Many of us have experienced a sprained ankle before. Typically, when the ankle is injured, it swells, stiffens, and is painful. Walking becomes difficult, and the ankle is weak. The ankle feels vulnerable for a while but, in time, returns to normal (it frequently doesn’t regain full mobility, which can contribute to problems later on, but this is another blog topic). Generally, we don’t worry too much about a sprained ankle because it eventually does well and rarely results in significant long-term disability. A testament to this is that there are few books and research articles written on chronic dysfunctional ankles and their impact on disability. In contrast, many books have been written and studies done on chronic back pain and its high rate of disability. Why the difference?
Anxiety, an emotional response to injury and pain, may be partially to blame. The anxiety level surrounding back injuries tends to be much higher than with ankle injuries. There are many reasons for this. The first consideration is, what is injured? Is it muscles, ligaments, disc? The cause is not easy to determine. Back pain is recognized to be 80% idiopathic, or of unknown cause. Moreover, there are many fear inducing words to describe the origins of back pain including a slipped disc, herniated disc, compressed nerve, and ruptured disc. These labels can be scary and unsettling when not understood. Many of the preceding diagnoses are common findings in individuals with no current/past history of back pain, and are not indicative of how well they will do in the future.
Additionally, back pain is a prevalent, debilitating ailment. Most of us know someone with back pain and its impact on quality of life and disability. This awareness adds to anxiety and the fear of what could happen in the future from a back injury. In addition, the media deluges us with references to back injuries and pain. From the outset, the possibility of prolonged problems is a concern. As mentioned in my previous blog, anxiety, fear, and worry about an injury add to the body’s inflammatory response and stress levels, thereby increasing pain experience. This exacerbates the problem. Fear and worry are not helpful responses unless they cause you to take a necessary action.
Although some tissues have better recuperative abilities than others, symptoms, and the physiology of injury, are similar in regards to the healing process. Tissues are damaged; a chemical inflammatory process ensues, which results in pain and swelling. The body then progresses through the healing process, and tissues gradually strengthen, becoming more stress tolerant. Through the rehab process, we work to insure healing, to help the patient regain mobility, strength, muscular control, and efficient movement patterns. With the preceding accomplished, the tissues and nervous system can return to normal, allowing for physical activity without pain. This is true of injured tissues in the ankle and the back.
We suggest considering all injuries, including back injuries, to be like an ankle sprain. Understand that when you injure your back, regardless of the tissue, it needs a chance to heal. Stress minimization and a period of protection to the tissue are necessary for optimal healing. Ankle sprains are easier to treat; we can splint, brace, or put you on crutches. However, with the back, we have to rely on reducing stress to tissues by avoiding painful activities, changing positions frequently, and doing your daily tasks with good position/efficient technique (no slouching on the couch!).
Working on regaining necessary attributes such as mobility, strength, muscular control, and efficient movement patterns is important in reducing your pain level and ability to be active without difficulty. Understand that your symptoms will be up and down as you work through the healing process. Likewise, occasional discomfort is not uncommon and should be expected. Last, but not least, work on your nervous system by having strong, positive thoughts. Be patient and stay in the present; do not project pain or problems into the future. Be confident you will heal. Affirm that you are healthy and strong in body and mind.
If you have a degenerative condition or pathology, there is still improvement possible. Commit to leading an active life. Complete elimination of pain should not be your goal. Success can be achieved by being active and doing what you enjoy.
By Clarke Tanner, PT, MPT, CMPT, ATC, CSCS and your OSPT Team
If you are experiencing pain, take action to eliminate it! We can help. Let us help you get back to the activities you enjoy. Call 804 320-2220 and setup an appointment today.