Returning to Activity Following a Lower Back Injury
Lower back pain can be debilitating. If you’ve experienced moderate to severe back pain, you know first-hand how much it can limit your ability to perform anything from a basic task to taking part in the physical activities that you enjoy.
Resolving the pain associated with these injuries is a top priority.
However, our primary goal is ensuring that we can guide our patients through the recovery process and help them get to a place where they’re not only out of pain, but also physically capable of returning to the activities they love.
When the primary goal is to return to activity, it’s imperative that we look beyond resolution of pain and focus on restoring function to 100% - if not better.
With that said, let’s cover one of the most important concepts within the context of returning to activity following an injury:
“Pain is the last thing to show up and the first thing to go away.”
Outside of occasional traumatic injuries (car accidents, slip & falls, etc), the majority of lower back injuries stem from a combination of repetitive motions and sustained poor postures that place excessive stress on the lower back.
Examples of repetitive motions include things like frequent flexing/extending of the lower back, rotation of the lower back, side to side bending, or a combination of any of these movements.
Examples of poor postures are often associated with either sitting or standing for too long, especially with an excessively rounded or extended posture. (Posture is a hot topic and something we get a lot of questions about, so we plan to cover posture in depth in a blog in the very near future…)
These types of prolonged exposures to stress cause physical changes within the anatomical structures of the lower back and progressively increase the risk of developing an injury, but pain isn’t necessarily a symptom until much later in the process.
In this context, the dysfunctional movement patterns and poor postures were present long before more severe pain showed up… This is why we say that “pain is the last thing to show up”.
Treatment can be extremely helpful for lower back pain, especially when combining Soft-Tissue Therapy, Chiropractic Adjustments, and Rehabilitative Exercises!
However, care should also focus on identifying the factors that contributed to the development of a patient’s back pain and help to resolve those dysfunctions in order to solve the true underlying cause rather than just treating the symptoms of that condition.
In other words, if the way that you bend forward, go from sitting to standing, or swing the golf club, tennis racquet, etc. is contributing to your back pain we should address those specific motions to build better habits that reduce overall stress on the lower back.
Risk of re-injury upon returning to activity increases if we leave these movement patterns unaddressed.
The resolution of pain can help to build confidence in moving again, but ensuring that the underlying causes (faulty movement patterns and poor postures) have been resolved along with the pain helps to prevent the pain from coming back.
In a nutshell, returning too early can significantly increase the risk of re-injury and can prolong the overall recovery process.
So, how do I know when I can return to activity?
There are a number of things that we consider when guiding patients returning to activity following a lower back injury, and it’s always going to be specific to each patient given that no two cases are the same.
However, there are a few key considerations that we want to highlight that may help you gain a better understanding of this process.
Identifying Provocative Movements & Positions
Assessing Tissue Tolerance
Accounting for Fatigue in Repetitive Tasks
Let’s dive into number 1…
1) Identifying Provocative Movements & Positions:
Lower back pain, sometimes referred to as “mechanical lower back pain”, can often be classified and categorized based on the types of movements and positions that recreate a patient’s specific pain.
While there are many potential underlying causes for lower back pain, understanding how this pain changes based on the movements we perform and the position of our lower back during various movements and postures can be extremely valuable.
Then, rehab focuses on applying various strategies to help someone accomplish an activity-specific task without getting into a position or performing a movement that provokes their pain.
Building these better habits not only helps to resolve pain in the short term, but also helps to prevent re-injury further down the road.
2) Assessing Tissue Tolerance:
In some cases, especially with acute lower back pain, the tolerance of the involved tissues can be a major factor in the return to activity timeline.
Soft-tissue structures include things like muscles, fascia, tendons, ligaments, blood vessels, nerves and the tissue that makes up the actual disc itself (the annular fibers and the nucleus pulposus).
When an injury occurs there are changes that happen within these structures, which can make them less able to withstand the physical demands of a given activity while they’re in the process of healing.
Identifying which of these structures are involved, and to what degree of severity, helps us understand appropriate loading strategies to begin strengthening and rehabbing these structures.
Progressively increasing load as tolerated not only helps to allow these structures to withstand the physical demands of a given activity, but it also aids in providing a stronger foundation within these structures that helps to prevent further injuries from occurring down the road.
3) Accounting for Fatigue in Repetitive Tasks:
Following a lower back injury, the ability to lift a weight, swing a golf club/tennis racquet, etc. without pain for one single repetition is a huge accomplishment.
Our goal is to be able to get you to a place where you can perform these activities repetitively, with good technique, and without pain.
Naturally, our quality of movement begins to deteriorate the more we fatigue. This is why it’s extremely important to ensure that we account for fatigue when returning to an activity to ensure that we can endure the repetitive nature of the activities we wish to return to.
Building strength and endurance by progressively increasing intensity and duration of given rehab exercises helps you return to “game speed” and prepares you better for the entire duration of the event.
In other words, we want to make sure that when you do return to activity you’re not going to be at an elevated risk of re-injury when you begin to fatigue and it becomes more challenging to maintain good technique.
Putting it all together…
Here’s a quick example of this type of “return to activity” approach.
Let’s imagine that someone develops a lower back injury while golfing. Oftentimes, this kind of pain is one-sided or right in the center of the lower back and becomes more limiting later on in a round.
In terms of provocative movements/posture, we find that lower back extension (extending backwards), bending towards the side of pain, and rotating either towards and/or away from the side of symptoms causes an increase in pain.
We also find that in more acute lower back pain there’s a presence of localized inflammation following the injury that limits movement at the joint level, as well as increases sensitivity within those joints making it more challenging to move that joint through its range of motion without pain/discomfort.
We find that the soft-tissues in the area, especially the involved musculature, becomes sensitive to movement and the tone of these muscles increases in response to injury making them “spasm” to prevent excessive movements of the joints.
Because this pain becomes progressively worse the longer this patient plays, the goal with care is to ensure that this patient is able to play a full 18 holes without the onset of pain.
So… how do we solve this case?
First, we can make a few small tweaks to this patient’s posture when setting up in their golf swing. These tweaks aren’t focused on fixing technique for the sake of improving performance, but more on respecting the patient’s anatomy and pain provoking mechanisms.
We find that hinging at the hips, slightly rotating the pelvis (posterior pelvic tilt), and emphasizing hip rotation helps to prevent movements like lower back extension, excessive side bending, and places the hips and lumbar spine in a better position to allow for rotation.
In terms of treatment, we utilize things like flexion-distraction, chiropractic adjustments, soft-tissue therapy and rehabilitative exercises to treat the spasmed musculature and decompress the involved joints to decrease inflammation and restore proper function of those joints.
As inflammation decreases and movement is more tolerated, we begin emphasizing more rotational exercises that take those joints through their full range of motion and progressively load those movements.
Then, once movement quality is improved and pain is decreased, we advocate for practicing and progressively increasing intensity/volume by focusing on returning to the driving range to practice swinging various clubs again.
When someone’s able to hit each club repetitively and without pain/discomfort, we recommend easing back into playing by starting with a round of 9 holes and progressively working their way back up to a full 18.
We also provide recommendations for rest in between each session to ensure that sufficient recovery is achieved between each session, which consists of at-home exercises, mobility work, etc.
There you have it!
Returning to activity following an injury can seem like an intimidating process, but with the right guidance it can be done in a way that allows you to get back to what you enjoy while providing you with the tools needed to prevent future injuries.
Are you dealing with gluteal pain? We’re here to help! Follow the link below to book your appointment today.
