What to do if you get ‘stuck’ and experience severe back pain.
The week had started well. Clear blue skies, a fresh layer of fluffy snow and relatively short queues at the lifts.
We eyed the fresh snow off piste, snowboards dangling as we climbed the mountains on precarious machines hovering 20ft up.
As with many injuries it was hard to establish the clear cause. Was it the 3 months leading up to the trip of repetitive flexion mucking out stables. Was it the 2 long days of overload on muscles that were not used to 5 hours snowboarding per day? Or perhaps the triple flip that occurred off piste as we got ourselves into trouble on an area so steep we couldn’t stop.
I am unsure why I felt no pain on the day of the accident. I remember feeling like it should have hurt. Particularly as I flew over a rock uncontrollably, taking out my friend who luckily was cushioned by the soft snow. Perhaps it was the adrenaline. Perhaps the ice cold snow that lay in my salopettes numbed any pain.
The following day I woke up, pain free and made breakfast. When pulling on my thermals I felt a twinge. Taking a deep breath I willed my brain to relax the muscle. As I raised my leg again to put the thermals on I felt searing pain in my lower back and then the rapid contraction of my muscles. Spasm.
So this was it. I was stuck. This phenomenon is not new to me. As a physio I have heard it describe often. However I had never experienced it first hand.
I knew I must not get on the floor as would be unable to get up. But I really couldn’t move. Everything tiny movement sent unbelievable pain through my back and gluts. I managed to lower to all four near to the bed but was unable to put weight through my left knee. My right arm began to shake under the weight, but I was fixed.
My fiancé looked on in shock asking what he could do but I knew the answer was absolutely nothing.
“Can you get me some pain relief?” I requested. From this crouched position he helped me take some paracetamol (all we had).
I knew I had to move. I tried to shift my weight from left to right with small side flexions through my lower back. Each created searing pain and my shirt was soaking.
Feeling faint and sweating is a common sign of intense pain and so I asked my fiancé to help me remove my shirt. Every movement exacerbated the pain and we manage to remove it. I was very close to demanding he cut it off with scissors.
I would like to talk through what to do if this happens to you.
If, like me, there has been no clear trauma (which may have caused fracture) for example falling off a horse, being hit by a car, falling from height and you have become ‘stuck’ from a fairly innocuous activity such as leaning forward then the pain is likely due to muscle spasm (very painful but not dangerous to you).
If you have pins and needles or numbness in your leg this may be a disc protrusion- also not normally dangerous but may take longer to recover.
Unless you experience bowel/bladder dysfunction, pins and needles or numbness in both legs or numbness In the groin region although very painful it is unlikely to be anything serious (ie cause equina, spinal infection, large disc protrusion) so ask someone to call 111 for further advice.
- Remove clothing to cool down if you become excessively sweaty from a pain response.
- Try to avoid drafts in the room as muscles don’t like drafts either!
- Try not to go to the floor. Try to go into 4 point kneeling- near to something you can lean onto to support your weight (the muscles are painful because you are contracting them!). A bed or low sofa can be good.
- Try to move in the least painful way. For example for me pelvic tilts were very painful so I tried to wiggle from side to side. It was very painful. But each time I gained slightly more range. Remember. Increased ROM is still a win even if pain stays the same.
- Get pain relief on board immediately if you can. Remember to eat a biscuit if you have not eaten recently to protect stomach.
- Don’t rush and accept that the back is in spasm, although it’s painful it’s not dangerous ( I repeat this because if you’ve felt this type of pain you’ll understand if feels so painful it’s hard to imagine it could only be muscle spasm and not something serious)!
- Try to put weight gently through your knee in four point kneeling. This will be painful at first but this is the first step to being able to crawl to the bed/ sofa.
- Allow your body to relax over the bed/sofa. You may have to wiggle forward slowly. Ask someone with you to place pillow under your hips if you get pain when you arch your back.
- Call 111 or a professional to get advice on what to do next. Doctors can prescribe diazepam and other muscle relaxants if necessary.
- If, Like me, you want to avoid high level pain meds take maximum dose paracetamol and Ibruprofen as described on packet.
Getting in and out of bed. This was the hardest thing for me. I would sit on the edge on the bed rocking from left to right buttock to try and loosen back. Knowing the shooting pain was coming I had to try hard not to brace. In the initial stages I had to use my hands to help me up but as soon as the pain starts to ease avoid this.
I was unable to get down the stairs day 1 and spent it walking, weight transference exercises in standing and applying firm pressure with combined side flexion to the left glut and quadratic lumborum. Although very painful this helped increase ROM. Please note that in the first few days my objective was to increase ROM. It was still very painful but the progress was that I could move even just a few degrees further before the pain. I also had to coach my set to push gentle into pain to ensure each day I was improving.
Contrary to popular belief – massage day 1 is not a good idea. The area is very sensitive and you are better to keep moving, take pain relief regularly and change position regularly.
Again you may start to panic because you are still very debilitated day 2. I managed to painfully negotiate the stairs and attempt a shower. The heat really helped and I attempted some gently stretches into flexion but concentrated mostly on side flexions. You need to remain dedicated to your rehab, change position regularly, and complete exercises- even if painful. I bullied myself to get out of bed regularly and each time my back loosened.
This is the time to try and see a professional to get the right advice and get a clearer diagnosis and treatment
If at any time you experience any of the following you must seek immediate medical attention
- Pins and needles or numbness in BOTH legs
- Numbness in the saddle area
- Fever when combined with back pain
- Gross weakness of your legs
Things to remember
- The damage does not necessarily correlate with the level of pain you are feeling- muscle spasm will resolve relatively quickly but is very painful!
- Move regularly.
- Avoid aggravating activities ie sitting/prolonged positions
- Take pain relief regularly. You can ask for stronger tablets such as muscle relaxants from your GP if you are unable to cope.
- Heat can be helpful in MUSCLE problems. Use a hot water bottle wrapped in a tea towel and apply for 20mins!
- Keep motivated with the exercises even if they are painful. Consult with your physio to ensure you are not doing any exercises that may agg symptoms.
If you need any further expert advice on backs or if you or a loved one have become stuck please call 0117 290 0242. This number can be used for any of the sites across the Southwest as will forward to Nicole’s mobile.