Lower Back Strain with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver, many time winners of best physiotherapists in Vancouver as voted by their customers. And we're talking about lower back strain today. How are you doing Wil?  

Wil: I'm doing well. Thanks. 

Mark: This is I'm sure I know in, because our business is to look at this kind of stuff that this is something that's searched for. So it happens to a lot of people, I guess, even everyone has some sort of lower back problem in their life. Is that accurate? 

Wil: You know, majority of people, for sure. I mean, I think, you know, the is a certain degree of it. It could just be like something where you feel a little bit soreness, a little bit of a mild discomfort or something like that, to something that might be a little bit more, but still on the moderate to mild side where it's hampering your function. 

Mark: I'm sure there's many kinds of strains and clauses. Can you outline some of those? 

Wil: Yeah. So one of the biggest things that most people come in and when it's more severe, you know, they think of like, oh, did I herniated a disc? Or did I do something really serious? So that's definitely a possibility when strain your back or when you hurt it. And then a big part of what you want to consider, when you think about what kind of an injury it is, is like, well, what were you doing? Like what happened? And I think a lot of what I've been seeing lately, too, just with the pandemic and lot of people working at home is more less the herniation. And people coming in and then just doing a lot more sitting and it's more postural. And they end up having more on the other end of the spectrum where it's not a disc, I don't want to downplay it, but it's a less severe than a disc. 

Disc injuries that in themselves can also be minor as well. So sometimes you might not even get back pain interestingly enough. And to say that you don't have back pain when you're getting a disc injury, it all depends on the symptoms that you're getting and other things you might have, like a lot of neurological things like gross weakness. And so those things need to be looked at and addressed. 

So with some of the clients that our physio team has been seeing lately, we've had people that have been coming in with more sort of minor back stuff where they can move and function, but it's still affecting their capacity to do things at a hundred percent. So for example, at rock climber who, you know, he had just gotten a new puppy. And basically he's been experiencing some more back pain. It could be disc, it could be maybe like a smaller joint. So the disc is basically the joint in the middle of the back, but then it could be something that's more minor, which is in the smaller joints of the back. And that's usually more common. 

So if you're over straining your back and you're not getting enough sleep, and then a lot of things where you're just utilizing your posture in ways that are basically not optimal in sitting. You know, it could be that. And with this individual, and then with another individual I'm thinking of too, that, you know, he's doing a little more shovelling, you know, it's a little joint in the back. I mean, it could be, like I said again, a disc, but then when we assessed it, it definitely looked like it was a little bit more into the little joints in the back.

So in terms of actually figuring that out, there's certain tests that we do and you touch and feel the area. And there's certain tests that actually indicate whether it's this or that. And then those are really important to also kind of determine if it's this or that, or if it's even something more serious.

So with something that's a little bit more involving the smaller joints in the back, there's certain things that we do more specific around the rehab and treatments. 

Mark: So symptoms can be just pain or weakness. In the back? Or in the legs? Is that kind of fair? 

Wil: Yeah. And even when you strain these little joints in the back called your facets, you can actually even have like a limp. And it can be from like a mild degree of it to like something more severe where you can barely walk. So that's why it gets really confusing. Where you're kind of like, oh geez, did I really hurt my back? Or what's going on? Because when you have swelling in those little joints and it becomes a little more than just a mild irritation, then it can cause compression in the nerves that come out between the vertebrae of the spine.

And so then that can cause a radiating pain or pain to shoot down or other symptoms that may mimic something more like a disc or whatnot. So you have to really get that looked at if it goes on for more than three days. 

Mark: So once you've kind of got a history, here's what the possible cause is, here we've diagnosed what we think the issues are. Then what's a typical course of treatment?

Wil: Yeah. So if it's these little joints called the facets and then the muscles all around, they're being really spasmy. The first thing that you want to do and especially like, you know, you've been suffering for this for a few days now, and it's still quite sore.

Then it's really important to actually work on pain management because you really need to get yourself moving. Because if you don't really address that pain and I'm a component of really doing things more naturally and just making sure that you don't have to take anything for it, to just do things on more of a natural basis for exercise or hands-on treatment kind of thing. But you really gotta address that pain and you definitely don't want to be going on bedrest and trying to stay bedbound definitely not more than like two days, for sure.

You get a lot of deconditioning effects. And a lot of negative things going on when you're not trying to modify your activity. And modifying your posture. And so doing those modifications initially are really helpful and then doing some active mobility things that just to just get things moving initially, is really important. 

So in terms of getting stronger is also important. Like doing a little things in those first 72 hours after the injury, because you don't want it to be totally deconditioned. That's really important. So that's huge because a lot of people think, oh, you know, like I'm just gonna need to stay in bed until this gets better. And that's really not good.

Mark: So you want to stay active, and then you're going to lay out like a course of treatment, basically. What does that look like? I know it depends on what it is, but give us a range. 

Wil: Yeah. So obviously with this type of injury, utilizing like when you come into the clinic, addressing that specific area that's been injured, and manual therapy is really, really good to open things up, get things moving, resetting some of the muscle tone around there. And also helping with the rehab process by facilitating certain muscle movements and joint movements. 

So that's our goal in the clinic is to help facilitate that. And then on a rehab perspective at a time, you know, so the initial period is to just get things moving. And get things activated in modifying the activity levels.

That way you're not totally turned off all the muscles aren't totally shut off and trying to re-engage that core. And so after you've moved beyond that stage, then you're also looking at the pain levels coming down. And things are starting to heal. And this is where you're looking at the first 72 hours, 48 to 72 hours when you have acute phase. You have a lot of that swelling and then anything after sort of that 48 to 72 hours, up to even like five days to like a week is kind of that period where now it's the second phase of the healing of the injury. Where now you want to work on getting even stronger.

And then trying to work towards more of that full range of movement that you had before. And then also one of the things that's really good to implement at this period is a little bit more cardio as well. Cause as you implement one more cardio, the blood flow really helps with the healing. 

And also there's been studies that have been shown that when you actually start to do more cardio, you get a little bit more fluid going in your spinal cord. And that helps with a certain pain modulation, which also helps with the whole rehab process. And then now you move into like, after the first week, and maybe even the like the second week, as long as you're not reaggravating it and things are kind of on this trajectory where you're healing. 

Then you really want to look at what you need to do to strengthen it because the strengthening process, which we call the remodelling phase now, which is like that final phase, can last from this period where it starts at post seven days, post 14 days up to three, four months of just rehabbing the strength and getting your full, not only your full function but preventing this from happening again. 

And then what usually happens, and it's funny because our physio team has seen this is that we've seen repeat clients that come in because things that felt great and then they kind of slacked off and oh, oh, look, it's snowing. And then they're going to shovel all that snow, and it's wet snow. But they slacked off from the rehab and they got a little weaker and then they ended up restraining something. And there's a lot of research to show that when you aren't strong and you had a pre-existing back injury and then go back to do something and then you can really increase your chance of reinjuring that same injury or doing something worse.

Mark: So on a bigger, like 10,000 foot view of prevention for back injury, specifically, what would you recommend as the steps that someone should take? 

Wil: Yeah, that's a big question. 

Mark: Well, give me three, like here's the three big ones that you need to do. 

Wil: Yeah. Well, I honestly, number one, get enough rest, get enough sleep. That's huge because your body needs that regeneration. So let's say you're doing everything else right. But you're not getting enough sleep. That is going to get you. Sleep is so important. 

 Number two is really, I think if you're looking at sleep, eating right. So those two kind of go together, sleep and eat right. And then I guess number two would be really making sure that you keep up with some kind of fitness. If you have days where you go, oh, I've got to shovel the snow and then you're not really in shape, make sure you try and keep some form of exercise, whether it's daily walks or even just some low level of fitness. And that's really, really, really important. 

And I think the third thing is just your posture. When it comes to sitting and work. And it's hard when you're working to really be cognizant of how you're sitting all the time. And to really be aware and setting timers, setting up your workstation. So that way you can change up like from sitting to standing every 45 minutes. And having a little spot where you can stretch out from like maybe five minutes after every hour is really helpful. Even myself and our physio team, we even catch ourselves having bad posture. And I think that that's one of the key things to really prevent, you know, things from going out because it's the long creep effect. 

So if you're sitting there for a long time, you don't realize it, then you know, your back takes the strain. And then you're also checked out of your awareness of how your body's feeling. So those are the big. 

Mark: If you've got some back problems the guys to see are Insync Physio. You can book your appointment at insyncphysio.com. They have two locations. One in Vancouver, you can call them at (604) 566-9716 or in North Burnaby, (604) 298-4878. You got to call and book ahead. They're always busy. But they are experts in this. Like I said, they're multi time winners of best physiotherapists, both in Burnaby and Vancouver as voted by their customers. People love these guys. You need to get in there and see them get feeling better. Insync Physio. Thanks Wil. 

Wil: Thanks Mark.