Did I just throw my back out?
“I threw my back out.” “I tweaked something in my back.” “My back went out.” Have you ever heard someone say one of these phrases? Or have you said one yourself? Back pain, and specifically low back pain, is the most common symptom I’ve heard from my patients. There are several reasons people experience back pain, and we will explore a few of the most common ones.
When people use the phrases above, they are often referencing a muscle strain. Muscle strains occur when muscles are stretched too far, too quickly. They can result from overuse, improper use, or even fatigue. Muscle strains often ensue when people engage in activities outside of the ordinary. For example, every winter, I have patients come in after a large snowfall and say they “threw their back out” while shoveling. Shoveling is a particularly precarious activity, especially when done incorrectly, and often leads to injury. We will cover shoveling more in depth on another day. Lifting a heavy object can also cause a muscle strain, especially if the lift was quick or if incorrect body mechanics were used.
Muscle strains can occur in one or multiple of the muscles in the low back. Several of the most commonly strained muscles of the back are the paraspinals, quadratus lumborum, and iliopsoas. These muscles are all considered stabilizers and work to protect the lumbar spine and spinal cord. When these muscles are strained, they often feel tense and as if they are unable to relax. This is due to their protective nature. Sometimes this can go away on its own, but often requires some type of intervention.
There are three grades of muscle strains, and are classified by the degree of muscle damage. A grade one strain, or a first degree strain, involves the least damage to the muscle, stretching fibers but only tearing a very few number of fibers. A grade three strain, or a third degree strain, is a full tear, or a complete rupture. Grade two involves more fiber tearing than grade one but less than grade three.
Back pain from a muscle strain usually lasts a matter of days, but some other injuries or conditions may last longer and tend to be chronic. One such condition is arthritis, which is another common cause of low back pain, especially in older adults. Arthritis pain is usually not a sudden onset; instead, it comes on gradually and is usually accompanied by stiffness. The pain usually worsens with prolonged positioning. The most common type of arthritis in the low back is called osteoarthritis (https://www.healthline.com/health/lumbar-arthritis).
Ligament sprains can cause acute, or sudden, pain in the back, and usually occur after traumatic incidents such as car accidents, sports injuries, falls, or quick twisting. However, ligament sprains can also occur due to overuse over a period of time. Ligament sprains can occur in isolation but often involve muscle damage as well. They usually produce localized, or “pinpointed” pain.
Another cause for acute low back pain is a disc injury. There are various levels of disc injury, ranging from bulging and protrusion to herniation. Lumbar disc injuries can occur rapidly or over a period of time. Symptoms often include radiating symptoms down the buttocks and thigh, and sometimes all the way down the leg or legs. Disc injuries can be fairly insignificant with reversible symptoms or they can be serious and require rigorous interventions. Rapid changes of symptoms within 24 hours, change in bladder or bowel habits (retention or loss of control), loss of sensation in the saddle region, and leg weakness or inability to walk require immediate medical attention (https://www.physio-pedia.com/Red_Flags_in_Spinal_Conditions).
Another reason people experience a sudden onset of pain in the back is a fracture. Falls, especially in the elderly population, contribute to a high number of vertebral fractures, and the likelihood of a fracture goes up if the patient has osteoporosis (https://www.umms.org/ummc/health-services/orthopedics/services/spine/patient-guides/lumbar-compression-fractures). Fractures can occur at multiple regions of the vertebra, and the most common is the first lumbar vertebra, or L1, closely followed by the thoracolumbar junction (https://www.physio-pedia.com/Lumbar_Spine_Fracture). Fractures of the spine can be serious and sometimes require bracing. If you suspect you have a spinal fracture, contact your physician.
I hope this brief overview of several common causes of low back pain was insightful. If you have back pain and are wondering if physical therapy is something that can help, contact us today and we can discuss your individual case to see if physical therapy is something to pursue. You can go to our contact page of our website www.momsinmotionpt.com/contact, email michelle@momsinmotionpt.com, or call 612-568-2462 for more information.