I pulled my back out, again!

Does this scenario sound familiar?

You are lifting something and suddenly feel a sharp pain in your lower back. Or you twist in a funny way and now you are scared to move. Everything tightens and you can barely stand up. 

You head to urgent care or your primary care and they tell you it's just a "muscle sprain" and prescribe you a muscle relaxant.

It's probably not a muscle strain and muscle relaxants will not help it. 

The muscles in your lower back are extremely robust and they don't tear or strain easily. A simple rule of thumb: if there is no bruising, then there is no muscular strain.

Most "back strains" aren't muscle injuries. That tightening you feel isn't random, it's protective. Your body is trying to keep you safe, and the only way it knows how, is to limit motion.

Your spine has specialized receptors called mechanoreceptors. They constantly monitor speed, direction, force, load and rotation. They are your internal surveillance system.

If a stabilizing structure like a disc, end plate or ligament experiences excessive load, those mechanoreceptors send an alert to your spinal cord. Your spinal cord sends a reflex signal to the surrounding muscles, locking them down! 

The muscle spasm isn't the problem. It's the reflexive response to the perceived injury.

Sometimes it's a mild irritation, a false alarm, or a temporary overload. But the tightening is protective, not destructive.

If you artificially relax the muscles with medication, you are treating the symptoms, not the reflex that caused them. The underlying signaling system remains unchanged. You just mute the alarm.

Your body is built to heal on the go. As you gradually move, the mechanoreceptors' alarm decreases, the reflexive guarding reduces, and the muscles calm down. Movements tell your system that we are safe. 

The most common advice is to lie down and rest, but that does not mean it's the best advice.

The longer you remain still and fearful of movement, the longer it can take to get better. Slow, gradual movement in a pain-free way is the best way to teach your brain that your body is safe. Breathing is a great strategy to utilize with this movement as well. Each time you move, think about exhaling. I remind patients to "exhale on the exhertion" or when you might be straining your muscles.

One of the first things we teach in physical therapy is to engage those muscles that have shut down due to pain and fear. Your brain needs a reminder that your back is safe and strong. If this all sounds too scary, please make an appointment with your physical therapist at the first sign of stress. Or better yet, see a physical therapist twice a year for regular wellness checks to prevent an injury before it happens.