Back pain? Is it serious? When to train, rest or get help


– Hi, Facebook! We’ve got another one of
our workshops this week. We’re just coming to the end
of our “Fix Your Squats” series so today we’re going to
be going over back pain, how to tell is it serious, when to train, when to rest or get help? Now, I’ve put together a really
comprehensive cheat sheet for today so if you want
to click the link above and just get a download
for that, that’d be great. That’ll be quite useful if
you are a coach or a trainer just to have that as a reference guide particularly for when you’re
working with your clients. It’s got all the information about the more serious conditions as well as the general ones. What we’re going to be doing
today is going through, first of all, just quickly telling you about the more acute or
dangerous kind of situations and, with that, what you need to do. But they are super rare. And then what we’re going
to spend a bit more time is talking about that
more chronic back pain and then also the tests
that you need to be doing to check whether it is serious or not. Now, obviously, as a general disclaimer, if you’ve got any back pain and there’s been any sort
of increase in intensity or have any other conditions
with regards to things like sudden weight loss or
weight gain, any fever, any tingling, numbness,
or anything like that, then we want to be getting some medical attention straight away. And this here’s just advice only, so if you’re ever worried then
do get in touch with a doctor as they will be able to
give you that information. So, first of all, for most of
you watching, you’re a lifter or you train in some way, shape or form. So we’re gonna be talking
about when to get help. So if you have an acute
disc pain or injury, so this scenario is gonna be typically, you may not get pain at the time but you’ll know within 48 hours or so that you’ve got pain and discomfort. For most of you, as well,
it’ll be quite intense pain if we have injured the disc. You would’ve trained before and got niggles and issues like that but this is the type of pain
that’s above seven out of 10 and really does cause you some concern. What we want to do is
make sure that you get immediate medical attention so that can be the
doctor or an A&E at all. If you’ve got any numbness,
if you’ve got any tingling, or if you’ve got any
loss of power or control because all of those are indications of either one of two things. Either the nerve itself is
compressed, which could be from just something like a Piriformis Syndrome, so a muscle’s compressing it,
or a spasm’s compressing it, or a disc injury where the
disc is bulged or burst, which is then pressing on it. Or what is most common, that
there’s some sort of swelling or inflammation around it. It will still give the
same sort of symptoms but it’s nowhere near as serious. But if there’s any nerve symptoms at all, so that’s numbness,
tingling, or loss of control, so again, as a lifter,
we should have strength. So if we find that we haven’t got control in the feet or strength in the legs, then that’s when we want to get our immediate medical
attention, at the very least, by going and seeing a doctor
within that 48 hour period where we’ve got that seven out of 10 pain. You’re gonna get hold of
some decent painkillers. And getting some decent painkillers means you’re gonna start moving properly and that’s actually gonna
help improve your progress. So, in this case, getting that help is really actually important. Just kind of grinning and bearing it isn’t necessarily the way forward even if you don’t think it’s
kind of anything sinister. Most of the time, the
patients that we see, this is the case. I’ve only seen probably
two or three in 10 years, like severe disc ruptures, which has taken six months
to a year to recover. So, for most of you, those first 48 hours will be pretty uncomfortable, but within a sort of
three to four week period, that back is gonna improve quite a lot. But even so, getting
that medical attention immediately is important. Do not train through it. Do not necessarily just purely rest. You need to be getting help, okay? I’m gonna just quickly talk about a little bit more serious
condition, which is super rare. I’ve only ever heard of two
cases of it in my career. I’ve never actually come across one. But one was a tutor at university and then one was when I had back pain, a doctor would tell me that
they had a patient that had it. And it’s called Cauda Equina Syndrome. So if you lift at all or
around lifters regularly, so your coach or you own a
gym or anything like that, knowing about Cauda Equina Syndrome is really, really important. So, what happens here is that
we’ve got the spinal cord that runs down the back here. And we have little nerve
roots that come off. So at different levels, the nerves will come
off of the spinal cord and then this is what often, if there’s any kind of tingling. Oh, hi guys. I’m back again, just losing signal here. So if there’s any tingling
in the fingers or toes, normally it’s one of these
nerve roots that compress. And the nerves are pretty well-supported and they’ve got the vertebra around them to try and help give them some safety or structure or support. But at the end of the spinal cord, so as you get all the way
down, as you get very low down into this section here, the
bottom of the spine fans out and it doesn’t have as
much protection to it and it’s what we call the cauda equina, which is horse’s tail. So it’s just literally sort
of fan of nerves that we get. And what can happen is in
some very, very rare cases, like I said, I’ve only ever heard of two in over a 10-year career, but we can get compression
on the nerves there. Now the symptoms are fairly similar to if we had another back injury. There’ll be tingling and numbness. But the big one is that there’ll
be quite a lack of control. And the nerves here, they actually go around
to your pelvic floor. So the big clue, and
you do need to ask this, it’s one of those kind of taboo topics that you don’t want to
ask people about it, but you need to ask any of your athletes or any of your friends
if they have back pain, is have they had any changes
in bladder or bowel movement? It can either be that
they don’t have control so they have accidents, or
that they’re constipated or they can’t go to the bathroom. And like I say, it’s
not one of those topics we like to talk about very
much but it is so important that if you’ve got a friend or yourself that’s got severe back pain, like severe, that’s normally very intense, as well, if they have that symptom, they need to get to A&E immediately. The only treatment course
for Cauda Equina Syndrome is have immediate surgery. The other symptom that we tend to have is, not only is there that lack of control, so that’s that muscle control, either to not be able
to go to the bathroom or be able to control it,
but it’s that you’re numb. So it’s what we call saddle numbness. So the question that we’re
told to ask in clinic is like, can you feel yourself when you
wipe to go to the bathroom? And again, I have never had a
patient say, “No, no I can’t.” But you do not want to
have somebody around you be that one person that has
that compression on there and actually do risk, in this case, that’s gonna be one of the areas that can risk having
paralysis down the leg. So it’s extremely important
to always ask the question. It’s very rare but I
just like to make sure that people know about it. So, with that in mind,
we’ve got rid of the two, sort of, more extreme things. So either someone who’s in acute back pain and then we’re gonna go and get help, and if we’ve got then the
numbness in the saddle region or problems going to the bathroom, then again, we need to go
and get immediate help. So, what about if you’re somebody who’s got more longer term back pain? It’s not as acute but
you’re suspicious about it and you really don’t know
whether to train or kind of not. What we’re gonna do is
go through two tests that I want you to perform now, if you’re watching this,
if you’ve got back pain. And if you’re positive in
either of those, again, it can indicate, it’s not 100%
positive, but it can indicate that there’s either some
compression on your nerve, which again, means somewhere
from where it comes out in the spine down that
leg is getting compressed or then there’s some
inflammation around that nerve. And both of those are things that we don’t want you training
through without advice. If you do the tests and you’re negative, then out of the options of
get help, rest, or train, you’re gonna train, that’s fine. We’re gonna train pain-free and we’re just gonna
introduce you to a system that we use for helping people train when they’ve got injuries or back pain. So, if you’re the person
with long term back pain, it flares, you might occasionally
get tingling and numbness, but then it goes again, what
tests do you need to be doing? Well, one, the first test is a Slump Test. It’s a super easy test, very, very quick. I’ll just show you through here. All we’re gonna do is get you sitting down and you’re physically going to slump. And what we’re looking for,
this is a provocative test, so we’re looking to see, does this reproduce any of your symptoms? So either pain, tingling, or numbness. And, in particular, we
might get some discomfort in your lower back because
flexion is uncomfortable. But are we getting any symptoms
going down into the glutes or down into the leg as a result? So all you do is slump which then puts pressure
on the discs gently. Head goes down, which pulls
on the spinal cord, as well. And then you’re just gonna move one leg, lift it up, and pull the toes towards you. You then compare to the other side. I’ve got full range. I’ve got a history of a disc
injury that I had in May. The right side, I literally get a pull. It’s not even pain but it’s just a pull on that right-hand side. If I slump in a bit more,
it gets a bit painful. It’s kind of more uncomfortable, like intense discomfort, than anything. Whereas on the left side, there’s no issue in that area at all. So, I would be a good example of somebody that has a historical disc
injury, and it may well be that you didn’t actually
notice it at the time, but that there’s clearly something restricting the nerve
movement at the moment. I know what the cause is for mine, but if you have a positive sign on that, do go and see somebody. It doesn’t mean you can’t train. I’ve been lifting fine,
I just have to make sure that I’m working with
it and doing things like I can’t pull from the floor very well but I have to pull from above the knee. Again, you can still train if
you have issues with the disc or sciatic nerve but you
do need advice, okay? Then the next test because that one tends to
be the most common one, but the other one that
can then sometimes be a bit irritable, as well, is what we call a Straight Leg Raise. I’ll see if I can just
change the couch angle. Perfect. Okay, so very simple, as it sounds. It’s the Straight Leg Raise. We’re lying flat down, legs nice and flat, then one leg comes up straight
and towards the ceiling here. The other leg needs to be down, we don’t want to be bending, like that. And then we swap sides. And I’m only slightly tight on this side. And, again, pull the toes towards you. As you do that, the nerve that runs down the leg, if you pull the toes towards you, it will then pull the nerve that way and put it under tension. So if that sciatic nerve is tight or under load anywhere in that chain, by pulling the toes towards you, it’s really going to emphasize it. The range of motion we look for for health is kind of 90 degrees or above. But if you’ve got a back injury and you are getting some tingling, pain, or lack of movement, I’m just going to have a quick look here, because the reference
ranges are quite important. If you find that it’s within 30 to 50 degree range that you’re getting problems, so you can lift the leg up a bit but you can’t get full range, again, it’s another indicator that
nerve is under tension for you. So, to summarize, if you’re someone who has had an acute injury,
so you’ve hurt your back and it’s within 48 hours and
you’re getting any tingling, numbness, any sort of intense
pain, over seven out of 10, go and get some medical attention. Alright, one of two things. Either it is something serious
and then you do need then somebody who knows what they’re
doing to look at it for you, or, which is actually
the most common scenario, is that you just need to get
some painkillers into you and you need to get
that improvement going. We find that within six
weeks of any back injury, no matter how severe, 50% of people are completely pain-free. And what you want to
be doing is making sure that you can get into that category by moving as much as
possible rather than rest. Rest is never the best
option for back injury. So, you’re either in the acute category, we’re gonna go to the doctors
and get some medical attention and work out if it is
something more serious and they will work that out for you, or that you need to be
then getting painkillers to just get yourself moving
normally as quickly as possible. Then we’re either in the
chronic pain category, so you’ve had back pain
for quite some time and then we’re gonna run through the Slump Test and the Straight Leg Raise. If either of those are positive, we’re gonna go and get some help, so either medical attention
or see a sports physio or visit a sports injury
clinic to give you advice on how to get that healing properly and get that movement back again. And if you have lower back pain and you haven’t been positive
on either of those tests, you haven’t got any symptoms
of tingling, numbness, or pain, then what you can do
is train, that’s fine. What we want to do is get you training. The body’s designed to
heal through movement. So what we suggest at the clinic here is using what we call
the Traffic Light Method. So we’ve got Green Light
activities which are pain-free, Amber, which is that you
might get pain at the time or it’s bearable or you
might get pain in 24 hours, and then Red Light activities where it’s where you
get pain all the time. If you have long term back pain but you weren’t positive
on any of the tests, do as many Green Light
activities as you can. And that might be walking,
that might be swimming, it might be, I can do
for example, like I said, work from the hang where I’m
not pulling from the floor. Train that as much as possible. Don’t work these Red Light activities. We’ll save this for a future session, but if you’ve got back pain and you work and continue to do stuff even if you’re not at risk
of any serious injury, if you continue to do
an aggravating activity, you’re gonna become sensitized and that back pain’s gonna continue. And then as a final note, for
the very, very rare occasions, and if you Google it, it
always will state rare because it is rare, but with
the Cauda Equina Syndrome, that’s if someone has got
the intense back pain, tingling, numbness, loss of power, but also if they’ve got that trouble with going to the bathroom or any numbness in the pelvic floor, that is immediately going to A&E. Next week, I think, my
goodness let me just check, I think it’s next week,
we’re gonna move on to our Mobility for
Athletes set of workshops. So if you have any particular topics, I’ve already put some questions out there for a few other people. If you’ve got any particular topics that you want addressing for mobility then drop them in the notes below and we’ll start planning
out the schedule for that. But next week’s one is the “Five Most Common Mobility
Mistakes and How to Fix Them”. So that’s gonna be quite a
good one for helping improve those mobility sessions
that you’ve been doing. And, as always, if you
want the cheat sheet then click the link and if
you have any other questions, let us know and I’ll see you next week. Bye, guys.

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