What does it mean when a back “goes out”? Does it really go out, and where does it go exactly?! Why does it hurt so much, and what should you do?

There are different explanations for why backs “go out,” which mostly depend on the background of the healthcare practitioner you’re talking to. Chiropractors blame shifting vertebrae and ribs, and medical doctors tend to talk about pinched nerves. As a massage therapist, my main concern is soft tissue (muscle and connective tissue), so that’s the first place my mind goes. When a back gets tweaked, I imagine that one of the many tiny muscles crisscrossing your spine and ribs got tweaked, setting off a cascade of painful events. Sometimes, it can be extremely difficult to diagnose and therefore it’s kind of a mystery as to what exactly happened and why.

Regardless of which explanation is correct, the effect is the same: You experience severe pain and local spasm. You may have noticed that your back seems to lock up when it’s injured. This is called “guarding,” and it’s something that your body does on purpose. All of the muscles in the region contract, forcing you to move stiffly until you finally give in and lay down. Your nervous system has used your muscles to form a cast, which is kind of clever when you think about it.

A tweaked back also tends to be very painful, making it difficult to stand, bend, or even breathe. This is another tool that your body uses to protect the presumed area of injury. By forcing you to spend a day or two on your back, you’re unable to further injure the area. This makes sense, but it’s also really unpleasant. Is there anything that you can do to shorten your recovery time, or prevent that series of events entirely?

To start, if you’ve got a back that goes out frequently, it might be time to change some of your habits. Back pain is correlated with low activity levels, so see if you can find ways to incorporate more movement into your daily routine. This can be as simple as daily walks, or as adventurous as working with a personal trainer to start strength training. Move in lots of interesting ways so that your back doesn’t stay habitually tight!

Next, if your back does go out, skip the part where you try to “stretch it out” or dig your fingers into the painful area. In my experience, that never, ever helps, and it can turn a minor tweak into a few days in bed. If you feel that familiar sharp pain, don’t panic! Just continue sitting for a little while, or try putting your back in a neutral position. Try laying down on the floor, on your back, with your feet on a chair. 

Once you’re laying down, try alternating some heat and ice. Use a heating pad for 20 minutes, swap it out with a covered cold pack under the affected area for ten minutes, and repeat as needed. This can be enough to soothe the local nervous system and break that cycle of spasm and pain, or at least make it more bearable. As your back recovers and moves into the “stiffness” phase of the injury (probably by the next day), you can add in some gentle stretches.

What about massage? If your back goes out, should you come in for a massage ASAP? It depends. If it’s your upper or mid-back, I recommend waiting a day or two. That area is usually too irritable to benefit from immediate contact, and is considered acute pain. Once you’re feeling a bit better, massage can help with the stiffness that comes after. If you’ve tweaked your low back or hips, however, I find that slow, firm massage can reduce the local spasm and get you feeling somewhat better that same day.

Thanks for reading and take care!