Hurty back - advice or sympathy please

A snowHead

As you may have gathered from the title I have hurt my back. I've done it before: there's a click/wrench in the middle of my back and then slowly over the next few hours pain develops down my leg. This time around I haven't been able to straighten up, which is good for sitting during the daytime but pretty miserable trying to sleep. I saw my physio the day I did it and she confirmed that my back was in full spasm. She suggested a 6 - 8 week recovery period. I then went to see the doctor who kindly supplied drugs and also confirmed my back was in spasm. He suggested 8 - 10 weeks recovery. Both physio and doctor explained that it could be a damaged disc but that the treatment would be the same whether it has herniated or prolapsed (my terminology) so there is no point getting an MRI. In the past I've found that the spasming lasts for a week or so but often reoccurs, which is where those timescales come in, I suppose.

I have a ski trip booked in 5 weeks time and this started a week ago - so I'm at the absolute limit of being fit by then.

What are people's experiences? Should I be positive and look to be recovered in time or take up the insurances company's refund?

A snowHead

@henzerani, I wouldn’t venture to predict how long until you can ski with it. I think it differs very much from injury to injury- “peak” spasm went on for 2-3 weeks for me and it can still get a bit uncomfortable now at 5-6 weeks. But there were different reasons behind mine, to do with leg muscles.
One suggestion though to make it more tolerable, if you haven’t tried it already: a hot water bottle behind your back when you’re sitting. Blessed relief. A million times more effective than a heat patch.

Well, the person's real but it's just a made up name, see?

From my education, experience and knowledge only an orthopedist who specializes in spine issues can tell - only after CT/MRI. Any medical problem/condition needs to be thoroughly diagnosed in order to be treated.
A physiotherapist will be helpful, NSAID drugs and local ointments are crucial for at least the next 2 weeks. There are specific simple exercises that can be recommended - i know what worked in my case and I suffer from chronic back pain and sciatica, but it might be hurtful for another person.
5 weeks is a long time, most probably things will be much better by then so I wouldn't cancel at this time.
Speedy recovery, and definitely consult those specialists instead of simply waiting.

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Ask around for the best chiropractor in your area. If he or she is good expect them to be busy.

Make an appointment and GO!

I used to rank chiropractors along side crystal healers until one fixed my back in 6 weeks. The NHS had messed me about for 2 years and I was near suicide

I skied that year and 35 years later am still on the white stuff. Utah this year.

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We have crashed and burned and needed to get back climbing/cycling/skiing as quickly as possible - for back nagliness we use relaxants anti-inflammatories and analgesics in conjunction - and this by a family which uses drugs as little as possible - I have used dicophenac horse pills to stop spasm and they have worked well....

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@henzerani, @valais2, my physio also said muscle relaxants would be the most effective. I was able to cope without in the end luckily, but if it happens again I’d go for it. I also had dry needling and massage, both of which hurt, but helped. The day after a session was always a bit torrid, but with a marked improvement 48 hours later.

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@BorntoRun, can I ask what dry needling is?

I guess my concern is that whilst I’ve had this before I have had plenty of time to recover before. This time It has happened really close to my skiing holiday. And feeling better might not be the same as being better. So a) I don’t want to get there and then not ski and b) I don’t want to spend hours in taxis and planes in this much pain.

An MRI would be useful but I imagine it’ll take a few weeks to organise under the NHS and I can’t really afford a private one.

I think I’ll take the advice of my physio on recovery to start with.They famously got Billy Morgan to the 2014 Olympics.

And I suppose I should put it on perspective. I just read another thread in this section where the advice was: there will be other years.

After all it is free

@henzerani, dry needling is a kind of acupuncture, but the theory is that it traumatises muscles which forces them to contract more than they are at the moment, which can release a spasm. Hurts a bit, helps sometimes, but can also seem like quackery. I think GPs feel useless with muscular stuff, and this gives them something to try...

@henzerani, dry needling involves essentially inserting acupuncture needles in myofascial trigger points (or knots in the muscles in layman terms as far as I understand). More detail here: https://en.m.wikipedia.org/wiki/Dry_needling
You’ll see they mention “a local twitch response” when the needle is inserted in the trigger point, and that was exactly how it felt to me - almost like a spring is uncoiling in the muscle. The bigger the knot/trigger point, the bigger the “twitch”. It’s uncomfortable if your back is in spasm, but 48 hours later I could feel a real difference. Some physios do it; I had 3 sessions of that plus massage with my physio and it got the back to a decent point. I’d already had quite a bit of dry needling on my leg though, as I’m 8 months post ACL reconstruction.
Your physio sounds great. Personally I’d go by his/her advice about the skiing. What do they think is causing the spasm?
Well said that feeling better isn’t necessarily the same as being better. And very wise to take the long view on this. It’s worth sorting this out properly now, so that you don’t make it worse and miss out on more skiing down the line. I wish I’d been as wise about my knees a year ago!!

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@ousekjarr, @BorntoRun, I tried acupuncture once. They do a test to check if you are responsive and I apparently wasn't so the acupuncturist decline to continue (which was pretty decent of her as she could have taken my money anyway). I've just been checking back through my diaries. The first time this happened I saw an older physiotherapist who practiced something called the McKenzie method. She laid me on my side, jumped on my pelvis and when I got up the problem was solved - it was one of those rare moments in my life when I believed in magic.! But apparently that isn't used any more as it is statistically no more effective than the current advice of staying active and doing exercises. Interestingly, an important factor of the McKenzie Method is postural training, which is something I neglect. So when I get better ...

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@henzerani, My back goes into spasm with monotonous regualry and it hurst like crazy when it's in that condition. My experience is as follows:
1. Take the drugs (painkillers, anti-inflammaotories etc.) Don't think that because drugs are 'bad' that it's better to struggle through. If you do take the pills then you are more likley to move and movement is good for your back.
2. Keeping moving (aka tottering up and down because some fule said 'movement is good') is the wrong approach IF it hurts. You may just prolong the spasm.
3. Lying down like a vegetable for the first day or so is often the very best course of action and the quickest way to ease a spasm.
4. Evert physio, doctor, spine consultant I have ever spoken to suggested you do NOT let anyone (especially a chiropractor) muck about with your back while in spasm.

Personally, I like a bit of science and evidence in my medicine, so I tend to avoid chirporactors generally ... From the BMJ ... 'The only systematic review of exclusively chiropractic spinal manipulation concluded that “the available RCTs provided no convincing evidence of the effectiveness of chiropractic for acute or chronic low back pain”.4 Since the publication of this article, the emerging trial data have not tended to be encouraging. The effectiveness of chiropractic spinal manipulation for back pain is thus at best uncertain.'

The good news is that, in my experience, your back spasm should have long since passed by the time you go skiing. Gooid luck and keep taking the pills!

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@henzerani, You have my sympathy. I have a lot of back pain and my work involves daily heavy lifting.
Once, on the morning of the first day of a trip to VT I stooped to put my socks on and put it out quite severely and was crawling around on the floor. It was the thought of how much money/fun was about to be wasted that made me get to my feet.
Interestingly it didn't seem to effect the skiing. Sitting, lying down, standing up, and walking were all horrid but the skiing was fine, though I did take it a bit steadier than normal.
I suppose it was lucky for me I was already there too, I would have dreaded the thought of travelling if it'd happened the week before.
I hope you make a full recovery. All the best!

@HotDogger, I wonder if the muscle spasms affect you in the position you were in as the inflammation developed. This time round I hurt it taking a bag out of my car. I then spent the next couple of hours sitting at my desk working on my computer. Whilst I can’t stand up, sit down, laydown I can sit leaning forward as if I were on the computer. The first time I did this I was digging with a shovel and I was mostly stood upright as the pain developed. I’d have been able to ski that time but I was only able to stand or lay.

You know it makes sense.

@foxtrotzulu, I too, tend to be more convinced by science (that’s not to say that other systems don’t work). I like what you say about movement. I basically didn’t for 2 days last week and then I started to do a series of exercises on my back with my knees up or on my hands and knees. I find that walking is about the worst thing to do because I have to walk around as if I’m in antunnel and it makes the rest of my back hips and thighs hurt. On top of which part of the sciatica has caused muscle twitches in my thigh which has made it feel as if it’s run a marathon!
The main issue at the moment is the mornings. I seem to get a reasonable amount of sleep but I think I wake up having laid in a painful position and it takes some hours for the pain to wear off.
The thing that is worrying me about the skiing is that in the past, once I’ve had an incident, I seem to have a series of other ones over the next couple of months.
Maybe, if I notice that it has happened again I should get myself into a skiing position and stay there Very Happy

Otherwise you'll just go on seeing the one name:

What also helped me in my bad times was sleeping on my side with an elongated pillow between my knees, it helped me alleviate the lower back compression.

A snowHead

@henzerani, if there’s inflammation involved, that could explain why your symptoms are worse in the morning. My (non-professional) understanding is that swelling can pool and fail to dissipate when you’re static for a long time.
In my case it was purely muscular according to the physio, as my back was always better in the morning and got worse as the day wore on, as the muscles got tired.
The good news is that NSAIDs should help you- though they wouldn’t have been much use to me.

A snowHead

I would avoid a chiropractor at all costs. Google stoke and chiropractor and then make your own decision. Having suffered a vertebral artery dissection, and knowing of many who have had strokes following chiropractor visits, I would say it isn't worth the risk. it was the first thing my vascular neurologist asked me, whether I had been to a chiro.

Well, the person's real but it's just a made up name, see?

My advice....based on a back that gradually deteriorated over 35 years.

1. Get a diagnosis from an orthopaedic surgeon.....so you understand if there is an underlying problem.

2. Take anti inflamatories and ice it for 10 min per hour every hour for a day ot two.

3. Try to see a good Osteopath when the inflammation has settled.

4. The Chiropractic route will try and suck you into their regime. They can be effective....so only go until the problem settles.

5. Dry needling or proper acupuncture is worth trying.

6. Physio, provided they are really good, can help....but, depending on the underlying problem, can make things worse. IME. They are good for a specific one off acute injury/rehab....less so for a reoccurring chronic problem.

7. Look up the names and addresses of Osteopaths and Chiropractors in your resort, in case of problems.

In my case, for many years, skiing loosened out my back.....but gradually the opposite happened and it turned out that I had a herniated disc....which after a lot of messing about with injections, resulted in a fusion. I'm now back skiing.

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@henzerani, without being too tongue in cheek, nothing other than medicine can work, because if it did work it would by definition be medicine.

Totally, yes, there are interventions and medicines that are not completely understood (many things in fact) but acupuncture and chiropractic are not two of those!

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I have had success with both chiropractors and osteopaths. I couldn’t tell you the difference between them in regard to the manipulations they use but each will tell you they are completely different to the other. Your chances of successful treatment depend on who you see - there are good and bad ones like there are good and bad doctors. Recent studies have shown that acupuncture is equally effective no matter where you put the needles so make of that what you will!

Personal recommendation is often a good guide. Good luck with it. snowHead

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@Old Fartbag, I am beginning to think about taking that route. I had 2 incidents in 2011 and 2013, both whilst I was an active archaeologist and I put both of those down as occupational injuries. But I now ride a desk, rarely dig and keep very fit at the gym which suggests this problem is more systemic. And I think you’re right that I should find out properly what it is.
I shalln’t get into the rights and wrong of alternate medicines. I work in a science based industry and and have a religious faith so I can see it from both sides.

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@under a new name, whoever wrote the Wikipedia page on chiropractic wasn’t a big fan. But, in common with most alt medicines it is based on an inherent desire within a body to be healthy so that a body will try to fix itself and the therapy helps to remove obstacles.

After all it is free

@henzerani, I didn't even bother to look at the Wiki page... almost if not all alt medicine is based on placebo, and in in musculo-skeletal problems the fact that anything that isn't "too badly damaged"* will tend to self-resolve.

*not actually a medical term.

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As a doctor who often sees patients who have previously met orthopaedic surgeons, stay away from everyone.

Use the GP to get pain relief in the short term.

Take up pilates/yoga for core and stretching and weights for strength. When you feel up to it.

Alignment is bunk for most people. Most commonly problem is caused by overly tight hamstrings fixing hips and triggering spasm in back. My 2p.

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@under a new name, actually most GPS seem to work on the same basis. 90% of illnesses get better on their own and if they don’t the patient will come back.

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@motdoc, that has confused me further. So as it has happened a few times is it worth thinking about an MRI? I know surgeons are surgeons and so their advice tends in the direction of operating. But I’d certainly like to know what caused the problem. Evidence based and all that.

You know it makes sense.

Currently the evidence is that for axial back pain, ie near the spine imaging is pretty useless. Nerve pain; going down leg etc MRI is sometimes useful. Basically recommended only if you are wanting to go under the knife or there is a question about the diagnosis.

As a rule people want scans but not surgery. If the pain is regular and disabling or constantly there get a scan. But I personally wouldn’t go near a scanner without having done first: a good physio, then pilates, then weights. They won't destroy your life, surgery sometimes will. While in the acute phase massage can also be hugely helpful.

If a disc is intermittently pressing on a nerve then the problem is normally fixable without surgery. Make your back stronger and your legs more flexible and bobs usually your uncle. It's a minority that need surgery.

Otherwise you'll just go on seeing the one name:

@motdoc, haha I only read your last post and was about to suggest "you weren't an orthopod were you?"

A snowHead

@motdoc, Thank you that was helpful. I do have sciatica at present. Pain is mostly in my thigh with disconcerning muscle twitches which are quite amusing to the family but which have the effect of fatiguing that leg. So it sounds as if an MRI might see the problem but only worth it if I want surgery, and while it feels really important now 3 attacks in 7 years is probably not a big problem.

A snowHead

@henzerani, For a summary of the evidence based advice, have a look at this:

https://www.nhs.uk/conditions/back-pain/

Well, the person's real but it's just a made up name, see?

That sounds reasonable to me. If most of the time is good, then with a bit of work hopefully all the time will be good.

My double tough GP mate went through this from surfing and in the end caved to family pressure and got an MRI. Unsurprisingly had disc pressing on nerve and got better with strength training. We know people who have imaging feel they have been treated better, but do worse! It induces anxiety etc and quality of life scores go down.

I'm a GP fwiw. Interested in musculoskeletal medicine and pain relief.

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@henzerani, I had an MRI because I have insurance, had to pay about £50 to get it. Decided the pain was significant enough that I wanted to check there wasn't an issue with the discs, then with the results of the scan could discuss with physio and doctors what treatment would actually work.

Chiropractics are snake oil salespeople. If it worked, they would be able to prove that it works. It doesn't, so they can't. Just as simple as that. If you want to waste your money funding a sham industry go ahead, but remember that they could make the injury massively worse and cause you other serious health problems. If you want to pay someone who will be less effective than lemsip and masturbation (a recognised and proven cure for almost any injury) then fine with me, but you might want to try actual medicine before you resort to imaginary medicine.

I've had a couple of issues over a few years, and it is miserable. Hopefully you will start to recover soon.

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I agree with @motdoc, that musclular issues in the lower back are often due to hamstring tightness. Commonly the tightness will get worse if you sit down for too long. Heating the back while sitting will relieve the pain in the back, but heating the hamstring on the affected side will stop the pain all over (if it is the source).

My advice which mostly generated from multiple sources and experience from too much heavy back lifting

1. Gentle exercise as much as possible such as walking to keep blood flowing
2. Sit down only for short periods, and try heating hamstring when sitting
3. Maybe alternate heat with ice on hamstrings
4. When things start to improve, gentle finger manipulation of the muscles (I mean just touching and pressing and holding for 10-20 secs then release) Find the affected muscle by holding the muscle with your thumb and moving your leg around to find the sore points. Press on the sore points gently, then release. Repeat.

I run regularly, and whilst I have no serious back issue, I do have a hamstring issue which can cause problems in lower back. The hamstring issue gets worse in cold weather. Completely eradicated in a sauna. Old age, lack of collagen!

Tennis balls in a sock, lay on ground, lie on the balls with your back (or lean against a wall). This will give a deep tissue massage of the muscles around the spine. Only do this when you find gentle finger massage is not enough, and is not painful.

Back stretcher off the internet can help when used in combination with heat and after exercise. (eg. https://www.ebay.co.uk/itm/Magic-Back-Stretcher-Lower-Lumbar-Pain-Acupuncture-Back-Massager-Posture-Relief/263812764022?_trkparms=aid%3D555017%26algo%3DPL.CASSINI%26ao%3D1%26asc%3D55149%26meid%3D96d0a632aeb44184b4ac65bf4801648b%26pid%3D101006%26rk%3D1%26rkt%3D1%26%26itm%3D263812764022&_trksid=p2045573.c101006.m3226)

Strengthening the lower back, and all the core body really helps both in removing pain and in fixing so it does not recur. I suggest the best exercise for this is https://www.youtube.com/watch?time_continue=27&v=MzzL63Tlq9A pelvic raises.

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@henzerani,

I've had back pain off / on for 40 years now. It was so much more persistently worse 20 / 25 / 30 years ago than now. A couple of times i've begged for surgery. 6 years ago, after i walked into his office, i was told by a consultant surgeon he'd only operate if i was incontinent. As i walked in straight without severe symptoms, he had a fairly good diagnosis. All i need now is fairly regular stretching.

motdoc said:

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After all it is free

@Bigtipper, thank you for the advice. I’m sitting here with a strange creature cuddled into my back - a microwave able toy from primark.
I have joked for a long time that my gym sessions are pretty much maintaince these days - a routine for my rotator cuff , another for my aductor tendon, yet another for my Achilles and of course my back. That final link is something that I do as part of my warmup and cooldown every gym session. It is very useful.

Often with backs keeping things moving is better than lying around.

I get bothered with back trouble (lumbar) and did prolapse a disc a decade ago but find that skiing never really bothers it, even fiarly soon after the prolapse, trouble usually arises from poor desk posture, sleeping and sitting around.

You could ski wearing a sports supporting belt for skiing.

Log shot but inversion boots can help some people - have used them when I was younger but just getting yourself into a hanging position is physically difficult. Does stretch things out well though. Very Happy

Guess listen to the doctors, everyone's different.

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@Klammertime, thanks. I am aware I have a “slump point” which is where the muscle spasm is. I’ve tried over the years to work on it but I also have an issue with my neck that gives me neuralgia pain and that usually takes priority when sitting. The slump point is quite high - the lowest vertebrae with a rib. Would the support you mean reach that high? I don’t think even my grandad pulled his trousers up that high Very Happy

Help!!

Hurty back - advice or sympathy please

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