Have you ever experienced acute neck or back pain? The way you know is that...well, you sort of can't move without debilitating pain. And, it totally sucks. Unfortunately, this just happened to me so I want to write about it. Self-management during this time in THE MOST IMPORTANT thing you can do. Let me explain.
Here's what happened to me: a few days ago I woke up and my neck was stiff. This is odd for me--though I do have a history of a neck injury back in 2013. I noticed it; and I did very little other than ignore it. That was Sunday. I woke up Monday feeling a little more stiff in my neck - so I did some movement - body weight stuff. Then Tuesday it was maybe even a little more stiff in the morning. I decided to do a bike ride. It initially loosened up, but by the evening I could hardly turn my head at all without pain. Tuesday night was pretty awful--I couldn't move my head/neck at all--even bending over (without even moving my neck!) hurt. When I lay down to sleep I realized I had a familiar related pain: deep aching pain in my R shoulder blade.
WHAT IS HAPPENING???
What is happening is that something is WRONG. Something is injured and your body is trying to talk to you about it. In my case, I had some warning signs -- AM stiffness -- that progressively worsened that I ignored. This morning stiffness is often a sign of inflammation. Any time this is present the ideal situation is that subsequent mornings are the same or LESS stiff. More stiffness means you are still doing something to piss things off. In my case: I was exercising and moving quite a bit thinking I needed the muscles to get warm and release. HOWEVER, the first time I injured my neck, it was REALLY CLEAR IMMEDIATELY that something was wrong--one moment I was fine and the next moment I couldn't move my neck in any direction more than millimeters.
Let's make an analogy here that I use for myself and my clients that helps drive this point home. Let's say you get a nasty paper cut right on your knuckle--maybe your thumb. That initial injury where the skin tears is often pretty obvious (for me this was Tuesday night, but in my initial injury (many years ago) it was right away). Now, in order for a open wound on your thumb knuckle to heal it has to remain closed, which often means you can't bend your thumb. Right? Because in order for the skin to repair itself, it has to have the 2 pieces of separated tissue near enough to one another to create a healing bridge. This is actually the SAME for the spine!
If you have an injured bit (this post is mostly about spinal pain though it can be extrapolated), then stretching or exercise or movement might NOT be the right thing because the injured structures need to heal. The stiffness you feel is your body trying to heal!
WHY DOES IT FEEL LIKE I SHOULD STRETCH???
In the spine when there is a structural injury, the muscles around the area will often go into spasm to try to make things more still--like with the thumb analogy, things need to be moving a little (or a lot) less for your tissue to repair itself to be able to move again. So, the spasms feel awful and painful in and of themselves, but often they are your body's way of protecting itself. However, if we think back to the analogy of the paper cut, perhaps we can appreciate why stretching the injured tissue will only...injure the tissue further or at the very least, prevent the body from doing the healing it knows how to do.
If we revisit my recent experience: I got some warning signs that things were inflammed. I kept pushing it until I really likely re-aggravated my old neck injury. Why do I think this? Well, the pain is basically identical though less intense. I want to note that part of the reason it feels less intense is because I recognized it and so it was less scary. I also knew what I had to do: stop tearing that paper cut back open!
HOW LONG DO I NEED TO LET HEALING HAPPEN?
This answer I base on the science behind tissue injury. Acute (new) injuries often take 7-10 days to heal. They can heal faster, but I advise 7-10 days of allowing stiffness. I call this period the "Protect and Defend Phase." This is the time to NOT push it. Any pain is a signal your body is giving you to NOT do that thing you just did. Usually, if this period is going well, ie. you aren't pissing things off, then the pain will reduce significantly. This is also a good time to use some pain medicine. I often actually recommend NOT using an anti-inflammatory (ibuprofen/advil/aleve) because that inflammation is what is going to heal you! Now, there are extreme cases where you may need something because the pain is too intense or you can't do anything to reduce the pain. These are more special cases.
For me, just spending a day not moving my neck means that my shoulder blade pain is gone. Whew! What a relief! For me, that shoulder blade pain is a referred pain and it is a spreading of pain. ALMOST ALWAYS: MORE PAIN IS MORE PAIN = BAD. This means that the shoulder blade pain is an indicator for me that things are NOT moving in the right direction. It's actually what really got my attention with this particular episode. Any time you have an additional pain add on like this, we call it peripheralization. This means the pain is moving away from the original site of injury. This is, in my words, your body trying to spread the pain to get you to PAY ATTENTION!!! As soon as I started paying attention and heeding my body's call that something was truly wrong in my neck, I stopped trying to use my neck like normal and now my shoulder blade symptom is reducing. In low back issues peripheralization often looks like pain into the leg (hopefully just one, but sometimes both legs). One sign that you are doing it right is that your pain will move back to the back or neck only. We in the biz call this centralization. Centralization of pain is a good sign in this instance. Though something to note is that often when the pain moves back to the place of injury, it can be more intense. This is still a good sign because the pain is at the site of injury and not somewhere else.
WHAT HAPPENS AFTER 7-10 DAYS?!
After that initial 7-10 days, which I call the "Protect and Defend" time. You will likely be able to tolerate a lot more. You might regain significant motion, muscle spasm should reduce, pain should be waning. This is a great time to start moving again but CAREFULLY. Typically, the same main movements that aggravated you will be remain the same, but you may be able to do mini versions of that movement. Generally, this is also a great time to start seeing a provider you trust to nip this in the bud. After an acute period of injury, core muscles become inhibited (they go on vacation) and this is the period to get them back online so this doesn't become a habitual thing. This is the subacute phase and it tends to last until it's been about 3 weeks from your injury. If you make it through this period without any more big painful moments, you are likely good! However, if you have a big painful moment...you could have just reset the clock back to day 1, which is a total bummer. If this happens, this is also a great time to call your trusted provider to get some help getting ahead of the pain!