How I treated my back pain as a Physiotherapist Pt.2

Continuing on the second day after initial injury I began some more consistent movement. My pain was relatively worse with toe touch as opposed to arching my back although both were painful, this is what a therapist may refer to as flexion intolerant, or if both are painful then its motion intolerant, I feel I was a combination of the two. This told me that doing some repeated extension along with working on maintaining some relatively light trunk stiffness could help. So I did some prone press ups(repeated extensions) knowing that I needed to desensitize my low back to movement to get through my work shift. I also tried some cat/camels but was unable to do much range in flexion but I still tried them every few hours. And arching was painful about mid-range onward so I just stuck to that small range not pushing into too much pain.

The press ups decreased the frequency of the sharp pains and intensity of the constant ache to a 4/10 throughout the day. Commuting to work along with working did increase the pain and sensitivity so I did do some press ups at the clinic. The rest of the day at home I did some gentle cat/camel and press ups and tried to do some bird dogs but was still unable to without getting sharp pains. I also started to do some quadraped rocking which allowed me to get some gentle motion through the hips and low back while being relatively pain free with just minor soreness. I also did some hip hinging with a stick to pattern more motion through the hips instead of my back since it was still relatively movement intolerant. The second night I was able to sleep on my L side for about 10-15 minutes before getting intermittent sharp pain but was able to sleep a total of about 5 hours.

Video of exercises mentioned in this post

On day 3 there was still some sharp pains up to 7-8/10 but did have some spans of only 2-3/10 of dull ache as long as I kept moving around. Sitting on a stool was relatively tolerable but a regular chair being low, especially for me was uncomfortable for the time being after a few minutes. At the end of day 3 I went for about a 15-20 minute walk. I also continue doing multiple daily sets of prone press up and my cat camel got a bit better with less pain at end range rounding of the low back. On this day I also started doing some gentle bird/dogs and glute bridges, they were also painful but the pain did not linger after.

On day 4 I took a roughly 45 minute walk. There were instances where there was increased pain but for the most part it ranged between 1-4/10. I continued to stay moving as much as possible throughout the day and changed postures and positions frequently. Sleep was still painful and rolling over at all was still sharp, the sharpness was eased with some gentle bracing that gave comfort although I tried to avoid bracing if I could tolerate it. I did not want to constantly be bracing consciously as this can increase general muscle guarding. Sleeping on the left side was only a bit of soreness after 20-30 minutes, which was long enough to fall asleep and I was able to and I was able to get about 5-6 hours of sleep with intermittent wake ups due to the pain.

By day 5 I finally started to get some relatively pain free segments of the day although going from lying to standing was still a pretty sharp pain. I continued with the exercises. This was my first night of more than 6 hours sleep since I was able to get about 7. Sleep and rest plays a role in pain sensitivity and that was evident the next day as it became more of a soreness than an actual pain. Only end range flexion was still a bit sharp otherwise a dull 1-2 ache intermittently. I also did some body weight squats of a few reps a few times throughout the day while at work. To end the day I went for a 30 minute walk during which I felt relatively good so I tried a bit of a more fast pace/brisk walk to test my tolerance to sudden movements of relatively low difficulty and tolerated well. Upon returning home I did some hip mobility and prone press ups and bird/dog and cat/camel and was able to get a relatively normal nights sleep but still woke up with stiffness and discomfort.

One of the main things that I found most helpful was one of the most simple; walking. It’s interesting to see studies, that despite all our treatment techniques, core exercises, etc showed that a simple walking program was one of the most effective things for back pain. So I tried to walk for 3-5 minutes at least every few hours, slowly working up to some longer 5-10 minute walks. One study (1) looked at a walking program vs specific low back exercises. Both were done 2x/wk for 6 weeks. In both groups there was significant improvement in pain and function with no significant difference between the groups. Another study (2) looked at 246 individuals with low back pain. These participants were randomized into one of three groups: a weekly exercise class for low back pain, standard physio or a walking program with 4 weekly walks. In this study there was also significant improvement overall, although more walkers had what can be considered a significant improvement than any other group as well as having better adherence than the other groups. These studies suggest two things: specificity in activity may not be clinically significant in the treatment of low back pain as well as walking being a valuable and easy to implement activity.

I also tried to stay hydrated by drinking plenty of water. The reason for this is twofold. One reason is simply to help with general healing, and assist with the inflammation and blood flow to the area. The other was to help with pain. This was based on some evidence (3) that hypohydration (underhydrated/dehydrated) can actually increase a person’s perception of pain.

I continued with this routine for the next week and a half or so. During this time I limited all of my lifting and working out otherwise. I did do some isometric squats once they were tolerable as well as a few push ups and pull ups here and there. Although they caused some pain, it was fairly tolerable and I knew that continuing to move as much as I could would benefit me both physically and psychologically. Exerting ones self within a tolerable limit can help increase the threshold to pain (4).

So that was my initial stage of rehab. I wanted to display the importance of evidence in my own recovery. My goal like any other injury was to return to activity, so I felt like rather than experiment and use theory based treatments I went with what has been proven and relatively plausible to help. Along with that the psychological understanding that healing takes time and I just had to take it day by day and let my body do it's thing.

In the next post I will detail some of the things I did to return to activity including heavy squats and deadlifts.

Thanks for reading, Vitas

1- Shnayderman, I. Katz-Leurer, M. “An aerobic walking program versus muscle strengthening programme for chronic low back pain: a randomized controlled trial.” Clin Rehabil. 2013.

2- Hurley DA, Tully MA, Lonsdale C, et al. Supervised walking in comparison with fitness training for chronic back pain in physiotherapy: results of the SWIFT single-blinded randomized controlled trial (ISRCTN17592092). Pain. 2015; 156( 1): 131– 147.

3- Bear, T., Philipp, M., Hill, S. and Mündel, T. (2016), A preliminary study on how hypohydration affects pain perception. Psychophysiol, 53: 605–610. doi:10.1111/psyp.12610

4- Tarr B, Launey J, Cohen E, et al. “Synchrony and exertion during dance independently raises pain threshold and encourage social bonding” October 2015.