What is happening in my back?
July 1, 2021 3:02 PM   Subscribe

YANMD, I’m just curious about how likely it is that the current prescription I have is going to fix the underlying cause. I’ve had persistent lower back pain recently that seems to begin in the afternoons/evenings, when I’m tired—I’ve always had something similar but it used to only happen after walking for 8+ hours a day on vacation. Now it’s happening every day. More details inside.

The pain is in my lower back just above my pelvis, does not radiate into my legs, hurts a lot when bending over, but doesn’t hurt if I’m lying down. Sitting/standing straight, it’s noticeable but bearable. But bending to get things out of the dishwasher, for example, is agonizing and I have to crouch using my legs instead of bending at the waist or stopping down.

I’ve been doing rowing, planks, kettlebell exercises to try and strengthen my core. Also some stretching, doing stuff like sun salutations. Lying with my lower back pressed onto the floor and doing leg lifts/slight crunches seems to help temporarily. I got a massage that wasn’t terribly helpful.

What I’ve tried doesn’t seem to be enough, so I talked to a doctor via my company’s telemedicine option, who prescribed prescription-strength naproxen and muscle relaxants (cyclobenzaprine) to take for a week. Lo and behold, the back pain is pretty much gone and I’m feeling much better. But what I don’t understand is whether this is actually fixing anything long-term, or just temporarily fixing the symptoms aka giving pain relief. Can someone explain to me what might be going on in my back and how these medicines are fixing it (or if they aren’t fixing anything long-term?)

You are not my doctor and this is not a diagnosis or anything that will change my treatment plan. I just don’t understand the possibilities of what’s happening physiologically and how likely it is that my problem will return once I’m off the heavy-duty pain meds. Also, other suggestions for relief welcome, I’m planning to see my PCP and/or a PT and/or chiropractor if the issue returns. Thanks!
posted by music for skeletons to Health & Fitness (7 answers total) 2 users marked this as a favorite
Best answer: This sounds similar to my hip issues. Leg lifts really, really help. Try some basic hip stretching and strengthening exercises. I thought it was my back as well but it turns out that hip pain often is perceived as back pain.

Long-term pain often causes you to unconsciously clench or guard the relevant muscles which can lead to further pain so a short-term course of pain relief can really turn certain muscular issues around, so this fix might help quite a lot.
posted by Rock 'em Sock 'em at 3:47 PM on July 1, 2021 [2 favorites]

Best answer: I had pain of a different sort and ended up seeing a physiatrist and a PT after getting imaging done. The PT they prescribed me was a particular modality, which led me to this book: Treat Your Own Back. Turned out that the PT had me do the same exercises as in the book. It's inexpensive and not long to read, so it might be worth a try.
posted by xo at 4:37 PM on July 1, 2021 [1 favorite]

Prescriptions are most likely changing the way your nerve and pain receptors are sending and receiving messages, but aren't actually solving the underlying issues.

In addition to looking into PT, you might want to check out taking some classes in Alexander Technique or Feldenkreis. These techniques will help you learn more about posture, alignment and develop proprioception that will go a long way towards permanently changing your body.
posted by brookeb at 5:36 PM on July 1, 2021 [1 favorite]

I am dealing with something similar, and I wish I had asked for a referral to physical therapy much sooner. The physical therapist gave me a thorough exam and basically said that the small stabilizer muscles along my spine (the multifidus) were frozen or weak (I don't remember which), so the larger muscles in my back were trying to keep my stable -- but they're not great at that, hence the pain. She gave me some stretches/exercises to do, and each week changes them based on how I am doing. I've been going for about a month now, and I'm continuing to go because I still feel some tightness on one side, and I want to fix/heal this, not just tolerate it.

At this point, you probably have all sorts of weird ways of doing things to compensate for this pain, and that could be hurting you more. I'm really concerned that you are still doing things like kettlebell swings when you're dealing with this pain (perhaps because a kettlebell swing was when I hurt myself, oops!).

I don't think the muscle relaxants are going to be enough, and I'd say to go ahead and ask for the PT referral now, via messaging or telehealth or whatever.
posted by bluedaisy at 5:48 PM on July 1, 2021 [2 favorites]

Best answer: Your doctor has prescribed one half of what should probably be a two-pronged approach. The prong he didn't mention is the need to do stretching exercises or whatever it takes to help you keep from developing the lower back issues. What he did, though, is offer you a "reset" in the form of relieving your symptoms, so you can sort of start from scratch with the better habits. IME, it really takes both. You can't really start doing things right until you stop hurting from, and compensating for, doing things wrong.

Oh, and the symptoms you describe seem like just the sort of thing the McKenzie Method was designed to fix. I learned about them here on Ask Metafilter and they were life-changing for me. YMMV, of course.
posted by DrGail at 7:04 PM on July 1, 2021

Stretch your quads. It's counterintuitive to stretch the fronts of your legs when your back is hurting, but one of my colleagues in kinesiology recommended this when my union was out on strike and we were walking picket shifts for two or three hours a day, and it has made a difference for me on a number of occasions.
posted by eviemath at 10:13 PM on July 1, 2021

Best answer: Sometimes backs just get tight and hurt, without a major “injury”. The nsaid and muscle relaxant are helping you relieve the pain while you wait for your back to release. It will release.
posted by toodleydoodley at 5:38 AM on July 2, 2021

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