What to do after Injuring your back
You wake up to what feels like just another normal day. You go through your morning routine taking for granted what it’s like to move freely without pain. Then, without warning, something happens. You injure your back. Maybe you bent down to pick something off the floor. Maybe you were lifting something heavy at work. Maybe you were working out as you do every morning. Hundreds if not thousands of times you have performed the same movement without a problem but for whatever reason on this day your body couldn’t handle the stress. In a split second you went from healthy and pain free to suffering an acute back injury and now it hurts to move. You’re scared. Maybe you have hurt your back before or maybe it’s the first time. Either way it has now become a major disruption in your life. Will this become a chronic issue that plagues you for the rest of your life? Will every future movement you make be done with fear that this movement may “throw out your back” again?
Injuring your back is SCARY but what I am hoping to accomplish with this post is to give you the tools you need to conquer your back injury rather than let it control your life. You’re body has amazing healing abilities if you provide the right environment.
The first and most important concept to understand is that the first 12-24 hours after you injure your back are the most important if you want to ensure a quick and full recovery. As soon as tissue injury occurs the inflammatory process is engaged. The inflammatory process begins in the area of the injured tissue but the surrounding area will also experience secondary changes as a result. With inflammation comes an influx of substances released by the tissues. These substances cause vasodilation of the local blood vessels (increased local blood flow), increased permeability of capillaries (allowing fluid to enter into the tissues), clotting of the fluid in the tissues, migration of white blood cells to the area and ultimately swelling of the tissue. The goal during this time is to encourage elimination of waste, allow for the influx of healthy nutrients to the injured area and encourage motion, motion, motion.
What I want to emphasize here is the importance of movement during the initial stages post injury. The tissues are in a vulnerable state and WILL STIFFEN UP if you do not encourage motion. If you allow the tissues to stiffen up then you are encouraging the waste chemicals to remain stuck within the tissue. You want to encourage blood flow in and out of the tissue allowing for the delivery of repair cells and the removal of waste. Gentle tolerable movement is encouraged while sitting or resting is detrimental.
If you do not have a medical background most of this may be sounding pretty foreign to you. These principles are grounded in research and clinical experience and I have used them in my own practice without question. It wasn’t, however, until I injured my own back that I realized just how important the initial post injury stage is and what a big role it plays in healing and future back injury prevention.
My back injury occurred on a Monday morning sometime between 5 and 6 am during a Crossfit workout. I was midway through a high rep deadlift workout when I felt a pop followed by stabbing pain in my left lower back. In the seconds to follow I immediately started thinking every possible negative outcome. My immediate decision was to finish the workout. In retrospect this was a mistake. At the end of the workout I was in excruciating pain and I held myself together long enough to make it home to my husband and tell him about the mistake I made. I contribute my injury to 3 main factors. First, I was running on very little sleep. My youngest son had kept me up most of the night before and while I wanted to sleep when my alarm went off at 4 am that morning I knew I would regret missing a workout. Fatigue will definitely increase injury likelihood especially when performing a strength movement in which form is a crucial component. Secondly, I made the unfortunate mistake of sacrificing form for speed. Lastly, My hamstring mobility is lacking and hamstring mobility is key in performing the deadlift movement. Recognizing what factors contributed to your injury is another important component when it comes to recovering from your injury and preventing future injury.
I am two weeks post injury and I am close to full recovery. The only thing that has changed from my normal activity is that I am doing a lot of stretching and I am taking a break from heavy weight training and rigorous exercise. As soon as I am fully recovered I plan on slowly returning to my previous workout routine. From the day I was injured until now I am continuing to bend down, pick up my kids, do housework, squat, rotate, and perform any usual movement that is required of everyday tasks even though, at times, it is uncomfortable. I avoid sitting as much as possible. I only took Advil one day. That day was 5 days after my injury when I tried to return to rigorous exercise to soon and flared up my injury. Pain is not something that should be avoided. It is your bodies way of letting you know that something is wrong. I want to know what movements hurt and what movements alleviate my symptoms. I want to know if my pain is improving or staying the same. Masking the pain disrupts the healing process and also your awareness of your symptoms and your recovery rate. I have narrowed down the steps to take after injuring your back to the following 5 steps:
Just keep moving. I can’t emphasize enough how important movement is here. The last thing you want to do after a back injury is to go lay down on your couch and watch Netflix for 8 hours. Stand, walk, squat, bend do all the movements required for daily life. You will probably move slower and that’s okay. Take your time and focus on your body. Its okay to be uncomfortable. Light activity is best during moments like this. Your first steps to recovery will include restoring full range of motion without pain. You will want to know what directions you are limited in so that you can slowly work on restoring that motion.
Skip the Advil and the Ice. Inflammation is a normal and necessary response to injury and it should be facilitated. Anti-inflammatory modalities such as Advil (ibuprofen) and ice counter act the inflammatory process. Allow yourself to feel pain and discomfort. Pay attention to what movements aggravate the pain and what movements alleviate the pain. If you can, take a hot bath. The heat will help to alleviate some discomfort and encourage blood flow in and out of the injured tissue.
Don’t skip the gym. You should avoid lifting heavy and performing rigorous exercise. Light cardio that encourages blood flow and sweating and gentle stretching during this time will make a big difference in your rate of recovery. Injured tissues have a tendency to stiffen up. It is best to encourage blood flow to help rid the injured tissue of built up waste and allow for an influx of tissue regenerating substances. Walking on incline, core training and body weight exercises are recommended. Avoid heavy strength training and ballistic movements and any activity that increases your symptoms during the activity. Stretch and identify which area of mobility you are lacking. This likely contributed to your injury and will be important to restore in order to avoid the same injury in the future.
Drink lots of water and eat healthy. Hydration and nutrition are key elements of the healing process. Each topic deserves a blog post of its own but for now I will keep it short. Eating a healthy, well rounded diet will ensure your body has what it needs to repair damaged tissue. Adequate hydration will decrease the strain on your kidneys and allow for efficient excretion of waste buildup resulting from the inflammatory process.
When in doubt, go see a PT. As soon as possible. If more people would go see a PT as soon as they injured their back rather than going to urgent care and getting muscle relaxers or pain medications there would be a lot less chronic back pain in this world. If you aren’t sure what stretches or range of motion exercises are safe or how to perform them….a physical therapist could show you. If you want to learn how to transition back to your pre-back injury workout without hurting yourself…a physical therapist can help you. If you want to know what caused you to be vulnerable to injury in the first place and address it so that you don’t injure yourself again…a physical therapist will identify that for you and show you what to do to fix it.
The last thing I want to stress is the importance of staying positive after a back injury. Injuring yourself is frustrating. It is easy to want to give up after an injury. Try to see it as a growth opportunity. Sometimes it is life’s way of saying slow down. Use it as time to break down your movement deficits and restore them to where they should be. Recovering from injury is an active process and requires just as much, if not more, hard work and dedication as it does to achieve your fitness goals (e.g strength, endurance, etc). Work hard now to achieve a full recovery and your chance of re-injury down the road will be much less. Not only are you decreasing your chance of re-injury when you finally address that lacking area of mobility you have been ignoring but you are also unlocking your athletic potential and will be able to perform at a higher level.