Low Back Injury While Lifting? What you need to know & how to recover

Introduction

Hurting your back while lifting weights can be alarming but for good reason. There are many injuries that are actually dangerous and we hear so many scary stories of back injuries leading to debilitating chronic low back pain. What do you need to look out for? What can you treat yourself at home and what do you need to see a doctor about?

Key Takeaways:

High-risk injuries where you should go to the ER immediately include those with red flags:

  • severe pain at one point along your spine
  • numbness or paralysis in one or both legs
  • difficulty or incontinence urinating or defecating

Concerning symptoms that you should stop exercising until you’ve seen your primary care doctor include:

  • unintentional weight loss
  • extremely low body weight or low body fat percentage
  • pain shooting down your leg
  • inflammatory symptoms: shortness of breath, chest pain, rash, pain in multiple other joints, swelling in your feet & ankles, tingling numbness in hands and feet, pain or redness in your eyes

What to do to recover:

  1. minimize bed rest and slowly, gently return to activity.
  2. Use heat on lower back.
  3. NSAIDs.
  4. Back-strengthening exercises.
  5. Physical Therapy.

Disclaimer: Internet Medical Advice

Obviously, this is the internet. While I am a doctor, I am not your doctor. This is meant as general advice for overall healthy, active adults.

Be sure to ask your own doctor if you are healthy enough for exercise.

If you have had previous back injuries or have known problems with your back or bones in general (such as slipped/herniated disc, sciatica, osteoporosis, eating disorder, autoimmune disease, etc) you need to have a lower threshold to go see a doctor about your injury.

Red Flags to go to the Emergency Room

  • Severe pain at a one point in the very middle of your back
    • Especially if the pain started with some sort of impact or quick extension/twisting of your lower back, this can be concerning for a break/fracture in one of your vertebrae bones and it is important to go to the ER to have this evaluated.
  • Difficulty moving one or both legs
    • You can’t stand on one leg because it collapses under you or you feel like you are dragging one leg behind you. Similarly, you can’t straighten your leg or lift your foot on one or both sides.
  • Numbness in one or both legs
    • Part or all of your leg is totally numb, for instance if you were to scrape it on something painful you wouldn’t feel it at all.
  • Inability to urinate or defecate or accidentally peeing or pooping on yourself

These are all concerning for a broken bone or one of the discs between your vertebrae pushing on the nerves in your back. These problems can be permanent if not treated as soon as possible so you need to go to the ER if one or more of these are happening.

Concerning symptoms that you should stop exercising and see your primary care doctor

  • Unintentional weight loss
    • If you are intentionally controlling the number of calories you consume and trying to lose weight, that’s okay. But if you find you’re losing weight even supplementing more calories than normal, this is a concerning sign and you need to stop exercising and go see your doctor.
  • Your BMI is < 18 or your body fat is < 14% (as a woman)
    • This puts you at high risk for bone and connective tissue injury as well as permanent damage to other organs when your body is under stress from low energy availability worsened by a back injury. In order for you to heal from any injury in this case, you need to stop exercising (but continue to eat full, nutritious meals) and schedule an appointment to see your doctor.
  • Pain shooting down your leg
    • This is concerning for problems such as sciatica or piriformis syndrome and this will likely not get better on its own. You should stop exercising and go see your doctor. Once they are able to determine exactly what is the problem, you should likely work with a physical therapist before returning to full activity.
  • Shortness of breath, chest pain, rash, pain in multiple other joints, swelling in your feet & ankles, tingling numbness in hands and feet, pain or redness in your eyes
    • These are all signs that you might have an auto-immune disease. Often new low back pain or joint pain are the first signs of an auto-immune disease in young adults. If you have several of these symptoms, stop exercising and schedule an appointment with your primary care doctor.

Side vs middle

Assuming you don’t have any of the red flags or concerning symptoms listed above, your pain is most likely a strain or sprain of the muscle or ligaments in your back.

Fun fact: what’s the difference between a strain and a sprain?

  • A sTrain with a “T” is a partial/minor tear of muscle tissue or tendon. Tendon is the connective tissue that connects your muscle to your bone.
  • A sPrain with a “P” is a partial/minor tear of a ligament. Ligaments are connective tissue that connects bone to bone.

If your pain is in the very middle of your low back, it is likely that you have sprained the ligaments, or bands of tissue, between the vertebrae bones of your back.

  • In this case, you should take less bed rest time and focus on strengthening the muscles of your lower back. Strengthening the muscles of your back takes the stress off of your ligaments and bones in that area since it can now use the muscle tissue to support your posture.
  • Using ice and anti-inflammatory medicines such as ibuprofen and naproxen is also particularly helpful here. Too much inflammation in ligaments and bones can cause scar tissue to build up and cause worse problems later on.

If your pain is on one side or both sides of your low back, it is likely that you have strained the muscle or tendons in your back.

  • In this case, you can take an extra day or two of rest to let the muscle tissue heal.
  • Use ice early on to decrease inflammation and then switch to using heat pads or warm baths to increase circulation to allow healing nutrients to flood the area. Less scar tissue tends to build up in muscle after strain injuries than in similar ligament injuries so allowing more inflammation and blood flow is a good thing to heal and allow the muscle to grow stronger.

Recovering from your back injury

If you don’t have any of the red flags or concerning symptoms listed above, here are the most effective tips (as shown by science) for full recovery.

Staying active & minimal bed rest

As stated above, if your pain is more directly in the middle of your back, it’s better to get up and walking sooner. If your pain is more out to the sides, you can wait a few more days.

This seems to be a general consensus, or expert opinion, among many different doctors, physical therapists, chiropractors, and trainers.

To be honest though, some data supports this but overall is not convincingly for it. Many high-quality studies and meta-analyses, including a Cochrane review (which is considered the highest level of all scientific evidence review) have been done on the subject. While a few studies show a small amount of benefit, the majority of studies show no effect on pain and no difference in return to full activity after several weeks. (Smith, 2002; Maher 1999; Dahm, 2010; Hayden, 2005)

Personally, I still think it’s better to be active earlier. The studies overwhelmingly show no difference in pain with or without early activity so obviously early activity is not dangerous to you (unless you have any of the red flags or concerning symptoms listed above). However, maintaining activity offers many more advantages to you over bedrest. Your work and household tasks don’t fall behind and mild activity, like walking, is incredibly beneficial to you cardiovascularly and mentally.

Heat & cold

It is widely practiced to use cold on injuries immediately, and then heat over the next few days.

This makes sense as cold works to both numb the area from acute pain and to minimize inflammation which can cause scar tissue. Scar tissue is problematic in that it both prevents full range of motion and it can cause pain alter on by pushing on nerves.

Eventually, scar tissue is needed to heal the torn tissue. But ideally, we want the minimal amount necessary to heal the tissue but not get in the way later.

Interestingly, there is little science done at all on using cold for low back pain. The science does support cold’s numbing effect and decrease in inflammation on different areas of the body so it makes sense that it would be similarly effective here. (Konrath, 1996)

There are some really creative cold-pack solutions that people have come up with for targeting the low back. Check some out here on Amazon.

After the acute inflammation has died down, heat allows more blood to get to the area, and more healing to get done. Then we avoid chronic tears with chronic inflammation, more scar tissue, and more pain.

There is good scientific evidence showing heat has a great effect on low back pain. Many studies (including a Cochrane review, the gold standard of evidence) show decreased pain and faster return to function using heat on your lower back. (French, 2006; Mayer, 2005)

Many of the studies used an electronic heat wrap, similar to these:

Anti-Inflammatory Medications

As above, non-steroid anti-inflammatory medications (ibuprofen, Motrin, Advil, naproxen, Aleve, etc) help reduce pain by reducing the amount of inflammation in the area of the injury.

There is good evidence, including a high-quality Cochrane review, showing NSAIDs help significantly in acute low-risk low back injuries. (Roelofs, 2008)

They found no benefit to one over the other so any ibuprofen or naproxen will help equally.

Return to Exercise

Start Slow

When exercising after a low-risk low back injury, it is important to remember to start slow. Do gentle exercises for the first several days after the injury and slowly, gradually increase intensity. Make sure as you’re increasing intensity to increase your warm-up time as well.

Check out my post here on the best ways to warm up.

Posture

It’s also important to focus heavily on maintaining good posture as you return to exercise. Try to elongate your spine as much as possible at all times, keeping a neutral, gentle curve in your lower back.

Protein Intake

It’s also helpful to increase your protein intake to give your body all the nutrients it needs to heal itself.

I personally love Optimum Nutrition protein powders because they are tasty, trustworthy, and inexpensive – can’t beat that!

Exercises

Some good exercises to work on strengthen your whole core, abs and back muscles.

Many good initial exercises are actually yoga poses. These strengthen your entire core in a gentle, gradual way and are a great way to start out when returning to activity.

  • Cat/Cow Pose
  • Supine Twist
  • Downward facing dog
  • Sphinx pose
  • Bridge pose
How to fix low back injury showing Cat Cow Pose
How to fix low back injury Downward dog and supine twist
How to fix low back injury - showing proper positioning of Bridge Pose with whole core engaged

Once you’re feeling comfortable in these poses, you can increase intensity by working on some of these below. It’s important when doing all of these that you keep your entire core contracted and you keep your lower spine in its gentle, neutral curve. Don’t let your back hyper-extend during these exercises.

  • Supermans
  • Quadruped alternate arm & leg
  • Farmers Carry
How to fix low back injury Superman - showing proper positioning with whole core engaged instead of abs loose
How to fix low back injury Quadruped showing proper positioning with whole core engaged instead of abs loose
How to fix low back injury Farmer's carry - showing proper positioning with torso upright and square instead of tilted

Physical Therapy

If you’re still feeling pain after trying some of these exercises, you may have some muscle imbalances that you don’t realize putting asymmetric stress on your spine and causing more pain.

I’d highly, highly recommend seeing a physical therapist, from as soon as you injure yourself if that’s available to you.

But if you’re getting to the point where it’s been 2-3 weeks after your injury and you’ve been gently increasing activity and core strength with no relief, this is the time you need to see a physical therapist.

There is likely something more specific going on that will benefit from particular muscular retraining that could really only be evaluated and treated by a physical therapist.

Spinal manipulation therapy has also been shown to have similar effects to physical therapy, NSAIDs, and back exercises so is also worth a shot if you have access to it. (Assendelft, 2004)

Things that have been tried but shown by science that don’t work

Steroids (Friedman, 2006; Heimovic, 1986)

Injections (Staal, 2008)

Acupuncture (only works in chronic low back pain, not acute injuries) (Furlan, 2005)

Traction (Wegner, 2013)

Continuous ultrasound as treatment (Nwuga, 1983; Ansari, 2006)

Laser therapy (Yousefi-Nooraie, 2008)

Conclusion

Low back injury can be painful and nerve-wracking. Here’s what you need to know about it:

High-risk injuries where you should go to the ER immediately include those with red flags:

  • severe pain at one point along your spine
  • numbness or paralysis in one or both legs
  • difficulty or incontinence urinating or defecating

Concerning symptoms that you should stop exercising until you’ve seen your primary care doctor include:

  • unintentional weight loss
  • extremely low body weight or low body fat percentage
  • pain shooting down your leg
  • inflammatory symptoms: shortness of breath, chest pain, rash, pain in multiple other joints, swelling in your feet & ankles, tingling numbness in hands and feet, pain or redness in your eyes

What to do to recover:

  1. minimize bed rest and slowly, gently return to activity.
  2. Use heat on lower back.
  3. NSAIDs.
  4. Back-strengthening exercises.
  5. Physical Therapy.

Sources:

  1. Ansari NN, Ebadi S, Talebian S, Naghdi S, Mazaheri H, Olyaei G, et al. A randomized, single blind placebo controlled clinical trial on the effect of continuous ultrasound on low back pain. Electromyogr Clin Neurophysiol.2006;46(6):329–36.
  2. Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev. 2004;(1):CD000447.
  3. Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low‐back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD007612. DOI: 10.1002/14651858.CD007612.pub2.
  4. French, S. D., Cameron, M., Walker, B. F., Reggars, J. W., & Esterman, A. J. (2006). A Cochrane review of superficial heat or cold for low back pain. Spine, 31(9), 998–1006. https://doi.org/10.1097/01.brs.0000214881.10814.64
  5. Friedman BW, Holden L, Esses D, Bijur PE, Choi HK, Solor- zano C, et al. Parenteral corticosteroids for Emergency Depart- ment patients with non-radicular low back pain. J Emerg Med. 2006;31(4):365–70.
  6. Furlan AD, van Tulder MW, Cherkin DC, Tsukayama H, Lao L, Koes BW, et al. Acupuncture and dry-needling for low back pain. Co- chrane Database Syst Rev. 2005;(1):CD001351.
  7. Haimovic IC, Beresford HR. Dexamethasone is not superior to placebo for treating lumbosacral radicular pain. Neurology. 1986;36(12):1593–4.
  8. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005;(3):CD000335.
  9. Konrath, G. A., Lock, T., Goitz, H. T., & Scheidler, J. (1996). The Use of Cold Therapy After Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized Study and Literature Review. The American Journal of Sports Medicine, 24(5), 629–633. https://doi.org/10.1177/036354659602400511
  10. Maher, C., Latimer, J., & Refshauge, K. (1999). Prescription of activity for low back pain: What works?. The Australian journal of physiotherapy, 45(2), 121–132. https://doi.org/10.1016/s0004-9514(14)60344-5
  11. Mayer, J. M., Ralph, L., Look, M., Erasala, G. N., Verna, J. L., Matheson, L. N., & Mooney, V. (2005). Treating acute low back pain with continuous low-level heat wrap therapy and/or exercise: a randomized controlled trial. The spine journal : official journal of the North American Spine Society, 5(4), 395–403. https://doi.org/10.1016/j.spinee.2005.03.009
  12. Nwuga VC. Ultrasound in treatment of back pain resulting from prolapsed intervertebral disc. Arch Phys Med Rehabil. 1983; 64 (2):88–9.
  13. Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD000396. DOI: 10.1002/14651858.CD000396.pub3
  14. Smith, D., McMurray, N., & Disler, P. (2002). Early intervention for acute back injury: can we finally develop an evidence-based approach?. Clinical rehabilitation, 16(1), 1–11. https://doi.org/10.1191/0269215502cr461oa
  15. Staal JB, de Bie R, de Vet HC, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Data- base Syst Rev. 2008;(3):CD001824.
  16. Wegner I, Widyahening IS, van Tulder MW, Blomberg SE, de Vet HC, Bronfort G, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2013;8:CD003010.
  17. Yousefi-Nooraie R, Schonstein E, Heidari K, Rashidian A, Pennick V, Akbari-Kamrani M, et al. Low level laser therapy for nonspecif- ic low-back pain. Cochrane Database Syst Rev. 2008;(2):CD005107.
How to fix low back injury Pinterest image showing woman holding lower back
Woman photo created by diana.grytsku – www.freepik.com
How to fix low back injury Pinterest image showing all different exercises to strengthen core
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