(Superhero picture source)
It turns out my osteopathic superpowers have failed to prevent me from another episode of low back pain (1). While frustrating, it is a useful lesson in learning to practise what I preach when it comes to minor injuries. This is a short post which I will elaborate on in more detail over the next few weeks.
You’ve just hurt yourself, what next?
If you are worried or concerned, get it checked out; if your back or whatever else ‘just doesn’t feel right’ or you are getting odd symptoms, go and see someone.
The approach I am about to outline won’t work for everything or everyone and is not intended to replace a consultation from a registered healthcare professional.
Essentially, the approach boils down to:
exercise and education.
In a little more detail:
Once more. This time with feeling.
Most musculo-skeletal injuries get better on their own. They just need time, the right beliefs, information and appropriate loading. Some problems need a more involved approach, which may occasionally involve drugs or surgery. However, for ‘minor’ issues, the advice I give out usually revolves around the following points.
Most people know this one.
Read this by Tom Goom for a more up-to-date take on this. (Yup, him again. There’a a reason he and his buddy Adam Meakins keep cropping up in my posts).
The ‘R’ in R.I.C.E. means relative rest not total rest. The body needs rest to heal but it also needs movement. Keep as active as you can. Within sensible, tolerable limits, activity will encourage healing. Go for a walk, stand up, do a little shuffle in your chair if you’re sitting down while reading this post. Don’t go crazy but do something.
It’s useful to think of the pain on a scale of 0 - 10: from no pain to the worst possible pain in the world.
If you’re at the bottom end, i.e. 1, 2 or maybe 3, that’s ok (as long as the condition doesn’t get worse and any worsening of pain is temporary). If you start pushing into 4 and over, I would be more careful and back off from whatever you’re doing. Pain doesn’t always mean you’re doing damage but it is not something I encourage people to ‘embrace too warmly’, particularly in acute conditions.
Why does it hurt?
Our understanding of pain is changing. Understanding WHY and HOW something may hurt could help with long-term resolution of the pain. Pain is a warning signal from the brain that something maybe amiss. I have touched on this briefly here and there are several links in that blog post to some excellent resources. For the time being, watch this and this. Download this by Greg Lehman.
Mobility rather than stretching
Stretching is not a bad thing. However, I don’t generally advise sustained, passive stretching for a sore joint, muscle or nerve. This can also apply to chronic conditions but is most relevant for acute presentations. If you really, really, really want to do some stretching, think mobility. Go gently into a position and come out of it straight away. This way you get the benefits of movement without the possible side-effects of stretching.
What side effects?
If you have an acute muscle or ligament strain/ sprain, the fibres need time to knit together. Stretching (or any kind of excessive loading) is not going to allow that.
Acute tendonopathies (a more up-to-date term for tendonitis) do not respond well to stretch. I tried it - to make sure. It didn’t work, it hurt (I know this is n=1, anecdotal, bottom-of-the-heap evidence).
Nerves have around a 4% tolerance to stretch. They don’t like being pulled around too much, especially when sensitised.
Showers rather than baths
Sometimes a ‘good soak’ can help acute issues. Sometimes it makes them worse. Why? Heat can help muscle spasms but it can aggravate inflammation. Inflammation, combined with a lack of movement, possibly in a slightly stretched position (such as lying in a bath) is not always the best thing to do in acutely painful situations.
Showers give you the benefit of the heat and minimise the risk of the other potential problems.
Hot baths (as with stretching etc.) are not a bad thing to do, they are just not always the panacea that some people make them out to be.
A ‘no-brainer’ that gets overlooked by some. There appears to be a macho element to how little sleep we can get away with these days. Wide-eyed people, fueled by energy drinks, stomp along streets clutching ever-larger cups of take-away coffee. Stop it. Go to bed. Sleep. Your body and your brain will thank you for it in the morning.
Use the time off to work out what may have happened. Learn from the injury so you are less likely to experience the same thing again. You don’t have to do this straight away, a break is good. Don’t over-analyse things either (note to self!). Instead, use the time positively to see if you can change/ tweak/ modify your training/life to reduce the chances of another episode recurring.
Respect the pain but don’t fear it
Don’t avoid positions or activities, modify them so they are relatively pain-free. For instance, replacing round-back forward bends with flat-back forward bends is fine as a short term strategy if it helps with the pain. However, you need to work to try and regain the ability of pain-free round-back bending when possible. Otherwise, you run the risk of your ‘emergency pattern’ becoming your ‘default pattern’. This can lead to developing an increasing intolerance (both physical and psychological) to the initial ’problem movement’.
A slow return to play
This ties in with the previous point. When things start easing up, consider a SLOW, PROGRESSIVE return to the same thing you were doing when you hurt yourself (read this for more detail). For example:
Movement and understanding
Various things drive tissue healing and musculo-skeletal health: beliefs, tissue loading, diet, genetics, sleep, drugs etc. Some of these we have more control over than others. It’s more productive to concentrate on those that we have more chance of affecting rather than those we can’t.
My short post ended up a little lengthier than I anticipated. I will go into more detail about some of the above in the near future but you have an idea of my approach to minor injury management.
So, the next time you hurt yourself . . .
(WARNING: SOUND BITE ALERT!)
Keep it simple:
eat, sleep, move, laugh & love.
Usually, that’s all you need.
Thanks for reading,
(1) 'Snatch-back'. I can just about deadlift 1.75% my own body weight and can press just over 50% b/w (I know, I know, I'm working on it . . .). I thought I should be able to snatch an empty barbell. Apparently not. A useful lesson that sends me back to the drawing board. Again. My pride hurts as much as my back does.
(2) Patterns of movement, as with posture, are poorly correlated with pain. There is so much variety to pain-free movement; it is not always reliable to state that a certain way of moving is problematic. When that movement is loaded/ weight-bearing/ explosive, I would be more inclined to go with the ‘industry-standard way of moving’. This also seems to vary depending on which expert is talking.
(3) I’m not talking about the number of limbs and heads we have, that’s usually a given. I’m referring to the ‘internal’ anatomy, the lumps, bumps and bits that are not as obvious. We all look different on the outside, why should we all look the same on the inside?