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Back Pain: When to see a Physiotherapist



Your back just went out and you’re not sure what to do. Your back has been hurting for weeks or months, and you don’t know how to make it go away. You’re worried you might have hurt a disc, pulled a muscle, something went out of place… Don’t worry, I’m here to tell you what to do.


Lets start with a simple fact: most injuries heal on their own with time. So start by taking a deep breath and remind yourself that this too shall pass.


The healing phases:

Imagine a future where we can put mini nanobots into our bodies that can hunt down bacteria & viruses, find broken and injured tissue and clear away the debris and build back better and stronger than before. Well the future is now! Human physiology is a beautiful invention of evolution. Your body has everything it needs at its disposal to clear away the debris and heal any tissue you may have injured. But just like repairing a potholed road, or fallen bridge, this process takes time. How much time?

There are 3 phases of healing that overlap with each other and begin immediately after injury and last up to a year after your injury. They are the inflammatory, proliferative, and remodeling phases.





The inflammatory phase:



The inflammatory phase of an injury lasts up to 2 weeks. This is the most painful part of the process. During this phase, its okay to take time off your sport or painful activites, rest, move around as much as you can tolerate, use heat and ice to help relieve pain, but most importantly: understand that this phase is painful, it’s super normal, and give yourself a couple weeks for this phase to pass.


If it’s been more than 2 weeks and your pain isn’t improving at all, or you’re still scared/apprehensive of returning to normal, its time to consult a physiotherapist for a proper assessment and rehab plan


Before 2 weeks, unless you need some reassurance about what to do, you do not need to consult a physiotherapist. Its normal for it to be painful. Give it time to calm down.


The proliferative phase:



The proliferative phase overlaps with the inflammatory phase, but this is the phase where new tissue grows to replace the broken tissues. This phases lasts up to a month and a half. During this phase it is important to begin returning to normal activities as soon as possible…gradually!


This is when you want to consider consulting a physiotherapist to be evaluated and have a plan made for you to help you understand what kind of pain is good and what kind of pain is bad, as well how to progressively return to your normal sports/hobbies/job/etc.


The Remodeling phase



This phase begins around day 9 post injury and lasts up to a year. During this phase the newly created tissues undergo maturation and become stronger and more resilient than they were before (similarly to when you exercise!) It is very important during this phase to load and strengthen your body, not only so that you get better, but so you can become more resilient and less likely to get injured again!


If you are feeling 90% better, are returning to your normal physical activities with minimal pain and you have no fears of being physically active you do not need to consult a physiotherapist


If you only feel moderately better or not any better, you are avoiding returning to physical activities or if they are very painful, if you are unsure of how to proceed, or you have fears of reinjury and fear that physical activity may harm you, its time to consult a physiotherapist. They will assess you, tell you what’s going on, and support you with a plan to help you get back to normal!


Other signs that you should consult a physiotherapist:

If you are having any sort of neurological symptoms accompanying your back pain such as:

- Pain spreading beyond the back into the hip, down the leg, knee or foot (or all of the above)

- Tingling or numbness in the back or leg

- Feeling of weakness in the back or leg

- Buckling of the knee

- Your foot dropping when walking

- Alteration of sensation (beyond just pain) in the back or leg


With any of these, you’re better off consulting a physiotherapist, even if you’re only still in the inflammatory phase


Signs you should go to the emergency room:

If you have any of the following signs, don’t wait, don’t go see a physiotherapist à go to the ER:


Red Flag Symptoms:

- Severe pain when you cough or sneeze

- Severe pain and severe weakness in the leg or both legs (if you can barely walk)

- Loss of sensation/numbness/tingling in the “saddle” area (the crotch area)

- Inability to control your bowel or bladder (can’t relax, or can’t hold it in)

*In absence of any other symptoms—if you have been struggling with incontinence or constipation, or pain during sex, consult a pelvic floor physiotherapist!


Once cleared of any serious pathology in the Emergency Room, you should then go consult a physiotherapist.



 

Summary


When to wait:



- If its been less than two weeks since your injury, the pain isn’t excruciating, and you are exhibiting zero red flag symptoms

- Rest, take it easy, move as much as you can tolerate, use ice/heat if you need it to help reduce pain—you don’t HAVE to use it, it doesn’t speed up healing.


When to see a physio:



- If your pain started more than two weeks ago, and is not improving (whether you had an injury or not)

- If your pain has worsened

- If you need reassurance on what to do

- If you are afraid of returning to Physical Activity, Sports, Hobbies, Work, etc.

- If you are not feeling significantly better after 2 weeks

- If you fear reinjury in the future

- If your back pain is accompanied by neurological symptoms such as:

o Pain, Tingling, Numbness, or Weakness in the back or leg

o Alteration of sensation in the back or leg

o Buckling of the knee or dropping of the foot when walking

- After being cleared in the ER when presenting with red flag symptoms


When to go to the ER:





- If you are presenting with any of the red flag symptoms


If you feel you need to see a physiotherapist, don’t hesitate, the process is super simple!

Go to paperminds.ca/Jordan and book an appointment that is convenient for you.



We’ll have a conversation about your pain and what activities it is limiting, and you’ll leave with a simple to follow plan to get you back to feeling 100% faster than you thought possible!


If it’s been more than 2 weeks and your pain isn’t improving at all, or you’re still scared/apprehensive of returning to normal, its time to consult a physiotherapist for a proper assessment and rehab plan.

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