How I as a physical therapist approach my own injury: Part 1

As a physical therapist I have seen my practice changing and adapting over the years. No more is this evident when I approach my own injury and pain. I thought this was a fitting post to start off with and let you see how I apply my approach to my own injury.

The key approach is the biopsychosocial modeal. BIOlogical, PSYCHological and SOCIAL. I will address each of those categories in terms of a recent injury to my low back. This approach can be applied to any situation and as a clinician all factors must always be considered.

About two months ago I was lifting with a focus on lower body. While doing some box squats, I descended onto the box and came to a full sit. Trying to ascend from the box was a challenge and required some momentum. Through this motion I felt a pull in my low back on my left side. After trying to continue with another set I knew it was unwise. After this I continued with some extensions on a glute ham raise machine. The extensions were a bit uncomfortable but not much more than a 2/10 on a pain scale so I did a few sets thinking this would help it ease up. Then I tried a warm up set of dead lifts and felt around a 3-4/10 after the set so I decided it was better to shut it down for the day.

I worked a few more hours then drove home. During the drive my low back started to tense up so I just tried to lightly brace consciously just a bit as it felt more comfortable.

After about an hour sitting at home it continued to tighten up and I started to get some sharp pains ranging from a 5 to as much as an 8/10 especially with transitioning from standing to sitting. Walking was frequent intermittent sharp pains along with a constant dull ache. There was a bit of radiating pain into my left butt cheek.

At this point my hope was to just get some good sleep although there was a bit of worry that it would progress, I was also optimistic that it would feel better in the morning. There was sharp pain for most of the night aside from 2-3 hours where either the sensitivity decreased enough to fall asleep or simply I was that tired.

The next morning I woke up with increased stiffness and pain at around a 8/10 with almost any movement in bed. I slowly got out of bed and started with some gentle mobility on the floor. A bit of prone extensions as well as gently rotating through my spine in side lying. Although while doing these it was fairly painful (up to 8/10) it did seem to reduce my pain once i was in standing to where it was a constant but manageable 4-5/10 while I was upright.

So at this point what did I make of all of this??

To truly get the full idea of all the factors I first had to consider my history. I have had about 5-7 incidents of significant back pain over the last 15-20 years. This included a very severe incident in which most of my left leg was pins and needles along with agonizing pain in the low back. The subsequent MRI after that showed 2 moderate to severe disc bulges. I also considered that as studies have shown many people with disc bulges are pain free, so it is possible those bulges were there prior to the incident. Even if I did have a disc bulge this time again it was not necessarily causing my pain. From a psychological aspect it would have been very understandable for me to immediately equate this current incident to a re-occurrence of the disc bulge which in turn could have negatively affected my pain. Many people tend to have a notion that strong back pain means they have bulged a disc, which can further drive their pain and create a fear of movement, essentially stifling their recovery. From a social aspect working a relatively physical job as a physical therapist I had the immediate concern of having to miss work as well as social events that I had planned for that weekend. That fear of missing out on socializing as well as income definitely could have had negative affects on the pain I was experiencing.

Another possible factor was that I had been a bit more sedentary that week including a lot of sitting and inherently slouching. Although this was not a cause of pain or injury as there is no reliable correlation between posture and pain, it could have played a role in terms of making my nervous system a bit more sensitive to low back rounding which occurred during the box squats.

Now let's break down the mechanical factors. As I sat down my pelvis rotated posteriorly aka low back rounding. In this situation I considered the potential of a disc injury but I ensured myself not to assume. Since the pain was relatively one sided I looked at what muscles could have been strained, which were any muscles that would have extended or arched my back, that gave in due to fatigue/too much load. The main muscles were the erectors along the spine (right), the quadratus lumborum (pictured above as the lateral muscles) and lastly the psoas (above image crossing the pelvis). The joints of the spine itself were also a possibility. Knowing that the pain only radiated into my buttock gave me an idea that it may have just been referring from the low back muscles an not necessarily the nerves from the disc.

At this point I had an idea of the possible contributing factors and was able to proceed with beginning my rehab process. The key for me at that point was to not assume anything serious. Many people will experience back pain in their life time, often nothing to be concerned about. In my case I took the same approach, knowing that even if it was a muscle strain it may take a few days to ease up. The key for me was to continue moving and trying to find relatively comfortable positions at times where i was sitting or lying down.

Now that we have the initial injury and first 24 hours or so covered of my injury we have a starting point. I hope this view of my pain has helped give you a better idea that pain has many factors and even in cases where a trauma occurs. Even as a therapist, knowing what I know I still had moments where I let fear and panic take over and assume the worst. In the next post in this series I will go over the next few days of my recovery, along with a return to activity and weightlifting, etc. in the post after. This will be a four part series.

Next post will continue the timeline further and cover my initial rehab exercises....... stay tuned.

Vitas