As mentioned in the past, our blog entries are not intended to be specific, individual advice for patients. They are perhaps best viewed as “food for thought” or talking points for you and your health professional. I cannot tell you through a blog entry what to do for your lower back pain because I don’t know the diagnosis or the structures involved. What I can comment on, however, is that most people who walk through the door of our clinic and tell me they have back pain, follow up that sentence with assuring me “it is muscular.” Sometimes it is. Most of the time, the problem isn’t that simple.
Is it Muscular?
Almost daily I have patients telling me their back pain is muscular. I understand why this happens. The symptoms feel like they are in the muscle and you can push on the area that hurts. Believing that the entire problem is muscular makes sense. Muscle is also the only tissue type that most people have a good understanding of and they can touch and feel it. Most people aren’t familiar with palpating ligaments, spinal joint structures or tissues related to nerve function. I also understand that somewhere in the subconscious, people fear back pain. Not that everyone is in denial, but let’s face it, most people want to view their injury optimistically and not assume that it is something severe. I’ve always held the belief that people want to convince themselves that their back pain really isn’t that serious, so deeming it as “just muscular” helps with this defence mechanism. Regardless, the reality is, most cases of lower back pain have many different structures involved. Relative to all the patients we see in our clinic, an isolated muscle strain that involves only muscle is rather rare. For example, if a lower back injury were only muscular and didn’t involve any other structure, I would expect there to be an event of injury that one could recall, and I would expect most of the tissue healing to occur in one to two weeks. Often, we might not be able to decipher accurately what tissues are involved in the early stages of the injury, but the time to recover often tells us the story. Muscle tissue does regenerate and recovers quickly. If your injury recovered in the span of a week or two, perhaps it was mostly muscular. The point is, muscles act on joints. Joints are highly innervated and respond to movement. Most cases of lower back pain are very complex and involve more than one tissue type.
Trust a Professional
So, what is the point or the take-home message here? As we’ve addressed in previous blogs, most people stretch their lower back pain, and this can make the problem much worse. Imagine you rolled your ankle and it’s very swollen and tender. Would you hold it in a prolonged stretch? Would it make sense to take that swollen, inflamed joint to its end range and hold it there? Of course not, that would likely cause more pain and more inflammation after a few minutes. So, when it comes to managing lower back pain, trust a professional when I say that most cases are not isolated to only muscular tissue. Consider the possibility that there are other structures involved, namely joint structures and possibly the corresponding nerves. If you keep taking those structures to sustained postures that they don’t like, they will stay symptomatic. Do not stretch your lower back pain unless your condition has been diagnosed by a qualified professional who agrees with that strategy. For some, stretching might be helpful. For most people with lower back pain, the problem is not just isolated to muscle tissue so stretching might be an aggravating force that is perpetuating the issue, despite the temporary relief that stretching may provide the patient.
Written by Dr. Kevin McIntyre
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