Who wants pancakes? I DO! I DO!

Dustin Penner became my hero the instant he shamelessly admitted to messing up his back while attempting to eat a stack of pancakes. He climbed even higher in my esteem when he then admitted to having his wife help him get dressed afterwards. Clearly Penner has a firm grip on the absurdity of this situation (as well as his pancake-eatin’ fork). Before we all hop on the “It’s his own fault for being so out of shape” bandwagon, let’s stop and consider the following – this injury is a real thing, and not as far-fetched as you might think. Welcome to the wonderful world of back spasms, and the many ridiculous ways in which they can happen.

Back injuries suck, and here’s why:

Your back has a cruddy job. It has a bunch of junk connected to it, it’s constantly fighting gravity, and you treat it like crap. You treat it like even more crap if you’re an NHL player. Consider the mechanics of playing hockey – constant back flexion (bending over) and extension, twisting, and contact (hitting and being hit). Back pain is common enough in normal people (as many as 80-90% of people will experience it at some point in their life), never mind in people who make their living skating around bent over and slamming one another into stationary objects. Back injuries can run the gamut from herniated discs to simple muscle strains, and all of them are fairly terrible. Penner doesn’t have a history of back issues, only missed one game and was skating the next day, so it sounds like he most likely had a paraspinal muscle strain causing spasm. In plain english, he tweaked his back and it locked up.

Your back has a lot of muscles, and all of them are out to get you.

Obviously there are a lot of muscles in the back. There have to be, since it has to be able to move in so many ways, and is made up of so many pieces. The paraspinal muscles (the ones that run the length of the spine) are responsible for movement of the vertebrae and the overall motion of the back. Imagine you’re bending forward to take a bite of a delicious pancake. Those paraspinal muscles are being pulled lengthwise. Now, a strain normally happens when you overstretch a muscle, causing tears in the fibers. Chances are a pancake bend isn’t enough to tear a muscle. But if you’re an NHL player who’s hard on his back (it’s hard not to be), you may have racked up some microinjuries (a bunch of really small strains) that haven’t been bothering you. And maybe that single pancake bend is the straw that broke the camel’s back (have I mentioned how hilarious I am?), finally irritating the muscles in your back to the point that they spasm.

Back spasms: How to hate everything in a hurry.

Muscle spasms are involuntary bolts of pure fire whose job it is to make you hate everything. Basically spasms are sudden muscle contractions, and they hurt. A lot. Spasms are a result of inflammation of the muscles (remember those microinjuries?), and they actually have a job. A hateful, awful job. If your back muscles are in spasm, you’ll be prevented from using them (and possibly hurting them even more). Since the muscles are contracted, chances are you’ll be bent over, unable (unwilling) to straighten up. You may end up needing your wife’s help to get dressed. You may even be kept from finishing your pancake breakfast.

Oh CRAP, so what do you do about it?

The first order of business in an injury like this is to make sure there’s not something terrible going on in the vertebral (spinal) column. A muscle strain can be differentiated from something more ominous (like a herniated disc) by a good history and physical exam. Imaging (x-ray) is actually very low-yield – some fancy studies by fancy people have shown that x-rays really don’t improve outcomes or treatment decisions. MRI is the way to go on back injuries, but that’s way down the road unless there are some very specific concerning symptoms (like saddle anesthesia, a nice way of saying that you can’t feel your junk).

Getting rid of the inflammation is the goal in treating pancake-induced injuries acute back pain. NSAIDs (non-steroidal anti-inflammatories like Advil or Aleve), heat (to relax the spasms), ultrasound (deep heat – same idea), cold (eases the pain), massage (who cares what it does, if someone offers you accept), and possibly muscle relaxing meds. What you don’t want to do is rest. No, seriously. Those fancy people that do research on things like whether x-rays are a good idea for back pain also figured out that if you lie around feeling sorry for yourself you can get deconditioned and actually take longer to heal. The best bet is a few days of activity restriction (don’t pick up heavy things), very light exercise, and hunting down the trainer for more massage and ultrasound.

Things that probably don’t help (per the fancy people):

• Back braces
• TENS (electrical stimulation)
• Acupuncture (sometimes it helps, but it’s unclear on whether it’s due to the placebo effect)
• Traction (hanging upside-down like you’re the wacky sidekick in an 80s sitcom)
• Chiropractic (this is still up for debate – short term it can help, but it’s not been shown to be any more effective than the modalities I listed above)