“Hot Low Back” (explained)

Are you experiencing on and off Low back pain?

With trouble changing position and feeling it more while getting out of bed?

Does it hurt like crazy to cough, sneeze or even laugh?

Sounds like a possible low back strain.  This is a VERY common injury seen in our clinic and for all doctors.  

Lumbar TORSION (strain): The symptoms are as follows:  some pain (sometimes a lot of pain)  –  tough to get out of bed or change position  –  coughing and sneezing may hurt  –  noticeable “tightness”  when getting out of a car or after sitting at work or school.    The most common symptom is moderate to severe SPASM (locking up) of the muscles on one or both sides of the lower spine.

The spasm is the easiest to feel and WHY the mistake in treatment happens.

With these injuries, it’s not the strain or spasm as much as it is the inflammation around the injury that causes the pain. 
That’s why anti-inflammatory medication seems to help for a large number of people and why ICE, not Heat, will work much better, also speeding the healing process up.
Let me repeat…  ICE, not heat.  These are inflammatory conditions. 

Think of a sprained ankle.    An ankle swells when it is injured. 

Probably the biggest change in physical healthcare in the last few years is the realization that different body parts respond to “Threats” differently.

Injuries to the low back won’t swell, there are too many nerves in the area.   Injuries to the low back cause a THREAT – and when the low back is “on threat” it locks down all the muscles around the area as protection.   The Tightness is the brain’s way to slow movement so you won’t reinjure it. 

The Warning Signal causing this reaction is inflammation.

Initially, most people try to treat tight muscles with stretch, massage, and heat. This feels good as more blood comes to the area. “It just feels good.” is something I hear 5x/a day. However, the brain senses that extra blood as extra inflammation and responds, “Something is wrong, there’s even more inflammation than 15 minutes ago!” and locks the body back down. It’s a never-ending cycle of spasm, heat, spasm, heat. aka “It feels good,, I can’t move, it feels good, I can’t move.”

Have you tried the hot shower?  Everybody does…and I know this feels good right away but 10 minutes later, watch out! In fact, I diagnose these injuries this way. “Does it hurt even more than 10 minutes after a hot tub, hot bath, or shower? Yep? you’re inflamed!”

 In my clinic we feel this is probably THE most mis-treated condition we see.  (often diagnosed old school as a “slipped disc”)

You will have a lot of muscle spasm and because of this, most doctors, therapists and chiropractors as well as helpful friends and family recommend heat, stretch and massage.  Realize, the muscles are spasmed only to protect the back – they will relax when the inflammation part of the injury is gone.  How long does that take?  Usually, about a week when you start treating it correctly – I would personally not suggest any heat until you have had 3 good days in a row!   

While this condition is in the inflammatory stage – we prefer you don’t do activities to the area that increase the inflammation and bring more blood to the area.  Typically recommending NO massage, NO to very little stretching, and NO heavy load especially with bent and twisted positions.

This doesn’t mean I don’t like massage and these treatments, I just think they will be so much more effective as you get to the second stage of treatment- after the “Fire is Put Out.”

Is there anything I can do????

Yes, but it’s not the typical idea. The newest information in the sports world is that the lower back doesn’t like twisting. It’s a stable area in the body. Motion should be happening at the hip and above, in the thoracic area. That’s why I recommend…

  1.  The best protocol is to treat the inflammation first.
  2. restore STABILITY to the lower back
  3. Increase Mobility to the hips and upper back.

Try Low Back stabilization protocols such as “suitcase carry/farmers carry” throughout the day in place of stretching and twisting the back. (this was a hard idea to swallow as a chiropractor but I see it outperform my old protocols about 20X /week!)

Let your body know the area is stable and safe!

Move the area above and below the low back:

“Open/Close the Gate”    Hip Motion
Thoracic Rotation

Move the upper back and Hips.    More movement above and below the painful area tells the brain the

“Threat is under control.” 

Something else important to know about these conditions is that they almost never respond by feeling better and better each day.   Recall when you have sprained an ankle in the past.   Each day seems to feel a little better, like a stair-step progression of pain.

“Hot Low Back’s” don’t respond like this.  They have huge waves of up and down pain where at times you will feel almost completely healed and then may get hit hard and feel bad again.  This can happen even in the course of a single day, so be ready for it.  

The pain and spasm with these issues can be severe, but feel comfortable that this is a small and easy issue and it will go away.   The pain is just pain…Pain is not a good indicator of the severity of the issue. 

Treat the issue as an inflammatory condition first.

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