Back injury from belayer collision...need advice

Last weekend I fell on a sport climb just above the first bolt. I swung sideways into my belayer who was slightly lifted off the ground. The side of my lower back impacted my belayer's knee HARD. His knee hit me so hard I went into shock and nearly blacked out. I eventually was able to be carried to the car. I was put into bed and thought I'd sleep it off. It was a LONG night. The next morning I went to the ER. X-rays were fine and it's not a spinal injury..good news. They discharged me with a heavy prescription of painkillers.

It's only been two days, but my movement is still severely limited. I can't bend over or from side to side at all. Any torque movement feels like a knife in the localized area from the impact.

I'm worried. Anybody else deal with something like this?

Back injuries just take a long time to heal.... sucks, but there are no real shortcuts. The tendons, ligaments and muscles you likely tore/pulled/bruised will probably hurt for a few weeks, and you may not feel "normal" for months. The good news is that even disk problems usually resolve themselves on their own without surgical intervention. I fell 30 feet from a roof and broke 2 vertebrae at the end of November and have just gotten back into climbing in the past 2 weeks. There's stuff in my back and pelvis that is still not aligned the way it used to be, and I've been hearing this could take a year or so... as dangerous as my spine injuries were, the most intense pain has been from the tendon and ligament damage around it, and I'm still in pain, though not nearly to the degree I was. I think patience is key- you'll want to get the blood flowing in the area you hurt, but not overdo it for a good long while.

Apply heat to the area that was injured. You want the blood to flow to the injured area. You dont have to get anything special. I`d also recommend taking some Aleve.

RockinOut wrote:Apply heat to the area that was injured. You want the blood to flow to the injured area. You dont have to get anything special. I`d also recommend taking some Aleve.

You may want to double check that advice.

There are benefits to heat but it creates swelling, which limits mobility and delays recovery. You want to keep things cold to keep inflammation down and to retain mobility.

Having said that, hot-cold cycles are the best solution. Apply cold for 20 minutes, followed by hot for 20 minutes, repeat. Finish with cold.

Oh, and, you should sue your belayer. What was he thinking standing below someone who was climbing?!

Crag Dweller wrote: You may want to double check that advice. There are benefits to heat but it creates swelling, which limits mobility and delays recovery. You want to keep things cold to keep inflammation down and to retain mobility. Having said that, hot-cold cycles are the best solution. Apply cold for 20 minutes, followed by hot for 20 minutes, repeat. Finish with cold. Oh, and, you should sue your belayer. What was he thinking standing below someone who was climbing?!

Contrast baths are used for extremities to reduce swelling. For postural muscle groups (neck, back, abdomen) you`ll want to use heat to relax the muscles. Yes swelling can occur due to vasodilation but the benefits of increased mobility. Take an anti inflammatory if you see any swelling and dont leave the heat source on you for more than 30 minutes

How good was the hospital? My husband had a bad snowboarding fall. He eventually stood back up and snowboarded down to the medical services building. They didn't want to call an ambulance as he was standing, but he pressed the issue and they eventually did.

At this point, the shock had worn off and he was in so much pain he was having trouble breathing.

We go to the ER, they do the x-rays and say he is fine, give him strong meds, and tell me to do the hot/cold compress thing.

After a few days with no real improvement, we go back to a good hospital we trust, and new x-rays, the attending said they couldn't even see the ones the other hospital used, showed FIVE FRACTURED VERTEBRAE!

The idiots at hospital one didn't take the time to get a clear x-ray and let him actually walk around with a broken back. He was in a full body brace for months.

If it is not a doctor you trust, and the pain is sticking around, get another opinion would be my suggestion.

RockinOut wrote: Contrast baths are used for extremities to reduce swelling. For postural muscle groups (neck, back, abdomen) you`ll want to use heat to relax the muscles. Yes swelling can occur due to vasodilation but the benefits of increased mobility. Take an anti inflammatory if you see any swelling and dont leave the heat source on you for more than 30 minutes

About 3 weeks ago, I was told by an MD to use ice, not heat on a back injury. I'm going with that advice.

Alicia Sokolowski wrote:If it is not a doctor you trust, and the pain is sticking around, get another opinion...

+1

Did they do a physical exam for a herniated disk? If not, might want to get that check out, as an X-ray will not show it. Until you know it is not a disk injury, do not use heat. Just ice and anti-inflammatories.

It sounds like you may have broken vertebrate. The bad news (as if that isn't bad enough) is that there really isn't any treatment...they're probably not going to do surgery unless there's a risk of spinal cord damage, so you're just going to be left with trying to manage the pain and immobilizing for 3-4 months.

Is there a chance you injured a kidney or something like that?

Yes - there are physical exams for a herniated disc.
A clinically significant herniated disc will cause either radicular pain in an extremity or radiculopathy ( weakness or loss of tendon reflexes or loss of sensation) in the distribution of the nerve root the herniation has affected. An astute orthopedic surgeon or neurologist or physiatrist can usually accurately diagnose the location of the herniated disc based on a physical exam without resorting to an $$$ MRI scan. An MRI scan is needed only in an operation is being considered, which as others have noted, is usually not necessary as most herniated discs resolve given enough time with no specific therapy.
Pain localized only in the back and with no radiation to the leg is almost aslways due to localized trauma to the back muscle, tendon and/or vertebrae.

As others mentioned your pain is probably coming from your back muscles and not a bone. I fractured my lower back a few years ago and stretching really helped. Try stretching out your hamstrings and lying down on the floor as if you were going to do a crunch and lowering your legs side to side. Also make sure that the drugs they gave you are anti-inflammatory. If your pain doesn't go down in the next week or so I would think about getting an mri. Back pains the worst hope everything turns out alright.

Thanks for all the info, I appreciate it. I guess I'll wait a week and get a second opinion if there's no improvement. I just woke up and I still have the same pain. Time for more hydrocodone and anti-inflammatories.

The only thing the doctor did was test my urine for blood, x-ray my back and test all my reflexes. Everything was fine.

To make matters more complex..I'm an American living in Australia, but I'm moving back to the States two weeks from today. I have full health cover here, but I'll be screwed back home. I also had plans to go bouldering in the Virgin Islands on June 2nd then off to Flagstaff in late June. I'll keep my fingers crossed.

I should've chosen a less competent belayer who would've just dropped me. Sore ankles would've been much easier to deal with.

Thanks again.

Have you considered seeing a Chiropractor regarding this injury? Last year I feel on a slab climb, slid over a bulge, and landed on a ledge below. Hitting my lower back directly above my hip to the left of my spine. I couldn't work or do much for a week. I made 3 Chiropractic appointments within 2 weeks, and noticed results immediately. Muscle stimulation, localized massage therapy, and skeletal adjustments made a huge difference in my recovery time.

Greg G wrote:Have you considered seeing a Chiropractor regarding this injury? Last year I feel on a slab climb, slid over a bulge, and landed on a ledge below. Hitting my lower back directly above my hip to the left of my spine. I couldn't work or do much for a week. I made 3 Chiropractic appointments within 2 weeks, and noticed results immediately. Muscle stimulation, localized massage therapy, and skeletal adjustments made a huge difference in my recovery time.

I haven't even thought of that as I come from a long line of chiropractory skeptics, but I'm willing to give anything a try. I've never been injured before and this well...sucks.

Thomas Willis wrote:Yes - there are physical exams for a herniated disc. A clinically significant herniated disc will cause either radicular pain in an extremity or radiculopathy ( weakness or loss of tendon reflexes or loss of sensation) in the distribution of the nerve root the herniation has affected. An astute orthopedic surgeon or neurologist or physiatrist can usually accurately diagnose the location of the herniated disc based on a physical exam without resorting to an $$$ MRI scan. An MRI scan is needed only in an operation is being considered, which as others have noted, is usually not necessary as most herniated discs resolve given enough time with no specific therapy. Pain localized only in the back and with no radiation to the leg is almost aslways due to localized trauma to the back muscle, tendon and/or vertebrae.

Its true they can do physical exams for herniated disks but its not always apparent without an MRI. I herniated a disk in October and had a MRI done almost immediately. I did not have radiating pain down my legs and most my pain was focused right at my lower back. My hernation was not from trama so your circumstance is a bit different. But if your coverage is good right now and not in a few weeks, I would get it now. An MRI will most likely show exactly whats wrong without question. The MRI I had pre-insurance was 3K. After insurance, I only paid a few hundred bucks.

I have also been to both chiropractors and physical therapists. In my experience, chiropactors are good for adjustments/alignments and relieving stress throughout the back but I do not think that his adjustments did much of anything for my actual disk injury. I think the physical therapy has done more to strengthen my back and get me back to climbing.

Another word of advice...once you do get back to feeling well, do not rush it. Patience is key. I have already learned that the hard way since I tweeked my back again in January and I am finally just now getting back to climbing and light jogs. Good Luck

Since you are currently in Australia, you might consider going to a physiotherapist - they can perform a good physical exam, and should be able to rule out any red flags (such as fracture). The Aussie PTs have a great reputation worldwide for being excellent manual therapists. There are so many factors that need to be considered, and honestly, not every back injury is the same. So, while stretching hamstrings might have worked great for one person, for another that may only seriously aggravate an irritated nerve root. I would be cautious about taking specific advice about what to do from a web forum.

I would guess that it might be unlikely to have access to MRI in Aus as freely as you would in the US (I may be wrong about that - but I know from living in Canada that diagnostic imaging was not nearly as widely used). That can be a good thing as the clinicians might be much more proficient at their physical examination if they do not rely as heavily on imaging.

Good luck!

Greg G wrote:Have you considered seeing a Chiropractor regarding this injury?

I'm going to paste what I wrote in response to another thread on MP regarding a back injury: "from 18 yrs of experience with back problems, having tried everything and being an absolute uber-nerd about learning and researching how the spine works, gets injured, and gets fixed... and researching and experiencing who knows what and who doesn't, my advice is to NOT (read: never) let a chiropractor touch or manipulate your back, or diagnose your injury. Ever. That profession is not qualified to deal with it (no matter what they themselves claim they are qualified at). Read up on the history of the profession, how it came to be, their refusal to answer objections by science-based medicine regarding their practices.... you will be shocked beyond belief that people trust their spines to chiropractors. The spine is serious shit, man."

In regards to your situation, did the doc do range of motion tests?, did they palpate (press on) your spine to feel for tender spots?, did they test the strength of your leg muscles (L vs. R)?, did they check your ability to balance on one foot vs the other? These are all parts of the standard neurological test they do for investigating a possible herniated disc injury. As mentioned above, blunt force can obviously fracture a vertebra (usually the spinous processes on the outside), but the force can also cause a slight temporary shift of the vertebra relative to each other. This shift will cause the brain to put the entire area on lockdown so no more shifts can happen, and this lockdown can hurt like hell... it makes the back stiff as sin and gets every nerve in the area to scream out in pain anytime you rotate/flex/bend/sneeze/cough/etc. The shift usually goes there and back immediately and your brain's lockdown of the back will go away in time (a week or so), but it's important that during that time that you don't aggravate the back by continually "testing" it... because the more you test it, the longer the brain send the lockdown directive.

I've dealt with some of the top spine surgeons and PT's in the country, and for the most part the recommendation is NSAIDS, ice, NSAIDS, ice, rinse and repeat. The tissue in the area is currently swollen from the trauma, and this swelling is a) part of the criteria that tells the brain to keeps things locked up, and b) causing additional trauma on it's own by stretching/moving fibers around to accomodate the extra mass of the swollen tissue. NSAIDS and ice are the standard protocol to help that.

Main thing though, stay away from chiropractors. Every friend I've challenged to do their own research on that profession has been shocked by what they found and immediately stopped going to chiropractors. You'll be out of service here for a couple days, spend it reading up, it's mind blowing.

A study was done several years ago in which people with NO symptoms of back or leg pain had an MRI scan of their lumbar spine. A significant number ( I have forgotten what percentage exactly but seem to remember approximately 30%) of these scans done on people with no back/leg pain showed a herniated disc. ( The study was published in the New England Journal of Medicine sometime in the 90's. ) It is clear that a herniated disc seen on a MRI scan may be asymptomatic. Thus the clinical exam of the patient must correlate with the MRI scan. For example, a
herniated disc on an MRI scan in someone who has no back-leg pain is not significant. A clinically significant herniated disc presses on a nerve root in the foramen which causes pain in the nerve root distribution. Someone with back pain ( from trauma or other reasons) but no radicular pain or evidence of radiculopathy can have an MRI scan done which shows a herniated disc with no compression of the nerve root - this finding of a herniated disc is simply coincidence.
This does not mean that only people with radicular symnptom/signs should have back MRI scans - other causes of back pain such as tumors, infections cand be diagnosed with the scan.

Rafiki wrote:I'm an American living in Australia, but I'm moving back to the States two weeks from today. I have full health cover here, but I'll be screwed back home.

Just about sums it up, mate...

Erik W wrote: I'm going to paste what I wrote in response to another thread on MP regarding a back injury: "from 18 yrs of experience with back problems, having tried everything and being an absolute uber-nerd about learning and researching how the spine works, gets injured, and gets fixed... and researching and experiencing who knows what and who doesn't, my advice is to NOT (read: never) let a chiropractor touch or manipulate your back, or diagnose your injury. Ever. That profession is not qualified to deal with it (no matter what they themselves claim they are qualified at). Read up on the history of the profession, how it came to be, their refusal to answer objections by science-based medicine regarding their practices.... you will be shocked beyond belief that people trust their spines to chiropractors. The spine is serious shit, man." In regards to your situation, did the doc do range of motion tests?, did they palpate (press on) your spine to feel for tender spots?, did they test the strength of your leg muscles (L vs. R)?, did they check your ability to balance on one foot vs the other? These are all parts of the standard neurological test they do for investigating a possible herniated disc injury. As mentioned above, blunt force can obviously fracture a vertebra (usually the spinous processes on the outside), but the force can also cause a slight temporary shift of the vertebra relative to each other. This shift will cause the brain to put the entire area on lockdown so no more shifts can happen, and this lockdown can hurt like hell... it makes the back stiff as sin and gets every nerve in the area to scream out in pain anytime you rotate/flex/bend/sneeze/cough/etc. The shift usually goes there and back immediately and your brain's lockdown of the back will go away in time (a week or so), but it's important that during that time that you don't aggravate the back by continually "testing" it... because the more you test it, the longer the brain send the lockdown directive. I've dealt with some of the top spine surgeons and PT's in the country, and for the most part the recommendation is NSAIDS, ice, NSAIDS, ice, rinse and repeat. The tissue in the area is currently swollen from the trauma, and this swelling is a) part of the criteria that tells the brain to keeps things locked up, and b) causing additional trauma on it's own by stretching/moving fibers around to accomodate the extra mass of the swollen tissue. NSAIDS and ice are the standard protocol to help that. Main thing though, stay away from chiropractors. Every friend I've challenged to do their own research on that profession has been shocked by what they found and immediately stopped going to chiropractors. You'll be out of service here for a couple days, spend it reading up, it's mind blowing.

I was on the bed and the doctor felt my back until he hit the point where I screamed. He got me to move my legs up and down while laying down, which was OK. Then I gave a urine sample and got x-rays..that was it..this was five days ago. I feel a bit better. I can walk around, but basic tasks are very painful like getting dressed. The other day I noticed my posture was tilted, probably to avoid pain. It looks better today. I'll give it until Monday then use my last week here to get an MRI, see a physio etc.

Thanks for the advice guys.