I was talking to a patient today about his low-back pain. He said his back goes “out”. Now I had to be firm that he should not use such rubbish terminology. They never go ‘out’ and I explained what he’d really done to himself. I then realised that I have been doing this quite a bit so I thought I’d blog about it.
What causes most low-back pain?
The best simile I’ve found for what happens in the vast majority of cases, so probably yours, is that you have a sprained ankle but of the low-back joints. These are your posterior facet joints or more accurately your zygapophyseal joints.
Interestingly, he added that sometimes it hurts like hell and could flatten him for 3 days and other times it’s just a dull-ache grumble. Pleasingly, the sprained ankle simile still works here. However, you have to injure these facet joints to change if from a dull-ache to a white-hot, passing out, sort of pain. Sometimes he’s experiencing a sprained thumb or finger sort of pain; you know, the one you get falling over whilst skiing, which can hurt but you can still use it and it just quietly rumbles and then goes away.
At the other end of the spectrum you have the acute sprained ankle pain which can be white-hot and can make you feel like you are about to pass out. I suspect most of us have experienced this at some point in our lives. I know I have – never run down the stairs at a station trying to catch a train, it is undignified and bloody painful. And I have done the same sort of injury to my low-back by lifting a rowing boat after an outing in the cold and I couldn’t move for 3 days. However, the anatomy of the facet joint and the ankle are similar in many fundamental ways. They are both bits of oddly shaped bone, covered with variable depths of cartilage in a capsule containing some fluid all supported by some pretty robust ligaments and muscles. As a result they behave in very similar way in response to injury.
How to make it really horrible!
The way you can alter the way they respond is by altering the amount of force you put through the joint:
light force = light injury = mild ache;
heavy force = heavy injury = hellish low-back pain.
However, if you really want to hurt your low-back the best way is like this:
- to ensure your core stability is poor by sitting down all day;
- make sure your low-back it’s pretty grumbly for a few days. This is important as it raises the sensitivity of the joint so it’ll respond far more vigorously to a far lighter injury;
- and then do something quick and unexpected with a fair bit of loading (the dreaded unguarded moment) and away you go!
Is it a muscle muscle injury?
This is not a muscle injury, though you will get loads of muscle guarding going on. This guarding will hurt but it is only your low-back muscles working over time and acting as scaffolding to stop you injuring your facet joints. So, please, ignore the muscle ache, focus on the underlying cause and DO NOT USE A HOT WATER BOTTLE. We have covered all of this before here: http://c1healthcentre.co.uk/can-you-sprain-your-back-muscles/
The solution is to treat it like a sprained ankle. So ice, first off, and then bring it in to us at C1 Chiropractic Health Centre and we can show empathy, sympathy and help it get better.