Lumbar Limbo
April 20, 2011 2:35 PM   Subscribe

This morning, I sneezed and threw out my lower back. Since then, I've been unable to walk any significant distance without severe pain throughout my lower back/butt/left thigh, and the pain while walking is getting worse. Should I go to the hospital?

The pain is constant, even while lying down, and when walking, flares up when I step with my left leg.

Here's the catch: I've got a fun work outing to a theme park that I'd like to be ambulatory for...tomorrow.

I'm trying to figure out if going to to the ER makes gut is that the doctor's going to tell me to rest, and maybe give me some prescription Tylenol, but I'm wondering if there are interventions that'll ease the pain more quickly.

Thanks for your advice.
posted by downing street memo to Health & Fitness (25 answers total)
I'm not a (medical) doctor, but here's a pretty decent rule of thumb: if you lose the ability to do something (especially something as important as walking), you go to the ER.

Please let us know what they tell you when you get back.
posted by Dr. Eigenvariable at 2:40 PM on April 20, 2011

If you have associated leg pain it probably is not going to get better by tomorrow. I doubt if it calls for a visit to the emergency room but probably your physician is it is not significantly better in 36-48 hours. Call and make an appointment, you can cancel if it improves. You could try alternating Tylenol and Ibuprofen if ibuprofen is not a problem for you (administration schedules on line). I would suggest that you lay on a firm surface with knees bent. If the leg pain worsens or you experience any loss of strength in the leg/toes/foot call your doctor immediately. BTW, Years ago I sneezed while brushing my teeth with exactly the same results. Good Luck.
posted by rmhsinc at 2:44 PM on April 20, 2011 [1 favorite]

Going to the ER will likely result in pain killers and muscle relaxers with a suggestion to rest. IANAD but I have been through something similar resulting in two trips to the ER, neither of which cured me. I'm still not cured - it's an ongoing battle, but ultimately PT has helped the most. Personally I would try to ice it and rest, but if the pain and your mobility are getting worse a trip to the ER may be a good idea - I just wouldn't expect them to give you a magic fix by tomorrow.
posted by katy song at 2:47 PM on April 20, 2011 [1 favorite]

Sounds very much like a herniated disc. In which case it's nothing to take lightly--you have a disc that's bulged out from between two vertebrae and is now pushing against your spinal cord, leading to pain along your sciatic nerve, among other things. Take three ibuprofen to ease the pain, make an appointment with your doctor and forget about that outing. The last thing you want to do is aggravate the injury; herniated discs are notoriously difficult to manage, and unfortunately bed rest followed by lots of annoying stretches and exercises is the usual course of treatment.
posted by bassomatic at 2:50 PM on April 20, 2011

Try an Urgent Care (aka "Doc in the Box," in my family at least) facility rather than the ER. You don't need an appointment as you would with your normal doctor, and it won't have the insane expense or (usually) insane wait of an ER. I had something similar happen over Christmas this past year and the doctor gave me a shot of something that seemed to loosen up the muscles in back so I wasn't in such agony. (Also a prescription for muscle relaxers and pain killers and big numbing patches.) Ultimately, yes, it took several weeks of rest, but whatever that shot was helped. Unfortunately, I was in such agony that I don't know for sure what it was, but it looks like it may have been a cortisone shot.
posted by wuzandfuzz at 2:53 PM on April 20, 2011 [1 favorite]

IANAD, but I threw my back out with a cough while bent over a couple of weeks ago. I took ibuprofen and walked through the pain. The pain and tension was the worst after I had been sitting at work and then got up from my chair. I was also having occasional spasms, one of which made me drop a lovely bacon pizza my wife had made me for lunch.
It was considerably better, but still tense within 3-4 days. No doctor involved.
posted by battleshipkropotkin at 2:53 PM on April 20, 2011

Just a note to say not all leg pain is caused by a herniated disc - it's quite possible to have referred sciatic nerve pain from muscular issues. Either way, the treatment at this point is likely to be the same. I like the suggestion above to make an appointment with your regular doctor and rest as much as you can in the meantime.
posted by katy song at 2:56 PM on April 20, 2011 [4 favorites]

I know a lot of people here on MetaFilter really don't like Chiropractors, but I had the exact same thing happen to me and one visit to a 'practor put me right. YMMV.
posted by TooFewShoes at 3:06 PM on April 20, 2011 [3 favorites]

Sorry for the bad news. Your back pain is probably not going to completely go away by tomorrow. You may want to consider staying home, or at least staying on the sidelines for any physical activities.

Assuming you are otherwise healthy, with no previous history of back problems, the main reason to go to the ER now is to get prescription pain relievers or muscle relaxers. You may be able to get sufficient pain relief with ibuprofen and heating pads and stretching exercises. If the OTC stuff does not work, then you should go to the ER to get something that does help. Otherwise, call your doctor and make an appointment to get in to see them within the next several days if possible.

Red flags for going to the ER "NOW"include a history of recent trauma, bowel or bladder incontinence, weakness in a leg or legs, gait problems, fever, a history of HIV or Cancer, significant recent weight loss (which would be suspicious for undiagnosed cancer), point tenderness on the spine itself (rather than the surrounding muscles (again suspicious for cancer)), history of IV drug use.... or unrelenting pain. Good luck.
posted by Meta-4 at 3:16 PM on April 20, 2011 [3 favorites]

Just a note to say not all leg pain is caused by a herniated disc - it's quite possible to have referred sciatic nerve pain from muscular issues.

Yep. I have occasional back things that happen; some involve a degree of sciatica, some do not. A friend who lives downstairs threw her back out a couple of years ago - she did have a herniated disc, and her pain and inability to move without screaming were orders of magnitude beyond what I have experienced.

That said, when my back has gone out and sciatica is involved, it's made worse by more walking. A little walking/moving can help, but hours of walking and standing would cripple me. If I were you, I'd skip the outing tomorrow and stay home, alternating hot and cold packs and loading up on ibuprofen.
posted by rtha at 3:22 PM on April 20, 2011

I'll jump in the camp that you *just* threw your back out. Can be really painful and take several days to recover from. A herniated disc is mind-bogglingly crippling and painful. Take it easy, try some naproxen sodium (Alieve) and if you can stand it, try some VERY gentle stretching. Good excuse for someone to give you a back rub too, although personal experience has shown that it really doesnt do that much for the problem per se.

And on a side note, six months of physical therapy for a herniated L7 taught me that what makes a strong lower back is all stomach and butt. So if you wanted an excuse to get all ripped and not worry about back problems, go that route. After you heal up.
posted by elendil71 at 3:32 PM on April 20, 2011

Sheesh L7.. I meant L5. Must have girl rockers on the brain....
posted by elendil71 at 3:35 PM on April 20, 2011

You really need to take it easy for about a week anyway.
posted by KokuRyu at 4:02 PM on April 20, 2011

IF you want to try something other than just painkillers, try this. Get a lumbar belt that can hold an ice pack against the area of pain. Put in an ice pack and then WALK around with the ice for 10 minutes. Discs do not have a direct blood supply, but they get blood through sponge-like compression/ decompression with movement. Walking while icing provides much more anti-inflammatory benefit than just ice. You can repeat this frequently. It may (or may not) let you get to the park. Then, call the chiropractor.
posted by grizzled at 4:18 PM on April 20, 2011

Ooh, ouch.

I've also thrown my back out, and it's not necessarily an "emergency room" situation, but it's also not a "walk it off" situation either. Here's a question: is the pain tingly-burny, kind of like it's electricity running through you, or is it more...muscle-y and "I've got a bad cramp" and achy? An old roommate and I both had different kinds of back trouble, and that's how her doctor said you tell the difference between nerve pain (the "electric-y" kind) and muscle pain (the achy kind). If it's the nerve pain, that's a bit more worrying, and a bit more urgent.

If it's muscle kind, though, it still sucks, but is a bit easier to recover from. Icing it down helps. Taking it very easy for the first couple days, with gentle stretching as you can manage it, and then trying to move around a little after that is also a good way to go. Naproxen (aka "Aleve") is the best for muscle spasms. The last time I threw my back out I used massage therapy, and usually only two sessions was enough.
posted by EmpressCallipygos at 4:43 PM on April 20, 2011 [1 favorite]

When my back "goes out," as it sometimes does, I take lorazepam to relax the back muscles and hydrocodone to reduce the pain. A heating pad helps, too.
posted by Short Attention Sp at 5:10 PM on April 20, 2011

Seconding EmpressCallipygos:

If you have:
a) burning/electric pain down the leg
b) numbness
c) loss of the ability to actually move your toes/feet

That's nerve problems and worth seeing a doctor.

If it's "Ow, fuckfuckfuck" muscle pain, then the best you can do is rest it up unless you have a physical therapist/skilled bodyworker you can call. The back has tons of small, overlapping muscles- a big twist or strain can injure one of them, which, isn't the worst thing, mechanically, but it hurts like all hell because the spine is used to having full motion and so much of our movement comes from the body.

Neither one of these things is something you fix in a day, but hopefully it's muscular, because muscles heal better than joints.
posted by yeloson at 6:54 PM on April 20, 2011

Just as a data point, the exact same thing happened to me about 15 years ago. I sneezed while bending forward to pick something up off the floor.

I panicked and called a friend over to take me to the ER. They seemed to rule out anything serious with the following test: the doctor had me sit at the edge of the table with my legs hanging down. Then she asked me to push my foot against her hand. The fact that I was able to exert some decent pressure was apparently proof enough that it wasn't a big problem.

They sent me home with instructions to take ibuprofen, a hot bath, and use a heating pad. I didn't get pain killers or muscle relaxants or anything. (Also, I kind of felt like they were all rolling their eyes at the silly fat girl who pulled something in her back and then wasted all their time.) (But to be fair, they were right.)

My advice is, make sure you have a phone within arm's reach tonight. That way if you can't move when you wake up, you'll be able to phone someone for help. If it happened to me today, I would take a bunch of ibuprofen right before bed, and sleep with my phone in my pocket just in case.
posted by ErikaB at 9:32 PM on April 20, 2011

Chiropractor. Soon as possible.
posted by northernlightgardener at 3:45 AM on April 21, 2011 [1 favorite]

Response by poster: Thanks all! Decided to skip the emergency room but also the work trip. I'm much better today (made it to the corner Starbucks without stopping!) but not good enough to traipse around a theme park all day.

To answer the question EmpressCallipygos, it's definitely more of an ache than "electric" pain, which is good. I feel like it might actually be a spasm, not a disc.

A bunch of suggestions to see a chiropractor - I'm a chiro-skeptic, do they actually help at all?
posted by downing street memo at 4:38 AM on April 21, 2011

A bunch of suggestions to see a chiropractor - I'm a chiro-skeptic, do they actually help at all?

I don't want to rain on the parades of other people here who are answering your question based on their own experiences, but: for god's sake, don't use a chiropractor as your first option. Pain radiating downward into your leg is the tipping point for whether you need to make a trip to the doctor--that's usually the sign that there's some sort of pressure being exerted on nerves running along your spinal cord. That's not a minor thing: if you (or someone else, like a guy who puts out a shingle as a medical practitioner despite not having any sort of medical degree, and who puts a lot of force onto an area that's inflamed from a muscular injury) mishandle this, you run the risk of inflicting permanent nerve damage. The fact that you're feeling better today is encouraging, but I'd still have somebody with an MD take a look at it if you're still having any sort of radiating pain.

I won't discount the possibility that chiros have helped people here, but the literature is very clear: there's no significant difference in outcomes between 'sham chiro' and the real thing. That is, if someone cracks your vertebrae for you, the chances are just as good that you'll report feeling better regardless of whether the person is actually a chiropractor or is just groping around blindly. Add to that the fact that fast-adjustment chiros cause a ton of major nerve injuries (and we're talking your spinal cord, so major nerve injuries = partial or total paralysis) and that you probably can't tell whether the guy you're dealing with is a fast-adjustment guy until he's actually working on you, and I'd say you'd be much better off talking to your regular doctor about treatment options. If you're still having pain in a couple of weeks, see a physical therapist or look into a cortisone injection. Otherwise, ibuprofen and ice, and stay off of it as much as possible. (In my case, that also means no driving--something about driving and low-back injuries makes for a really nasty combo)
posted by Mayor West at 4:53 AM on April 21, 2011

The FIRST time I threw my back out, I did see a chiropractor, and that did help, yeah. If this is the very first time ever this has happened, I'd especially recommend it -- the chiropractor may give you a pretty thorough exam to figure out "okay, why exactly did your back go out now when it hasn't ever done so before?" I thought I'd just lifted something much too heavy, but the chiropractor's initial exam included an x-ray, and that's how he found that "ah, see, you have some scoliosis in your lower back because one of your legs is a tiny bit longer than the other, and so that's kind of been a weak spot that was going to go sooner or later."

In addition to the spinal adjustments, he gave me some recommendations for stretches and exercises, and also talked to me about proper shoes, etc., and they're all things I've kept in mind ever since. I haven't been back to a chiropractor since I had to stop with him (workers' comp covered it), but my back hasn't gone out AS bad since, because I've been trying to keep up with the stretching and such that he first gave me.
posted by EmpressCallipygos at 4:54 AM on April 21, 2011 [1 favorite]

I can honestly say I was really skeptical about going to a chiropractor the first time my back "went out". My back pain was so severe that I had trouble standing, sitting and even laying down. I couldn't do anythng without being in constant severe pain. I was on muscle relaxers, pain killers, was getting muscle relaxer shots. After about a month of this, I started to lose the ability to move my legs. Turns out it was a pinched spinal nerve. By adjusting my back/spine, he freed the nerve from being pinched between my vertebrae and the pain went away in a few days! Every day it was a little bit better. My chiropractor literally saved my life. (If I had to suffer through that pain for any longer than I had to, I was going to do something drastic -- that's how painful it was).

When your back is out, you move and stand in ways that are unnatural to compensate for the injury and this throws everything else out of alignment. The chiropractor will help put everything back where it should be.

To this day I still go to the chiropractor at least once a week to have him put everything into alignment - even if I'm feeling great, I'll still go. I'm an athelete (runner, rowing/crew) and he really helps keep me going.
posted by ATX Peanut at 6:17 AM on April 21, 2011

You might have done something funky to your SI joint, especially if you felt a bit of a pop or something in that region when you sneezed, though even if you didn't you could've strained something in that area.

I've not have much experience with chiropractors, but the one time I bunged mine up a physical therapist took one look at it, did... something incredibly weird (trigger point therapy? Myofascial release?), everything unlocked and I was up and running within a couple of weeks.

For the time being, if you aren't feeling a sharp pain at any particular site, you could try lying on your back, legs bent with a pillow underneath (adjust for comfort) with an electric heating pad underneath your lower back on the side where you're feeling the pain. YMMV - this was helpful for me, but if you're feeling any inflammation/swelling, I'd stick a ice gel pack under there instead. If the pain isn't too bad and you're feeling like you want to try some DIY, I've found tennis ball massage (lying down on top of the ball underneath the affected area and moving around on it) or a foam roller to help with pain - assuming this is something SI-related/muscle-related and not a slipped disc/other scary things. IANYD, etc, etc. Good luck!
posted by zennish at 6:58 AM on April 21, 2011

Put it this way: the chiropractors who fix people's back problems without getting into the theory of chiropractic are actually practicing physical therapy. If it were me, I'd prefer to get mine from someone actually licensed to do physical therapy.

I do suggest you see a doctor - I injured a ligament in my lower back and didn't see a doctor for it because I had no health insurance. After a year of pain when standing up and gaining 50 pounds because I couldn't do much physical exercise I finally got a job with insurance. I went in and was treated for it ... but it took me four more years to heal so that I no longer felt pain when walking or carrying objects. Don't be me!
posted by telophase at 8:48 AM on April 21, 2011

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