follow to address your issue or condition. These steps are as follows:
- 2Acute treatment
- 4Return to activity
But as always, before we get straight to it we need to take a step back and look at a crucial part of understanding injuries- The pain cycle.
Understanding the cycle of pain
The pain cycle is a graphic representation of the effect of chronic pain on the human body. Pain is not by any means linear in its presentation. It is a complex phenomenon that facts multiple areas of our existence, both direct and indirectly. Once acute pain transitions to a chronic issue the pain cycle is initiated. The cycle is very simple…
As you can see the pain cycle can very easily become a serious problem. As the onset of pain affects multiple factors in your body that in turn worsen your pain and thus the pain cycle continues. With each cycle we usually see an increase in the severity of the initial pain, and this then has a trickle down effect on the rest of the factors within the cycle.
Now as a rehabilitation specialist myself, I see this cycle on a daily basis as most people will experience some form of chronic pain at some point within their lives. I think we should also mention that the pain cycle can and may occur as a result of any type of physical pain. However for the sake of this article series we’re going to discuss it within the realms of chronic lower back pain.
The biggest challenge with regards to the pain cycle and chronic lower back injuries is trying to break the cycle and then by means of new habits, trying to reverse the damage the cycle has caused. Now on paper that seems like a very straightforward concept however it’s far from it. You see, most chronic pain sufferers do not even realize that they are experiencing the pain cycle and those that can I identify it are more often than not in some form of denial. This can be noted as a form of ignorance towards pain. In other cases fear plays a significant role in the inability of a patient to break the cycle. This is because chronic pain has such a significant psychological effect on the patients life, that they develop an abnormal fear for whatever causes them pain. For example, if a patient experiences pain during physical activity, they associate pain with all forms of physical activity. This in turn makes it significantly more difficult to break the pain cycle as they usually refuse any physical therapy or rehabilitation of any kind. In turn they become more sedentary, develop poor postural habits due compensatory mechanisms and the cycle proceeds to go on and on getting worse and worse over time.
Yes, this is a very simple example, but you’d be surprised how often this is the case or the reasoning behind a patient's reluctance to seek any form of help.
So the point we’re trying to make is that we urge you to become more vigilant of your own specific pain situation. Identify issues, bad habits and physical and mental responses to your pain. This will help you come to terms with the fact that you are in fact sitting within your own unique pain cycle… Which is the first step to recovery.
Step 1: Identifying your source of pain…
Being able to accurately identify your specific source of pain is really important. In fact, if you cannot successfully identify why you are experiencing chronic back pain then anything else we are about to cover is null and void. This is actually a very simple concept… If you know what disease you have you can understand how to treat it. In this case the disease is your chronic lower back pain and the treatment will depend on your specific condition. This is why we can’t stress the importance of this step enough, because lower back injuries particularly those of a chronic nature tend to have significant overlap in their presentation. The similarity makes it difficult to determine what injury you might be suffering from. Therefore, you might need some assistance thus utilizing special tests and diagnostic tools such as x rays or scans can significantly aid pinpointing your source of pain.
Step 2: Treating the source of pain…
Pain is well painful, regardless if your pain is acute or has already developed into a chronic issue, before any form of recovery or rehabilitation can take place you first need to treat your pain or painful symptoms. This is where your primary care physician comes into play. After getting injured the first thing you need to do is go see your doctor. Our backs are at the center of our entire lives; without a healthy back you literally cannot move. Seriously, I know we’re all busy and going to see our family doctor seems like such a schlep, but honestly take my advice, you do not want to find yourself in a position down the line where you wish you had listened to this advice.
But that being said, the most common method of treating pain is with pharmaceuticals. Over the counter painkillers or prescription medications can reduce your pain almost immediately. However, there are significant risks with continuous use of pain medication such as addiction.
Therefore, a holistic non-pharmacological approach to treating your pain. Methods like contrast therapy, a modality that uses alternating bouts of hot and cold therapies. This is a great method to reduce pain and inflammation without the need of taking any medications.
So whether it’s going to a doctor or getting some over the counter pain medication, treating your pain will significantly increase your chances of recovery. But we should point out that this step of the process merely focuses on your symptoms and not the cause of your pain.
Step 3: Treat the problem…
However, we understand that not everyone has access to a doctor due to geographical and or financial restrictions. Your alternative? Physical therapy.
PT’s are a class of allied healthcare workers that are grossly underappreciated, most people know they exist but have no idea the value they hold. So, if you’re sitting there reading this article and you currently have some form of chronic lower back pain and you don’t feel like or can’t get around to seeing a doctor… Go see your local physical therapist!
They’re insanely skilled professionals that literally teach people how to walk again. Okay, that’s a bit dramatic I know but the point is PTs have an amazing repertoire of treatment modalities that can significantly reduce your pain.
It is usually easier and a little more cost effective to go see a physical therapist. Because not only can they treat your pain they also have the skill-set to help fix any underlying biomechanical issues or compensations you might have developed due to your chronic pain.
All in all, physical therapy is probably your best bet at treating your problem.
Step 4: Returning to your activities…
Return to activity, sometimes known as return to play or return to sport is a term given to the final stage of musculoskeletal rehabilitation. During this phase the focus is on restoring normal functioning that might have been influenced or restricted by your chronic lower back injury. Climbing the dreaded staircase, carrying the groceries all in one trip, running more than 2km or sprinting and jumping again are all just examples of return to activity practices. It is the intentional introduction of a former painful stimuli that causes a flare up within your pain cycle. This step is absolutely critical as it sort of laminates the break of the pain cycle and the introduction of positive stimuli to reinforce positive behaviors.
You need to go out and practice the movements and or activities that you have been avoiding for all this time.
Yes, that was very technical but honestly this was the best way to go about stressing the importance of this step. Breaking your pain cycle will ensure you fully recover from this chronic injury. This step not only deals with the physical aspect of breaking the pain cycle but more importantly the psychological issues that arise with chronic pain.
Understand the pain cycle and how it really is or has affected your activities of daily living. Now follow the four steps by starting out by identifying your source of pain and start with a treatment modality for acute pain management. After that your next step should be looking at some long term corrections by treating and ultimately trying to fix the underlying source of your pain. Finally it’s time to break the cycle by doing all the things your chronic pain was stopping you from doing. By intentionally practicing these movements or activities you will be reteaching your body and your mind that it is okay to move like normal again.
All in all, this article is far from scientific. There are hundreds of articles online that cover this issue from that perspective. The point of this article is to guide you towards recovery but in a relatable manner. At the end of the day your chronic lower back pain has a much more deeper affect on your life than you might care to believe. This might not be the most technical perspective on the topic but we genuinely believe that this is the real prognosis of your lower back pain.