What should you do after you hurt your back?

As physical therapists, one of the most common questions we are asked is

“What should I do if I hurt my back?”.

The main reason is that low back pain is one of the most common musculoskeletal injury and has been shown to lead to disability and significant absence from work. Up to 80% of the population will experience back problems at least once in their lifetime. So clearly, this is a topic that concerns the most of us.

When an episode of back pain occurs, depending on the degree and extent of damage, most people don’t know what to do and what not to do at that point. If you can protect yourself right after a back injury happens, you can improve your prognosis and shorten your recovery time significantly. This has been proven repeatedly with my patients. When they have knowledge of how to protect themselves, the damage will not affect them to the same extent.

First of all, when a back injury occurs, it is important to find a comfortable, pain-free position. This indicates you are not creating any further damage, as pain is usually a warning signal from the body.

With this in mind, let’s discuss how to best manage a few essential daily activities following a back injury.

1) SLEEPING:

Sleeping is a huge factor for a successful recovery. It is the time when the body runs it’s healing mechanism. In addition, without a good sleep, the body is unable to regenerate the energy necessary to function well during the day.

Back pain often wakes us up when turning in bed or it is difficult to find a comfortable position. There is no overall concensus as to which sleep position is superior since it depends greatly on the anatomy of each individual.

Side sleepers are more common, therefore I would like to give a few tips regarding how to position yourself to maintain a neutral spine. Using a pillow between your legs to make sure your knees are shoulder width apart can help you maintain a neutral alignment of your lower back and thus diminish unnecessary stress. Without it, the low spine will naturally curve towards the side of the bed, almost like if you are side bending.

Second, I couldn’t emphasize more how your neck position directly impacts your lower back alignment. You really want to make sure that your pillow is not too thick or thin, so that your chin can be aligned with the center of your collar bone. This may require you to try out a few other pillows in order to find the suitable one.

Furthermore, try to avoid bending your head forward like in the foetal position because this can pull on the spine’s neural structures, which are likely already inflamed or sensitized following the back injury. Normally, the neural structures are quite free to move but with an injury, the surrounding inflammation compresses the nerve pathway. Think of it like this. Tugging on your thumb when it’s jammed between the door probably isn’t fun.

For the back sleeper, avoid using two pillows as this again brings you into a foetal position and pulls on your neural structure. In the long run, this can decrease the blood supply to your nerves. See below what happens when the pillow is too thick.

Instead of putting a pillow between your knees, it may be beneficial to put 1 or 2 under your knees (Only during acute phase). This will help keep your knees slightly bent, which in turn reduces the pull on your back.

One side note I have to mention here (some of my patients would probably laugh when they see this one) is that the bed is only for sleeping and private life. Stop reading in bed!!! As reading in bed with head bent forward and legs straight puts maximum stretch on your nerve, and remember your nerve doesn’t like to be stretched!! This also applies even if you don’t have a back injury. See below the position to avoid.

 

One last thing, when you turn in bed, squeeze the pillow between your knees, and turn your body as a block to minimize the twisting motion at your back. Imagine yourself rolling like a log. Use your elbow to help your upper body which can minimize the muscle contractions that can potentially pull on the injured site.

 

2) GETTING IN AND OUT OF BED:

This we have no choice to do at least twice a day. To get out of bed, I always suggest to turn onto your side first with your knees bent. Then slide your feet off the bed while using your elbow of the same side and hand of the opposite side to push your upper body up simultaneously. Basically you want to make sure your upper and lower body moves at the same time (imagine your trunk is like a plank of wood). DO NOT try to get up by swinging, or as a sit-up. We see our injured patients trying this all the time, even though it induces more pain.

Once your are up in sitting, move your bum forward to the edge of the bed so that your feet can touch the ground. You want to optimize the use of your leg muscles to help you get up instead of swinging your trunk with momentum.

To get up, keep your back slightly arched backwards and bring your chest forward until you feel weight through your legs. Stick your buttocks out. This will help maintain that arch in your back and engage your leg muscles. Push through your legs to stand up. The curvature of your lower spine should not change at all during this process. Furthermore, the getting up motion should originate from the hips, not the lower back.

Note that there is a difference between slouching forward and bending the trunk forward. compare the following pictures.

 

To get in the bed, it is exactly the reverse order. Maintain your spine neutral and pain free, get close to the bed, and sit down using your legs. Again avoid slouching your back, and especially do not drop into the mattress.
Then, as you lie down on the side, use the elbow and hand to support the upper body and slowly lift the legs up onto the bed. If the weight of the legs create too much stress on your back, just cross your legs so they can support each other’s weight.
At the end, put a pillow between your knees, check your neck position, then you’re ready for a good night sleep 🙂

 

3) SITTING:

The biggest part of our day involves sitting such as when we eat our meals, watch TV, or work in front of a desk. Therefore, finding a comfortable sitting position will greatly minimize the damage to your back.

To sit down, it is the same as the previous paragraph explaining how to sit in bed. You always want to be close to the chair, keeping your feet shoulder width apart to have a large enough base support for good balance. Then sticking your bum out will help you maintain a neutral alignment and avoid slouching when sitting back down. When sticking your bum out, imagine that the chair is 2-3 feet behind you and you need to stretch your bum backwards to reach it. Lowering yourself down to the chair with your leg muscles should take about 2 seconds. Again, DO NOT drop into the chair.

It may also be preferable to have a chair with arm rests, so you can use your hands on the arm rest to support some of your upper body weight.

LUMBAR SUPPORT

Once you are sitting down, it is beneficial to use a lumbar support to create and maintain that natural lumbar alignment without the need of excessive muscular contraction. You do not need some fancy expensive lumbar roll. Simply take a bath towel and roll it up so that it makes a cylinder. It will be approximately 5-6 inches in diameter.

Place the towel slightly above your pant line on your back and against the back rest. Make sure your bum is touching the backrest. Then lean back on the roll such that your shoulder blades also touch the backrest. This will help maintain the natural alignment of your spine without needing to contract your muscles, which may exacerbate the injury.

Now you might also want to adjust a few things on your desk which can help you maintain this lumbar rolled position. With this new position, you will be sitting taller so make sure the computer screen is at eyes level and not too far to look at. If you keep your computer screen low on your desk, you will eventually slouch to bring your eye level to the mid-screen level.
Bring the keyboard and mouse and table close to you so you do not need to lean forward.

You would want to as much as you can to keep the chin slightly tucked in, and not poking out. This can also prevent you from having headaches as well 🙂 If you have trouble finding a good desk ergonomic, definitively have a professional help you out and look at it!

 

4) GETTING INTO AND OUT OF YOUR CAR:

Driving gives us our autonomy. We need to drive to work, to do our grocery, or even simply to go see our physiotherapist. So many of our patients mention that the loss of ability to drive is one of the things that disturbs them the most.

Here are a few tips.

First off, if you have the option of cars, select a larger taller car rather than a smaller one. This may require you to borrow your wife or family member’s car, but it is worth it. Trying to get into a low ceiling car (especially those more sporty type cars) will require you to bend both your neck and low back, bringing you into a straining position. Remember the point we made about being in a foetal position? Try to drive in an SUV. It’ll be easier to get in and you can sit straight with proper support for your back.

Note: we are not suggesting you to go out now to buy an SUV 😉

You can also put a lumbar support in your car to give extra support and comfort. Once again, it may be simply a rolled up towel. I keep one in my car all the time. This comes even more in handy for longer drives (> 1 hour).

Second, you may want your seat to be a little closer to the brake and accelerator so that your knee is about 30 degrees bent. Remember how I mentioned earlier, if your leg is fully straightened out, it puts maximum pulling stress on your nerve.

Third, when switching from brake to accelerator, keep your heel down and just pivot your foot instead of lifting your leg. Every time you lift your leg, you are using your abs and pulling on your back.

Last but not least, lean back against the lumbar roll so that your upper back is fully against the back rest. This will ensure that your head can touch the headrest and avoid that poking chin out position.

When getting in the car, stand with your back facing the car seat, sit down using the techniques I previously mentioned. Once you’ve sat down, don’t bring your legs into the car one at a time, since this creates a torsional stress to the back. Instead, hook one foot under the other, and pivot on your bum to swing both legs together to bring them into the car. By pivoting on your bum, you can minimize the amount of work from your abs (like doing a sit-up).

To get out of the car is the same. Have your legs crossed, swing them out of the car (again pivoting on your bum) before getting up. Use the car door, seat, door frame or anything to help your self push up. Again, do not bring out one leg at a time.

 

5) REACHING AND LIFTING:

If your sock falls on the ground (or chances are, it’s already on the ground), what do you do?

This can easily happen, and I think it is important that I cover this. Certainly after you hurt your back, you don’t want to lift anything too heavy. It is not the time to finish your gardening, or rake the leaves, or change your winter tires, or set up the Tempo. It sounds obvious, but so many of my patients have done it (and hurt themselves more).
It is OK and actually recommended to ask for help. I know many of you don’t like to ask for help and want to do things independently, but this is one of those moments where it is better to set your pride aside.

For something that is light, you can definitively reach it and lift it yourself with a proper technique to protect your back. Similar to the technique mentioned in the ‘get out of bed’ section, make sure to stick your bum out, keep your lower back slightly arched, and bend your knees to lower yourself towards the ground. Avoid curving your lower back like a camel. It puts a lot of strain on the spine. Make sure the object is already between your legs so you can reach it from below you. If the object is in front of you, it creates a lever arm that increases the strain on your back.

If you are in a confined space or you lack the flexibility to squat down, then try a lunge. Put one leg in front, and one leg in the back, with the legs at around a 45 degrees angle. Lower yourself by bending the back knee (like if you are doing a marriage proposal) to the ground while keeping your back vertical. Reach with your hand to pick up the sock.

PUTTING ON YOUR SOCK:

Once you get your sock, find a chair to sit down with enough back support, then slowly bring your foot onto the opposite knee. Do not bend forward to reach your foot. You can use a lumbar roll against your lower back to further help maintain the back straight.

If you cannot reach your foot, alternatively you can try to stand and put your back against the wall. Bend your knees slightly, and bend one leg up as if to cross it over the opposite leg. While keeping the back fully against the wall, try to reach with your arms to get to your foot. Hopefully you are able to reach the foot to put on your socks. If not, do not hesitate to ask a loved one to help you. Once again, set your pride aside. It is better to ask for help than to worsen your injury.

6) STANDING:

Standing seems easy to do, but actually a lot of people hurt themselves while standing during cooking, washing dishes or shower. This may relate to the back movements it induces or may relate to needing to pace the amount of time standing. After an injury, pace yourself. If you need to wash the dishes, maybe ask for help. If you can’t, you may need to split it into 2-3 10 minute blocks. Staying in the same position for a prolonged period of time will fatigue your already injured muscles, which can exacerbate the condition.

When cooking or washing dishes, we also tend to bend our head down or bend our back forward. This is definitely something to be avoided. You might need to modify your routine by cutting vegetables sitting down on a table and pace the amount of time looking down cooking to avoid the onset of symptoms.

If you must stand while doing a particular chore, it may help to place one foot approximately 8-10 inches in front of the other at shoulder width apart. This helps ensure your back stays in neutral, and allows the legs to do most of the work. Compare the following photos.

When washing your hair, bend your head backward instead of forward. This will again prevent pulling on the lower back.

When standing, avoid looking down at your phone for prolonged periods. Yes…this means that after your back injury, it is not the time to try to beat your candy crush high score. This applies not only to cellphone use, but also cooking, washing dishes, brushing teeth etc..

 

 



CONCLUSION:

This is a long post packed with a lot of information.

Please refer to the sections that relate the most to your injury.

Now of course, there is no universal right way to do things nor can it be considered a replacement of seeking professional help.
If you have other activities or positions that gives you back pain, you should definitely bring it up during your treatment session with your physiotherapist.

Pain is a warning the body gives you, don’t ignore it, change your position and modify your behaviour to make your body happy. This will in turn allow you to heal faster.

To wrap up, I like using this analogy to better understand the healing process after an injury. Imagine you’ve fallen down and scraped your knee. There is now a scab there. But everyday, you poke and prod at it, re-inflaming the injury.
The back is the same. Every time you are in a movement or position that creates pain, you are once again picking at the scab. It exacerbates the injury and slows down the overall healing. Instead, change your behaviors and activities. We guarantee the recovery will be smoother.


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