What is the difference between good pain and bad pain in the low back?

November 9, 2009 | by Dr. Jess

This is a question that gets asked frequently by athletes and coaches alike. Both want and need to know when the athlete should take a short break and possibly seek medical care OR if the athlete should continue to push themselves through the practice. The risk in not seeking care is that the injury will worsen and in the worst case scenario, put the athlete out of practice or competition for an extended period of time. It is important for the coach-athlete communication to be good enough to allow for high quality training and keeping all the athletes as healthy as possible. In this case, I will talk about low back pain in particular. If you have strained or overused a muscle, the complaint will generally be that of an ache across the back or on one side of the back. This may happen after a hard workout, weight lifting, or even some technical work focusing on a repetitive motion. This will usually resolve within a few days with some stretching, heat and working it out on a foam roller or even a massage. The athlete should make sure to continue to be warmed up before practice, especially in cold weather and should be stretching his/her back, legs and glutes regularly. For the purpose of this discussion, this could be called ‘good pain’. Some warning signs that athletes and coaches should be aware of include progressively worsening stiffness in the morning upon waking up, difficulty sleeping due to pain/discomfort, sharp pain that limits motion, increased pain with sitting in class or at work, and the bigger warning signs of what we call radiating symptoms. These include numbness or tingling down the leg(s), with some possible complaints of burning, hot/cold sensations, or even just a sharp line of pain radiating from the buttocks down the back, front or side of the leg. Any symptoms like this should be examined by a medical professional and treated by a physical therapist or chiropractor who is proficient and skilled at treating lower back problems. For these kinds of problems, the coach and the athlete should ask questions of their healthcare providers to ensure the practitioner IS knowledgeable with treating lower back injuries. Many activities can cause some back soreness and it is important that the athlete, coach, and therapist knows the difference between soreness and ‘bad pain’ and can help keep the athlete both healthy AND competitive. Deirdre McLoughlin, DPT is a physical therapist at Innersport who likes to get to the bottom of injuries, unveiling the WHY of an injury. Her goal is to figure it out, get the athlete moving, get out of the office and back to walking the dog, playing with the kids or running a marathon. She works with all kinds of athletes from weekend warriors and those who want to be to collegiate, NCAA and Olympic athletes. She rows and coaches rowing in her spare time too so you can find her on the water if not in the office. To contact Dr. McLoughlin, email her at deirdre@innesport.com or all 510-883.1126.
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