Have you ever had this happen to you? You bend down to pick something up, or maybe you combine lifting and twisting movements, and you feel something in your back. You feel as though your back has "gone". That is, sudden onset lower back pain which is quite severe and makes moving around and changing postures difficult and painful.
You've slipped a disc right?
No. Discs don't slip. The phrase "slipped disc" usually conjures up an image of an intervertebral disc popping out slightly from the spine. This can't happen. There are lots of connective tissue structures holding the disc in place.
Phew, that's a relief. So what did happen?
We call these injuries a lower back sprain or a lower back strain. Essentially they're like a sprained ankle but in a joint in your back. Joints in your lower back have the same sorts of connective tissues (muscles, tendons, fascia, joint capsule, cartilage etc) as joints like your ankles and you can tear the fibers that make up these structures. If it is the disc that is injured, you get a tear through some of the fibers of the disc that causes a "disc bulge" where the fluid inside the disc pushes into where the tear is, causing a bulge (not a "slip").
Will it heal?
Yes. These structures have a good blood supply and they'll heal themselves. The healing process will take up to three months, however in the vast majority of cases you'll be symptom free well before three months after the injury.
You might have heard of people requiring surgery on these sorts of injuries. While this does sometimes happen, the overwhelming majority of these injuries resolve without any need for surgery.
So what can I do about it?
Like a sprained ankle, you need to take it relatively easy for particularly the first 3-7 days. This doesn't mean spend the day in bed, but just potter around, changing positions regularly between lying, sitting, standing and some gentle walking. In the early stages try to avoid activities such as gardening, vacuuming, mopping, stacking and unstacking dishwashers and other lifting tasks.
You might find using ice packs helps to reduce pain and inflammation. It can also be worth discussing with your doctor or a pharmacist the short-term use of painkillers or anti-inflammatories. Your physio will be able to help with pain relief with some joint mobilisations, gentle massage etc.
As you get out of the acute, inflammatory stage of healing your pain will begin to settle and you'll be able to gradually introduce more and more normal daily activities. Your physio will be able to provide some strengthening, stretching and proprioceptive exercises, which will help to make you able to perform functional tasks more easily and reduce your risk of re-injury.
These injuries don't sound very nice. How can I prevent them from happening?
Prevention is of course better than treatment. While you can't guarantee you won't ever suffer a lower back sprain or strain, the following strategies will help reduce your risk.
Maintaining a good level of physical fitness will help reduce your risk of back injury. An unfit person who decides to spend the day in the garden is at a greater risk of hurting their back than someone who spends a lot of time lifting weights at the gym or playing sport.
Use good lifting technique. Keeping the object close to you, bending from the knees and hips as well as the back and avoiding combining lifting with twisting movements will reduce your risk of injuring your back during lifting activities.
Pilates and yoga type exercise is helpful for improving your proprioception of your lower back and pelvis, as well as strengthening muscles that help to stabilise through your lower back.