Stop Overtreating Acute Back Pain
You’re doing too much when you see a client with acute back pain… This episode of the Unreal Results podcast is sparked by recent incidents involving a colleague and an athlete who both experienced acute back pain symptoms. Most health and movement professionals are trying to do too much when treating acute back pain, most often neglecting the body’s natural protective mechanisms. In this episode, you’ll hear me talk about what I do when I have an athlete experiencing severe back pain and how to assess and provide gentle, effective treatment for acute back pain. This episode is filled with immediately applicable techniques for what is most likely a very common issue that health and movement professionals see in their practice. Don’t miss it!
Resources Mentioned In This Episode
Episode 18: Lessons From My Back Surgery- Part 1
Episode 19: Lessons From My Back Surgery- Part 2
Episode 20: Reflexive Core Stability: Lessons From My Back Surgery - Part 3
Episode 67: Meeting The Body Where The Back Is At
Blog Post: Lessons I Learned From My Back Surgery
Blog Post: Prop It Like It's Hot- Why Props Should Be Your BFF
Learn the LTAP™ In-Person in one of my upcoming courses
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there and welcome. I'm Anna Hartman and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs in the nervous system on movement, pain and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello. Hello. Welcome to another episode of the Unreal Results Podcast. Here we are. I'm at home. I've been on the road for a couple weeks, three weeks. I don't even know. It all blends together and I'm happy to be in my house. San Diego is like, I mean, I heard since I, when I was gone, the weather was not great.
A lot of gray and rain. But since I've been back, it's rained like overnight and like in the morning, but then by noon, like cleared off and a beautiful sunny day. Very spring vibes. So I am here for that. And then also, um, my plants are exploding right now. I had cut some plants and like created, like made starts of a couple plants and wow, the, the two weeks I was gone or however long I was gone, I have like four or five new leaves on my fiddle leaf.
Uh, two new stems and multiple leaves on my rubber tree. I've got new leaves on my wax plant. I've got my fiddle leaf start. I. I created rooted a ton. My Audrey Ficus rooted a ton. Even my corn plant rooted like so many starts my monstera that I cut has big old roots. So it's like it is growth season my friends for the plants.
And actually it's funny 'cause I, I went to Sacramento to take care of my sister for a little bit. Well take care. That she's fine. Um, I went for a couple days to help her out to do treatment on her and then just like help her out 'cause kids are hard. A puppy is hard, life is hard. And, um, I hadn't been there in a while, so I wanted to, to go anyways.
I had encouraged her to cut back her fiddle leaf that was kinda like dying. Um, and just like not happy. I had her cut the healthy leaves off of it and create a start from it and then cut the main plant down to like, just like a stick and her, that is going crazy for her too. And so I was like jealous until I got home and I saw how all mine were doing too, and it was just like confirmed that this is like
the time of year. This is a growth season baby. We're, I am ready for it. And I am like, it's all I can do to not go to the nursery and buy more pots and buy more plants and like, and I calm down because I leave town tomorrow. So not the best time for me to do like all this yard work and, oh, and because that's the thing too, like in my yard, my jasmine is just blown up and has got so many buds.
It's gonna again, have a year of just like smelling. So good. Last year was the first year that it really like bloomed crazy and it was so cool because there was so many blues on blooms on it. It's right in front of my living room window, and so I was able to open the window and the aroma in my whole house from that plant in the yard was so good.
Like literally one of my favorite things. Hard to beat it. Um. So anyways, springtime vibes, I'm here for it. Like I said, tomorrow I go outta town. I'm headed to Nashville for a business thing with my strategy and scale, um, business group, the with that Jill Fit team, and, um, looking forward to seeing my business besties and, um, having some fun in Nashville.
Nashville. I've been a lot. If you're new here, maybe you don't know, but one of my athletes that I used to travel with for seven, eight years, he played for the Tennessee Titan. So I literally would go to Nashville every single week of football season and then multiple times throughout the um rest of the year.
And if I'm being honest, it's not my favorite place in the world. I am like one of those weirdos that actually don't really like Las Vegas or las, see, I called it Las Vegas. I don't like Las Vegas either. So no surprise. I don't like Nashville. 'cause Nashville, like Broadway is a combination of like Las Vegas in Times Square and maybe even New Orleans Front Street.
Uh, just not my vibe. I love all the music. I do love the music. I just don't love what comes with that and um, also feel very Californian in Nashville, even though there's so many transplants there nowadays, you would think it was more liberal, but it's not, not at all. So it's just not my vibe. Um, I also
the weather sucks. There's like literally one good month of the year and um, I think it sucks the rest of the time. And then even in that good weather time of the year, there's like ticks and stuff like, ugh, it's just annoying. Anyways, this was not, uh, intended to shit on Nashville. I am looking forward to the trip 'cause of the people, uh, we're gonna, the Grand Ole Opry super pumped for that.
I've actually never been in, all the times I've gone to Nashville, I've been to the Ryman. I actually saw Garth Brooks at the Ryman. Do a like acoustic show, you know, and for those of you who don't know what the Ryman is, it's like Country Music Church. Um, it was actually the Grand Ole Opry before the Grand Ole Ry moved to a bigger location, uh, that the Ryman, um, has like 1200 seats and um, it literally is a church.
Or at least it feels like a church, um, that the seats are like wooden pews. And so I, I, on a whim one day when I was, when I was on an extended trip for my football player there, um, normally I would only be there for two days and it was after, um game. I came in early so I could go to the game, so I had like an extra couple days.
I just happened to see on my SeatGeek app that Garth Brooks was in town at the Ryman and there was tickets available. And so I was like total last minute. Bought a ticket for like $850, which is a lot, but 100% was worth it. It was one of the best experiences ever. So I really enjoyed that about Nashville, that you can like do that on a whim.
Um, so Grand Ole Opry will be fun. Um, seeing my friends will be fun. Seeing my athlete will be fun. I haven't seen him for maybe two years, like kind of crazy how long it's been since I've seen him. He retired and, um. I've not seen him. And so I am like super pumped to see him and his family, his wife, his kids, um, and hopefully have dinner with them because I.
They have a chef, and I think that's the best food in Nashville is actually the food that he cooks at their house. So, um, I'm looking forward to that. Um, even if I don't get food, I'm still going to be looking forward to visit with them and see the kids. Um, I'm sure they're gonna feel so grown up. Um, but I'm actually really pumped for that.
So I hope it works out. And then after that I head back to, uh, the East coast. Help my athlete out and um, then eventually I'll come back home and hopefully I won't miss all that blooming of the jasmine and the springtime vibes. But I also heard from my whale watching crew that I might be able to not be able to, I might be helping out on the boat more this summer for blue whale season, and I am super pumped about that.
So. I'm sure you'll hear all about it. Uh, anyways, this podcast episode, what the hell am I talking about? Um, it wasn't just like, oh, I know what I'm talking about. I remember now. I'm like, it wasn't just an update of life though. I, I felt like I was lot overdue for that. Um, I do have a topic. I actually have two topics, and if I'm being honest.
I already recorded like 20 minutes of a podcast and then decided I didn't want to continue it and I didn't like where it was going, and so I deleted it. So this is take two with a different topic. Um, and the topic is, um, acute back pain. And the reason we're talking about this is because two people in my life recently
had hurt their back, you know, their back quote unquote went out. I hate that I, when people tell me that something went out, I'm like, oh, really? Where did it go? Your back's still in you. It never, it doesn't go somewhere. So anyways, but you know what I mean, when I say the back went out, um, so two people that I know, their back went out.
One was one of my athletes and one was a colleague of mine. Um, and so the colleague, like immediately when she did it. She like called me like within minutes after it happening and she was in excruciating pain and she was like, oh my God, I'm so glad you picked up. Which also for a, like that in itself is kind of a miracle that I picked up the phone.
I never answered the phone. Um, so. But I picked up and I'm so glad I did because I felt terrible for her. And um, she like was like, I think I just had an annular tear at my desk. And she's like, what should I do? I know you've been here before and I trust you and I don't know how to navigate this. And I was like, Ooh.
And then not even like 10 days later, I was with one of my athletes and he was lifting and literally all of a sudden like did was doing a lift and like did one movement, drop the weight and then looked at me and like just his knees buckled. And I was like, are, are you okay? Like what just happened? I was like, did you pull your hamstring or did you like get shot?
Like, I'm not sure what happened. And he is like my back. And I was like, oh my gosh. I was like, was it a zinger? And he was like, yes. And I was like, oh, disc. And so, you know, just navigating that too. I felt like, you know what, I've done podcast episodes on my journey with my back and I'll have Joe link those in the show notes.
I did like a three part series on my whole thing with my back. Um, and then I did another episode about like what I would do if my back went out today, um, like how I would navigate that. And um, so I'll make sure Joe links those four episodes in the show notes. Uh, but I just kind of wanted to reiterate it and.
I don't remember what I said on that, what I would do if this happened to me today. Um, and so I'm sure some of what I'll tell you today probably coincides with it. But I also was like, you know, I, I think it's important to say and I, and, and a reminder to people and then also to highlight like, man, I, this is what, you know, I love obviously.
I'm a biased opinion 'cause I'm gonna tell you how much I love the LTAP the Locator test assessment protocol in times like these and or my general listening ability in times like these, because it gives, well, two, it adds to the appreciation that the body is. The way it reacts after an injury like that is exactly how it's supposed to and exactly what you need.
I'm gonna repeat that. The way your body reacts after an injury like that, right after your back goes out, the pain, the spasming, the body telling you to stop what you're doing, like all the things that the body does. In response is exactly what it needs to do for you in that moment. Your body is the smartest person in the room.
It's reaction to something happening to it
is so much smarter than anything I would do for it. And oftentimes this concept of like, oh my gosh, I hurt my back. I. I'm in so much pain. There's this thought process of I need to get out of pain and I need to fix this as soon as possible. And I don't disagree with that in terms of like, it fucking sucks, and there's nothing that is more debilitating and more depressing than acute low back pain of a discogenic nature.
However, once it happens, it can't unh, you can't reverse things, so you sort of have to just like let it run its course a little bit. And the more you try to resist that, the more you try to force yourself out of that response, the worse you're gonna feel and it's not helpful. And so, you know, that was sort of my, my, my biggest advice for my colleague that called me and, and my athlete was like, listen, you need to do, like, the best thing for you is sit your ass down in terms of like, find a position that your body is not painful in, which is challenging at first sometimes in this scenario.
And like, just take a beat. Take a beat. Like your body is like, hold on, we need to like figure this out. You could also just walk walking. The act of walking is very, um, nourishing for the discs and for blood flow and for lymphatic flow. And so if you can walk, walk. Sometimes keeping moving often feels the best, but then sometimes just sits your ass down, right?
So it's a little bit of like, oh, how do you know which one you're going to be? You don't. You see how it feels, and this is a real big lesson in listening to your body and not forcing it. Right. So you listen to your body, you, you know, you try to walk it out. And if that doesn't feel right, you try to find a position of rest of repose.
You might need bolsters, you might need, um, different, you know, pieces of furniture, you might need assistance. All of that is okay and like, let it happen. And the tightness, so, so what happens right is your disc, you get a zinger. It is this like very sharp, intense and then this zinging feeling and then all of a sudden this feeling of like, you can't load your spine.
And I don't mean load your spine like with weight. I mean like your body cannot be on top of your spine in terms of like your, try to avoid it by hunching over or extending or laterally shifting or side bending, whatever it may be. Let it happen. Meet it there. And sometimes meeting it there, you might like some reflexive stability with it.
And so I actually am like, okay, like try to grab a bag and hold it on one side. Hold it on the other side, hold it in front of you, hold it behind you. See if any of that makes you feel better. If it does, great, now you know where you need to hold that weight to counter or to help. Create some reflexive stiffness in your spine.
Sometimes it's a hard no that that doesn't make anything feel better, so then you know you don't need to hold it. Right. Um, and then everybody's different. Some people feel better sitting. Some people feel better lying on their back. Some people feel better lying on their front. Some people feel good on their right side.
Some people could feel good on your left side. Most of the time, everyone, when it's a disc like this. Whatever position you find yourself in that makes it is comfortable to rest in. When you go to move, when you go to change position, there will be a five to 10 minute period of excruciating pain as the disc.
Drains it's hydration because when we are resting, our discs fill back up with fluid. And so sometimes then when we stand back up and then gravity starts to squish that disc and the fluid drains out, that is excruciating pain because the fluid is very, um, chemo tax, not chemotactic very.
Uh, I'm not sure what the word is, but it's like very irritating, right? Chem, it's a chemical irritation to the nerve root, and that can be very painful, but it goes away, you know, as like time sets in. This is also why often, first thing in the morning for people with disc did. Like internal disc arrangement, first thing in the morning is pretty painful because it takes some time.
Your, your discs are so rehydrated from laying down overnight that it takes time than in the morning about an hour to fully drain them out again and feel more comfortable. Now, um,
obviously every disc is not a herniation. Every disc discogenic back pain is not a herniation. It could be, um, a in every, like the word herniation is too, is like, what does that even mean? Right? You could have a prolapse, you could have a, um, in the prolapse could be central or lateral. Anterior posterior, um, it could be, um, a herniation or it could be an extrusion.
Extrusion is like disc material has like squeezed out and is on the nerve root. Or you can have a combination of all three and it's really hard to sometimes tell the difference. And so obviously like the first important thing. The first important thing with any injury or like rehab, right, is like decreased pain.
Decreased swelling. So same thing goes here, and then the next thing is like to assess the situation and like, how bad is this? Like how, how significant is this going to be? Is it significant? Like do you have motor loss? Do you have sensory loss? Do you have a reflex lost? Right? What is your nerve root?
Capacity and then also what is driving this. Is a good place to start from a treatment standpoint. Traditionally, I'd say when somebody comes in and is like, oh, I hurt my back, make me feel better, you know, if they get any manual therapy, the massage therapist or the manual therapist, whether it be a physical therapist or an athlete or trainer who, whoever, chiropractor, whoever it is, oftentimes they do deep tissue on the muscles that are.
Spasming to protect the area. And what happens is they feel better for a second, but as soon as they get off the table and that segmental instability is unstable again, they tighten back up and sometimes feel even worse. So it's like the last thing I tell people to do as actually the first thing I tell them is, whatever you do, do not do deep tissue to the hips and the low back and the muscles that are tightened up to protect the disc.
Let them do their thing. The muscles, the joints, but the muscles, especially our bodyguards to the body, they're bodyguards to that disc. Let them do their job, let them do their job. So, um, that's like I always tell people immediately.
So that's like the most important thing, right? Like to not break that protective response like you want that set yourself up, that you're meeting the body where it's at. Don't take, don't, um, block that protective response then. Obviously you've done the, um, you know, assessment to make sure there's nothing that you need to refer, right?
Like no motor weakness, like loss of bowel and bladder control. Like those kind of like more emergency things. And then it's like, okay, like, so what do we do? I already said like, meet the body where it's at. Um, first things first just like, see if you need to sit your ass down or keep moving, and then then
the next day, like I would let a whole day go by before I'm gonna actually do treatment to try and make things feel better. In the 23 years of my career, every time an athlete has come in immediately, like off the weight room floor or off the field with a discogenic pain like this. Any treatment that I've tried to do on them has not helped.
It's like literally just been painful for them and not helpful. I sometimes, if I have access to a pool, I'll just tell the athlete, like, just if you get in the pool and you know, move your body around as long as it feels good. Like the pool is like such a great friend with a flare up here. But at the end of the day, like
it's fine for like a day to just rest, like sit your ass down, let your body do its thing then, then maybe we will talk about treatment. And that's what I want to talk about now and, and going back to the, yes, I have a biased opinion, but the beauty of the LTAP is that when you have an assessment that can ask the body what it wants.
Do treatment there, it's never going to lead you to a treatment that is gonna make things worse. And that is a wonderful thing. So for obviously my friend who called me, my colleague who called me, I, I, we don't live in the same town, so I wasn't able to help her. Um, but with my athlete who I was with, it's like I, I went through the same thing.
I say, Hey, listen bro, like I wish there was something I could do for you right now in this moment because it sucks and I've, all I can tell you is I've been there and it sucks, and like, let's try to meet your body where it's at and like is, you know, so we walked for a little bit and it did seem to help, but then it was also like, he's like, I just need to like not move.
And I'm like, that's fair. Let's let, let's find a position that you can rest in and just like let your body do its thing. And then the next day, then I was like, okay, now I can do assessment on you. It's again, like he doesn't feel good, can barely move. And it was like first things first. Like, can I find a position for you on the table that I can still do the assessment and you're gonna be comfortable?
And so that was like, what kind of pillows pads do we need? How do I need to help you onto the table? Can you even get onto the table? Can you be on your back? Can you be on your front? Can you be on your side? Once I find that, then I do my assessments from there. And. Those of you who've gone through the LTAP or at least part of the LTAP with the missing link, you might be like, well then how are you supposed to assess their SI joint if you can't?
If it's not a good test and if not being able to get in the po, great positions would be a reason. Then we just move on to the next test. Because we'll still get very valid information and those tests you can do in any position and they're very, very gentle. And so, um, that's where, you know, that's where we start.
Luckily, he was able to lay on his back on the table, so it was great. I didn't move him around a lot though, and I made sure that he stayed comfortable because meeting the body where it's at is the first step to make it feel safe. Yeah, so that I have a better chance of actually helping, and then sure enough on him specifically.
So, and then this goes back, like everybody's gonna be different on what their body is presenting at them. That moment in time of what treatment the body thinks is going to support. Helping their back. This could be the original driver that led to the incident in the first place, or it might not be related at all.
It might just be a way that the body's like, okay, I'll let you in this way to peel back this layer of protection pattern that I was dealing with that is preventing me from focusing on the disc or focusing on whatever. So for this specific athlete, at first when I worked on him. He had a central nervous system tension, um, a little something going on in his neck as well.
So I treated that first, and then that brought his pain down. Um, and then the next thing was he had a little bit around like his liver and his colon. So I treated that next real gentle, treated as diaphragm. As diaphragm as you could imagine, was very splinted. It was one of the muscles that was protecting his back.
I did a very gentle first visceral treatment on those organs, and then I followed up with a very gentle diaphragm treatment. I was especially gentle on the diaphragm thing because since it's a muscle and I knew it was involved in the sprinting splinting, I didn't wanna completely get rid of that response.
And then, um, we reassessed and you know, just with those two real gentle treatments, he was moving around on the table easier, his pain subjectively decreased, and then his, um, sensory disturbance, his dermatome that was affected, improved as well. And so then I was like, okay, let's decide where we're gonna go.
Next, and the next thing we did was because I did some manual therapy that could have compromised his protective response around those discs I opted for. Oh, I also treated the disc itself. You know, you may or may not have the skillset to do that, but it felt appropriate. The body was like directing me there.
It didn't seem to not like that, so I did that as well. But then since I did all those manual therapies, which could have also destabilized this protective response, I followed it up with some exercises to facilitate some. Reflexive stability, some deep hip flexor strength because the hip flexors are often a protector of the discs as well.
Um, some breathing exercises more aimed at diaphragm mobility. Um, because a nice, well-functioning diaphragm also helps to support unloading the discs as well as protecting them from a stability standpoint. So we did those and then that was it. Did he go from like a level, like a six outta 10 pain to a zero?
No. He like literally herniated a disc. Uh, that was, that would've been an unrealistic. Expectation, but he did go from a six to like a three, and then he went from barely able to move to like move around. Pretty good. And so that was it. But I knew that because it was so acute, we didn't do like specific movement at those segments yet.
We did things around that. And that is, I, I think on, on the. Last podcast episode with the back, I probably talked about the, um, like stages of rehab. The first stage of rehab in an acute disc thing is like, don't move the area that you just hurt. Like, let the protection, let the protection pattern be there, let the splinting happen and like just honor the things that are happening there and work around it.
And so, you know, we did stuff in the thorax. We did stuff in the hips, and then we just left the center on its own. And then the next day he woke up feeling even better. And then he was moving around better. His dermatome, um, numbness was, um, very minimal, if at all. And then we were able to. Then progressed to the second stage of rehab, which was controlled movement through the area of the lesion.
And again, we let pain be the guide, and then we built on our exercises from there.
It was in that moment, I was like, oh man. Thinking back to all the times that I've had incidences like that with my back. I'm like, man, I would've loved to have the ability to do treatment, have treatment done by someone that would, had the same skillset as I do 'cause I like watching him and watching this progression.
I was like, man, this is probably, honestly, of all the athletes over the, you know, my 23 year career, that was probably the. Uh, best treatment response I've gotten in such an acute disc thing, and it is again, because I'm applying all these principles that I've learned that works from my own experience with my back, but then also these principles that work for any injury in the body that the LTAP
teaches us that, that LTAP gives us the techniques for and gives us this lens of view for of like the body is the smartest thing in the room. Let its do its job. It has the ability to heal itself and it works much better when we don't get in the way and try to force it to what we think it needs. So instead we ask it what it needs.
We maneuver with the idea in our head that the spasm, that protection pattern that the body is creating in response to this disc irritation is not a bad thing. It is exactly what you need. And this is just, again, like this is why you wanted to share it. Because it's, again, it's like this lens of view just gives us such a more.
Whole organism and patient-centered way to go about it, and a less forceful and a more. A more gentle way of like feeling better. And I think oftentimes, especially with back, especially with disc things, because it feels so horrible and because it is so debilitating, we get in this mode of like, we're going to feel better whether we kill ourselves doing it right, like we inflict so much pain on ourselves or so much pain on our clients in the idea that it will be.
Helpful when it's not at all. It is that that is the ego driving the bus, and this is all about letting go of this ego, letting go of this idea that I know best what the body needs and I need to stop its response versus, nope, its response is exactly what it needs and the body knows what to do. And if I can follow that.
Go through the steps in a thoughtful way. The body actually changes very quickly. So hopefully this was helpful. Um, a helpful reminder, a helpful like reframe. And like I said, if you're interested in hearing me talk about it more, there's those four podcast episodes that I'll have Joe link in the show notes.
So thanks for being here. We'll see you next time.