How soon should someone seek help for spinal pain or injury? This is a question we get often in the clinic, and the answer varies by condition. Statistics show that most of us will experience at least one episode of low back or neck pain during our lifetime (studies suggest this happening approximately 75% of time after age of 25). Approximately 52% of the patient visits seen at our facilities are treated for neck and/or low back pain. As always, each patient’s condition is unique but for the purposes of this article, I will discuss some general principles that should help in the decision process.
The first thing to consider is the inflammatory response. Assuming there is a start date of the injury or episode, there is a chemical inflammatory process that occurs; consisting of three days. During the acute first phase, it is advisable to rest, ice and gentle non-aggressive stretching. In our office, we would typically administer modalities such as ultrasound and electrical stimulation to address inflammation, as well as manual therapy to break spasm and decrease pain.
After day 3, there is a middle phase of inflammation that lasts from day 4 to day 20. During this stage, lymphocyte cells travel to the area of injury and begin the healing process by laying down new scar tissue. This is the time where stretching of muscle tissue and joint mobilization techniques are most vital and beneficial to speed up recovery. Typically, some of the pain begins to decrease from the first phase; however, there is range of motion limitations and alignment issues. This is also the time when strategic core, trunk, and lower extremity exercises should be initiated. Even when the pain is decreased, the affected tissues are not ready for normal activities and the exercises should be somewhat conservative in nature.
The final phase of the inflammatory response begins around day 21 and can last until 4-6 weeks from the initial injury. During this phase, the above mentioned scar tissue fibers begin to mature. It is important that normal range of motion has been restored by this time to eliminate the scar maturation leading to loss of mobility. Typically the pain is significantly lessened and intermittent in nature. During this phase, we are guiding patients with progressive strengthening exercises, as well as advancing their home exercise programs towards full restoration of pre-injury levels.
The above mentioned phases are a guideline for healing process, but does not account for any re-injury that occurs or for older chronic injuries. Those situations may still warrant treatment, but often the decision making process is modified by pain level and the extent of loss of joint mobility and muscle flexibility – both of which may require more aggressive measures.
So what now? It is evident that early treatment certainly helps speed up the healing process physiologically; and there is value of knowing which exercises should or should not be done to facilitate recovery, regardless of acute or chronic injury. In addition to self assessment of needs, patients need access to service. One of the toughest challenges in the medical field is to seek help in a timely fashion, as there can be several days to a few weeks to see a specialist. Our office has been very proactive in allowing same day appointments for new injuries to assist in early management and speed up recovery by addressing the inflammatory phases acutely.
Michael Dow MSPT received his degree from Sacred Heart University in Fairfield. He is the founder, CEO/Director of Amity Physical Therapy with locations in Woodbridge, Branford and Hamden. He has been recognized by the US Dept of Health and Human Services for his work with the National Multiple Sclerosis Society and works with patients of all ages, pediatrics to geriatrics, as well as local high school and college athletes. He can be reached at 203-389-4593 or visit www.amitypt.com.