August 13, 2012

Back Pain # 2: Attack of the Hip Flexors

 Back Pain? Attack of the Hip Flexors 

By Gary R. Epler M.D. 

I know the pain.

Two weeks ago I slept on a soft mattress and had the morning low back pain that disappeared after an hour, not an unusual occurrence and caused by the prolonged contraction of the lower back hip flexors from a slumped back.

One week later, the same pain occurred after an eight-hour plane ride, but this time it was a vicious harbinger of things to come! 

The muscle spasms did not go away and spread to both sides of my lower back, the right worse than the left, and lasted throughout the day and night without let-up. Sleep was difficult, no position was pain free, but somehow, from pure exhaustion, I managed to get some sleep. The next morning was brutal – every turn to get out of bed was a sharp, level ten pain, only a few seconds but intense. Fortunately, a level ten pain doesn’t last long because our pain system has nerve endings firing the pain response, and within a few seconds, it sends anti-pain response neutralizing the pain. So these level ten pain episodes are tolerable because they only last a few seconds.

I then began 30 minutes of very slow and painful stretching. I started on my back with legs curled toward my stomach and then turned over onto my stomach to do “cobras”, with my arms out and my chin back, pulling up my head. For the morning workout, I was able to do upper body work and ten minutes on the treadmill at a snail’s pace. This was worth it as I was able to get through the day, but only to repeat the same painful experience at night and the next morning.

Day three worsened –  something I didn’t think was possible because of duration and intensity of the back pain. New episodes developed – brief, intense lower back muscle spasms so intense, I couldn’t move. These occurred during the day while walking, sometimes after stepping on a small stone or tiny incline. They lasted 15 seconds, and I moved on. There were about six to eight of these over a 48-hour period. 

That night was just about unbearable, with level ten pain at every turn and in the morning, it took me 15 minutes to get out of bed and stand up straight enough to walk. I did my 30 minutes of stretching. It was during this time that I thought I might have had a compression fracture on the right side, as the pain was so intense and continual. I could not do the treadmill, not even at a walking pace. Now the negative power of my mind began taking over – thoughts of never being able to move fast or run again. I continually dismissed these thoughts and moved on – that decision would become a turning point. I had a five-hour car ride in front of me. It was no problem, and my back spasms improved. The ordeal had ended. The next day wasn’t bad, and by the 17th, seven days later, life had returned to its baseline.

I had followed the five-step directions in the You’re the Boss book. Ten days later, the low back pain was level two to three, so low that it didn’t exist unless I thought about it or if someone asked me about it. I had an occasional spasm to level five pain, but nothing to interfere with an action-packed day. By day 20, the pain and spasm were completely gone.

Editorial note: I learned several lessons. First, I had not realized how long the intensity of the pain persisted when those posterior (low back) hip flexors go into spasm. I had thought it would last a few hours or one day at the most, but it can continue every day and night for one week or more. Second, it’s tempting to give in and let the negative power of the mind take over because of the relentless and prolonged intensity of the pain. I almost did, which would have interfered with my enjoyable time, prolonged the problem, and potentially sent me to a medical facility for complex diagnostic studies and unpredictable treatment. Third, slow, deliberate stretches saved the day, and deep muscle therapy can ease the spasms. Finally, stay with the five-step plan. It works.


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