HOW LOW BACK PAIN CAN THREATEN YOUR INCOME
I ignored a niggly pain in my lower back last month. There were no appointment times that suited me, so I took the “she’ll be right” approach. Mistake. Two weeks later I was cancelling appointments with my clients because I couldn’t work.
Now, I’m fortunate. I’m an osteopath. I know low back pain, I know other osteopaths. I was able to get things back under control fairly quickly.
But a lurking thought kept creeping in: What if it hadn’t just been a niggle? What if I’d hurt myself seriously? What if, rather than needing a long weekend off work, I’d needed a few weeks?
It’s a sobering thought to think about how you’re going to pay the bills when you’re an injured sub-contractor.
In this post I’m going to talk about:
The most common cause of low back pain
Why it can happen to you.
How it happened to me.
What happens when you're lazy about rehab
The difference between pain and injury
What I did about it the second time
Why taking preventative action is so important
THE MOST COMMON CAUSE OF LOW BACK PAIN
Everyone has heard of "doing a disc". Think of these discs as a dense cushion between the bones of the spine, surrounded by a thick band of strong ligaments.
The most common injury in this region is a sprain affecting this band of ligaments on the inside of the disc, technically called an Internal Disc Disruption. While it is certainly painful, it is actually a ligament sprain more similar to spraining an ankle, but deep within the spine. Nothing is out of place and there is no nerve involvement.
An internal disc disruption is different to a disc bulge/prolapse/herniation (sometimes called "blowing out" a disc), which can cause direct pressure onto the nerves in the spine and result in weakness or numbness into the buttock and/or legs. Sciatica is the term to describe this and it is far less common than people think.
What's important for you to know is that discs are placed under the pressure when we bend forward. The pressure is increased if we then twist while in that bent position. The maximum load occurs if we then lift while in this posture. This is when our spine is at the most risk – bent forward, in a slightly awkward position, while lifting.
“IT WON’T HAPPEN TO ME”
Yep, we’ve all said this. Even me. But the truth is, you just don’t know. When your job is physical, or really repetitive, the spine is placed in a strained or compromised position on a daily basis, without you giving it much thought.
Day in day out, I help people who are suffering back pain. They make up over 50% of my clients. My knowledge of what causes low back pain and injury didn't make immune to suffering it myself.
That’s like saying that a mechanic will never get a flat tyre or that a fireman’s house is inflammable. There are no guarantees.
Speak to any tradie who’s been on the tools for over 10 years and I guarantee they can tell you about at least one episode of low back pain.
The year my mates turned 30, I started to hear the boys saying “I just don’t bounce back like I used to”. Didn’t matter if it was work, footy or the pub, the guys started to notice that they were slowing down a little.
The reality is that, as we get a bit older, our muscles and joints have a longer story to tell. Wear and tear starts to creep in and those little niggles and knocks that you used to forget by the next day when you were an apprentice start to happen more often and hang around for longer.
My injury happened when I was just 23.
THE MOST RIDICULOUS DISC INJURY IN THE WORLD
While I was at university I injured the lowest disc in my spine. I had been casually and comfortably slouching in a twisted position on my bed, leaning forwards over a text book. When I went to move two hours later, I couldn’t. Like I said before, discs don’t like us to bend and twist at the same time.
I couldn’t put on socks and shoes, couldn’t drive and every time I sneezed I had to brace myself so I didn’t collapse.
It seemed ridiculous that something so simple could have caused so much pain. After all, I hadn’t been doing anything difficult or strenuous.
Frankly, it scared the shit out of me.
A QUICK ASIDE ABOUT THE DIFFERENCE BETWEEN PAIN AND INJURY
An injury occurs when there is damage to the tissues of the body: think broken bones, torn muscles, sprained ligaments.
Pain is different in that it is a feeling. Pain is the reaction that happens in our brain to minimse our risk of injury.
Most people think that pain = injury, and sometimes it does. But we can also suffer pain WITHOUT injury. And, most confusingly, injury WITHOUT pain. This goes to show that things aren't always as straightforward as they seem. Seeking professional advice from someone who understands these concepts thoroughly can help you avoid wasting time and ensure that the rehabilitation plan for any injury is accurate from the outset.
Think of pain as an alarm system. The siren goes off to warn us. Alarms are useless if they only go off after we’ve been robbed.
The point of the alarm system is to let us know that something is up, so that we can investigate and prevent the robbery.
It would be irresponsible to hear the alarm and not look into what’s triggered it. That’s like feeling pain, even a little niggle, and ignoring it in the hope that it will just go away.
Alternatively, it would be extreme to hear the alarm, panic and suddenly sell the house and move to a new neighbourhood without knowing who or what has tripped the wire. That would be like feeling pain and avoiding all activity so that body isn’t challenged at all. This reaction stops us doing the fun things in life, makes work difficult and rapidly leads to boredom and fatigue.
I SOLD THE HOUSE
So, despite my growing education that suggested otherwise, I fearfully did NOTHING for the next 4 months. What can I say? Some people have to learn the hard way, especially 20-somethings...
The pain gradually went away with time, as the sprain healed and the inflammation died down. I could move and sit comfortably. But I was still scared of it happening again. So I played it “safe”. No cardio, no weights, no surfing. No rehab! I gained a few kilos in the process.
My fear meant that I didn’t take decisive action to fix the problem. Instead of hearing the alarm and looking into cause of the INJURY, I freaked out and reacted to the PAIN.
THE POWER OF STRENGTH
To spell out what I hope seems obvious, by doing nothing I increased the weight that my low back had to carry and I lost my core strength. This is a disastrous combo when it comes to low back pain. And it actually slowed my recovery progress.
Sprains heal. There is a natural process that takes about six weeks for any ligament or bone to recover from trauma. If you do the rehab, develop your strength, you reduce the likelihood of it happening again.
If you do nothing, the same patterns that led to the initial injury happen again, and chances are you end up in pain again.
How many people have you heard say they have a "weak ankle" or "weak back"? This is a simple statement that reflects that a previous injury hasn't been fully rehabilitated. Obviously, any weak points in our musculo-skeletal system will crumble under pressure before our normal, healthy bones, ligaments and muscles.
Strength is the key to recovery. But it has to be specific. It's not a matter of just being strong. Rehab is about making sure that you are able to activate the deep stabilising muscles that protect our joints. After an injury, these muscles lose strength and forget their role, or they go into complete overdrive and forget how to release, creating local muscle fatigue and pain. These stabilisers are what require attention.
Once my pain had settled I slowly got into a more active lifestyle. I was in my 20’s and so my strength and fitness returned quite quickly. I stopped thinking of myself as a person with a bad back. Occasionally I’d feel a tweak, but it would settle quickly.
But in my 30’s, work became more demanding and I was time-poor. While exercise wasn’t non-existent, it was often the part of my day that was overlooked when push came to shove or if I was too tired. Afterall, my job is pretty physical, so that would keep me strong enough, right?
Those little niggles that I ignored developed a few layers. My body was clever and able to adapt without me feeling the changes much.
Until that day when I overdid it. It was as simple as taking a long, hilly walk. But my body wasn’t used to it. I expected to bounce back easily, but instead I overworked my glutes which, unbeknownst to me, weren’t as strong as they should be.
Like last time, a LOUD SIREN went off, indication that if I didn't take action quickly I was heading towards trouble. The pain mimicked my earlier disc injury and my memory of that process meant that I listened early and got the pain assessed.
Fortunately this episode of pain hadn't involved any tissue damage. I put new rehab processes in place and I got strong. Today, I have no pain.
WHY TAKING PREVENTATIVE ACTION IS SO IMPORTANT
Now, what happens if you just keep ignoring the siren? Maybe nothing. Or maybe you have an acute episode of pain that means you're off work for a week: inconvenient, but no big deal? But what if it's not a week, what if it's a month of no lifting, no ladders, no long periods in the car?
It's worse than the stress of not being able to work and juggling who is going to cover your job or run around quoting.
It means no time in the surf. Being incapable of wrestling with the kids. Unfinished projects at home. Reliance on your partner for simple day-to-day chores (maybe even help with putting on your shoes).
For those who are used to being outside and active, a week or so on the sidelines can feel like an eternity. A month is excruciating. And the longer it goes on, the bigger the impact on your income. Financial stress on top of physical pain leads to increase tension and poor sleep. Neither of these are beneficial to your recovery progress.
This is why paying attention to your body's alarm system is so important: is your pain warning you about an area that is strained and overworked, which left unattended is going to cause an injury and stop you being the boss, employee, dad and partner you want to be?
This may sound dramatic, until you've been through it and have the benefit of hindsight.
SO, ABOUT YOUR BACK PAIN
My back pain is not your pain, but some (or all) of this may sound familiar to you. You probably package it in a taller, stronger body than I do (but make no mistake, I'm tough for a girl.)
My work as an osteopath means that I’ve heard and seen a lof of versions of a similar story when it comes to pain.
If I hadn’t known better, when I hurt my back a few weeks ago, I would have completely freaked out that I had re-injured my disc injury. Like last time, it would have healed. Unlike last time, I got professional help, and recovered much more quickly.
My big, fat disclaimer is that reading this post is not a substitute for seeking professional advice. A practitioner who is trained to diagnose the cause of your pain will also be able to give you a specific diagnosis and advice for your specific situation. I don’t know you or your injury, your medical history or the way you use your body day to day, so I am unable to provide you with specific info in this forum. What I can tell you, is that I have seen little niggles turn into big problems with simple, unexpected triggers. I do not want you to suffer this fate.
Here is the take-home info from this post:
Pain hurts, but it’s purpose is to warn you pre-injury. Investigate why it’s happening.
There are different causes for low back pain, disc sprains are the most common. Discs are at the most risk when we bend and twist under load.
Ignoring pain can work for a while, but you run the risk of re-injury or weakness leading to different strains/injuries.
Strength is important in both avoiding and recovering from low back injuries. Put together a fitness plan that compliments your occupational and recreational demands.
We risk more than missing out on work when we're injured.