Acute Back Pain: Cause and Solution
Dr. Charlie’s Number One After Hours Phone Call Topic and How You Can Prevent It From Happening To You
All Ages Osteopathy is different from traditional medical care because we provide easy access to your doctor and hands on treatment for physical discomfort. But still, people come in after a week of excruciating pain and tell us, “I didn't come in sooner because I didn’t want to bother you.” However, there is one problem that prompts people to call me outside of business hours…
Acute.
Low.
Back.
Pain.
There are a variety of things that can cause acute back pain, but the primary causes are psoas spasm, herniated disc, and sciatica. A herniated disc or sciatica will also present with pain radiating down some part of the leg or buttock. If the pain is only located in the back, came on suddenly and is extremely intense, there is a good chance the pain is secondary to a psoas spasm. Read on to learn about psoas spasm causes and solutions!
What is the psoas?
The psoas is a large muscle located primarily on the backside of the abdomen. There is one on each side of the body connecting the upper body to the lower body. The primary job of the psoas is to flex the hip. It stretches from the bottom of our ribs and diaphragm all the way through the pelvis and attaches at the top part of the femur. It’s hard to access in massage therapy because its primarily inside the abdominal cavity.
The psoas is a common source of low back pain because in the modern-day American culture, we do a lot of activities that cause the psoas to shorten. For example, when someone drives a car for a long period of time, sitting causes the psoas to get shorter and tighter. Then, when they employ the psoas to do something else such as lift, walk, carry, etc. the shortened, tightened psoas becomes aggravated causing excruciating low back pain. Also, if that person has a weak core, the body will recruit the psoas to do jobs that are meant for the abdominals which also contributes to the psoas aggravation.
While I personally haven’t ever experienced this particular symptom (knock on wood), I can tell that it’s next level miserable. I’m motivated to get to work quickly to a) calm the pain, b) fix the cause and c) come up with a plan for prevention.
A. To calm the pain, take (gentle) action.
While it may sound counterintuitive, when the psoas is in spasm, I don’t recommend stretching. It is in spasm, so forcing the psoas into a more lengthened position risks worsening the pain. Therefore, the first thing I recommend to my patient with low back pain from a psoas spasm is to put their legs up a wall. This causes the psoas to hyperflex and get back into the preferred anatomical position. One option is to lay on the bed and bring feet up the headboard. Another option is to lay on the couch and place feet on the armrest.
The second thing I recommend is to move the body. It is tempting to lay around, but I recommend walking around as able so it doesn’t continue to seize up.
The third thing I recommend is medication. There are times to be tough, but I don’t think a psoas spasm needs to be one of those times. So long as it is not otherwise contraindicated, I recommend ibuprofen 800 mg mgs every 8 hours and 1000 mg of acetaminophen every 8 hours. You can alternate them, so you are taking something every 4 hours. Don’t forget topicals! CBD, arnica, tiger balm, icy hot, special cream from Blackburn Drug (if you don’t know what I’m talking about, please ask at your next visit) are all great topical options for ‘throwing the kitchen sink’ at this excruciating back pain.
B. Fix the cause and encourage the psoas to stop spasming.
The body is amazing. An important Osteopathic tenet is ‘the body is able to regulate and heal itself;’ therefore, at some point, with gentle encouragement, the psoas spasm will release. However, when you have access to an Osteopath, or another bodyworker, I encourage you to take advantage of that healing modality as soon as possible.
A typical office visit with me for this particular problem will include a neurological assessment and an assessment for more serious conditions. Then, I will align the vertebra in the spine as well as the pelvic bones. I work with neurofeedback mechanism to ‘reset’ the psoas to a more relaxed and lengthened position. Depending on the severity of the condition, I may also recommend a trigger point injection into the affected musculature.
Finally, we will assess what pharmaceutical options to employ. Medications in the toolbox of options may include muscle relaxants, steroid pack, stronger pain medication, and Blackburn Drug’s magic cream.
C. Come up with a plan for prevention of future psoas spasms.
As the saying goes, an ounce of prevention is worth a pound of cure. To prevent the psoas spasming again, I ask my patient to assess their lifestyle and habits to determine the root cause. Some questions I ask:
Are you stressed?
Do you have a long commute followed by sitting at a desk all day?
Did you start a new home project such as gardening?
Do you strengthen your core or is your psoas trying to compensate for weak abdominals?
This last question is critically important. Be honest with yourself…do you strengthen your core or is your psoas trying to compensate for weak abdominals? If your core is weak, start with 2 to 3 minutes of abdominal strengtheners a day. It is beyond the scope of this article to talk about core strengthening exercises, but there are abundant options and resources on the internet. And I’m happy to discuss core strengthening exercises with you at your next appointment. If you’re not already a member, sign up here!