Hi, I'm Dr. Molly with Your Goals Physical Therapy, have you ever coughed or sneezed and had sudden low back pain? You are not alone. It happens more often than you would think. Of course it’s very disconcerting when this happens. How scary it has to be that you just sneezed and now your low back hurts. And for people the pain is so severe that it's hard to move afterwards. It can be hard to catch your breath. No matter the intensity of the pain, it was just so shocking that a lot of people ended up at the doctor's office. How on earth could coughing or sneezing cause your back to hurt this much?
I want to explain how that happens. I want to explain what is going on in your back that would allow simply coughing to create that much pain.
For an illustration, let's talk about what happened with my daughter the other day.
I was just standing at the kitchen counter, probably cleaning things up or cooking. And my daughter comes running in from behind me. So I had no idea she was coming and she jumped on the back of my leg. Like she's going to be a monkey and wrap her arms around my leg. But when she did that, it was so shocking that my knee buckled and I almost fell backwards. Now I was able to catch myself so I didn't fall on her. But I did have to have a conversation with her that she can't jump on people like that without them being aware. If she had jumped on grandma the same way. Grandma might've fallen over because grandma isn't as stable as mommy.
The fact grandma doesn't have the balance (stability) to counteract the sudden force from the weight of an ambitious two year old is the same mechanism that happens when we sneeze or cough and we end up with a huge muscle spasm.
All the bones in our lower back, we have the five lumbar bones, are supposed to stack on top of each other, creating a small curve. These bones are surrounded by ligaments and muscles. The major stabilizer and movers of your lower back are your stomach muscles. But you do have low back muscles that are supposed to help stabilize each vertebrae in your lower back to keep them in an upright position. So when we cough suddenly or sneeze suddenly, all this extra pressure pushes down on our diaphragm and everything in our abdomen expands all of a sudden into our stomach area.
So everything gets pushed down suddenly, causing everything to expand and contract quickly. That causes all the muscles in our low back to have to react to that increase in pressure to stabilize the spine.
If those muscles are not prepared for it, then when the sudden pressure change happens and one of the bones shifts a little bit. Your spine says it doesn’t want that bone shift causing the muscle to pull hard to keep it from moving farther. Resulting in your muscle to spasm and clamp down. And now you have this sharp, intense pain in your lower, that is very alarming. Because your back is not supposed to hurt that bad after a cough or a sneeze. And in many cases, of course, people go to the doctor to get anti-inflammatories or muscle relaxers to help with the pain.
In addition, you will probably have some form of imaging; which many times tells you that you have a herniated disc.
As a side note: if they found a herniated disc and you didn’t have pain before the cough/ sneeze then
I really think that you've had that herniated disc for a while. The idea that a cough or a sneeze could move a disc enough to change the shape of the disc seems like a reach. There is a lot of research that shows about 90% of the population has some level of herniated disc and they have absolutely no pain.
When these sudden random events occur, people become aware that there's something going on in their spine. If you didn't have pain yesterday, you just coughed or sneezed, and now you have pain.
The likelihood is that all of that pain can be resolved.
I guess that's my major message of hope. If you coughed or sneezed, even if that pain is severe right afterwards, especially if you didn’t have pain before the cough then you can get back to pain free. In fact, there is a really good chance that you can get back to 100%.
It’s just a matter of calming down the tissues in your body that got aggravated from the sudden shift and protecting itself from the instability in your spine. So how do we calm that down and allow those muscles to relax? We have to convince them that they're not in danger and that the spine is stable by strengthening everything around the spine. By strengthening everything around the spine we will prevent this from becoming a chronic problem. This way you won’t have to worry every time you cough or sneeze, that you’ll to keep reinjuring that same area.
The big things that you need to worry about strengthening are your abdominal muscles, your diaphragm, and your pelvic floor. I know even for guys strengthening the pelvic floor is important for back stability and strength. In addition to strength it’s important to make sure that your abdominal muscles, your diaphragm, and your pelvic floor, your back muscle and your hip muscle all work together properly. When one area of your body is dramatically stronger or weaker than the other it throws things out of balance.
For instance if your hip muscles are weak then your lower back muscles have to do more work. But those lower back muscles are only designed to stabilize bones; they are not designed to flex and lift heavy loads over and over again.
By making sure all your muscles are a robust system you’ll not only be getting rid of your pain, which is obviously very important, but you’ll be preventing it from recurring.
I hope people strengthen everything around their spine and help them create good movement patterns. In order to ensure their spine isn't susceptible to those sudden increases in pressure that results in a sudden shifting and acute pain that just grabs them making them think they need to have surgery and that life as they know it is over.
If you have recently or ever in your past have coughed and had this kind of a problem and you’d like this type of service, feel free to contact me. If you're not sure if your back problem is something that I can help you with, we can set up a phone consultation and I would just chat with you to find out if I can help you. If nothing else then I can direct you to the next best thing. So I hope that you're having a wonderful day and I'll talk to you later.
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WE HELP ACTIVE ADULTS OVERCOME THEIR ACHES AND PAINS TO GET THEM BACK TO THEIR FAVORITE ACTIVITIES WITHOUT MEDICATION, INJECTIONS OR SURGERIES.
Dr. Molly McDonald