Low Back Pain First Aid Chest

Back Rx: A Fifteen Minute A Day Yoga And Pilates Based Program to End Low Back Pain Forever
by Vijay Vad, M.D.

(Page 2 of 6)

What to Do if You're in Pain Right Now

After a low back injury, follow these simple steps to ease your pain and begin your healing.

Focus on and regulate your breathing. Proper breathing in a slow, controlled rhythm is the fastest pain reliever you can use. It shifts the mind's attention away from the pain and triggers the body's natural relaxation response. You can do this in any position, but if possible:

• Lie flat on the floor on your back with your knees up and your lower legs resting on a chair, an ottoman, or some pillows, or lie on your side in bed in a fetal position with a pillow between your knees. These positions should take the strain off your lower back, but if another position feels better, that's fine. Every injury is different. Let your body guide you into the least painful position possible.

• Slow your breathing down as much as possible. Exhale fully, then inhale deeply and hold the breath in your lungs for a count of three. Exhale fully, and continue breathing in this way for at least two to three minutes.

• Repeat this process throughout the day to calm yourself and to deliver extra oxygen to overstressed muscles and disks, allowing them to begin to relax, breathe, and take in nourishment.

Use visual imagery to guide your breathing and enhance the relaxation response. For example, try imagining your breath as a wave of golden light flowing through your entire body. Another good technique is to picture yourself in a favorite spot, real or imagined, where you feel safe and at ease.

• The more relaxed your breathing becomes, the less pain you will feel. As you become better able to focus on your breathing for a few minutes at a time, you will also prepare your mind and body to work together in the rest of your healing.

Pain or Gain. Being overly stoic may actually slow your recovery. Take anti-inflammatory and pain-relief medication to speed healing.

• The most readily available over-the-counter pain relief medicines are aspirin, ibuprofen (Advil), and acetaminophen (Tylenol). Ibuprofen is generally the best choice for low back pain, because unlike acetaminophen, it combines pain relief and antiinflammatory benefits.

Liquid gel pills work best, because they are absorbed more readily in the bloodstream. As a general rule, unless a doctor prescribes otherwise, you should take two liquid gel ibuprofen two to three times a day.

Everybody reacts to medicine slightly differently, and you may find that it helps to to combine ibuprofen with acetaminophen, taking the first for pain and inflammation and the second for additional pain relief. In any case, do not take more than eight pills a day, total, unless your doctor prescribes otherwise.

People with diabetes should be especially careful not to take high doses of these medicines for extended periods, because of the potential for kidney damage. Anti-inflammatory medication is also contraindicated for those with a history of gastric ulcers or compromised kidney function.

If severe pain persists after seven to ten days of taking ibuprofen and/or acetaminophen, you should consult a physician.

If over-the-counter medicines don't lessen your pain and inflammation significantly, don't wait a whole week to go to the doctor. More powerful pain relievers, anti-inflammatories, and muscle relaxants are available by prescription, and they are safe if used as directed.

Like over-the-counter remedies, these medicines should only be taken short term. If they have not brought you any significant lasting relief after a few days, you should reconsult your physician.

A number of herbal and other remedies are available for treating low back pain. These include herbal medicines prescribed by practitioners of traditional Chinese medicine and packaged natural and synthetic compounds sold by health food stores. Herbal medicine has great potential health benefits. The problem with herbal remedies, however, is that their benefits and drawbacks, if any, have not yet been tested in controlled studies. Some of them contain substances that could cause serious harm. For example, many Chinese herbs contain atropine, a substance that affects heart function. Equally important, the quality of herbal remedies varies widely. You cannot always be confident that you are getting the advertised ingredients in the right form. It is far safer to stick with well-tested over-the-counter and prescription medicines.

Take modified bed rest for two to three days. This means that you should:

• Spend most of the day resting quietly in the most comfortable position you can find. The two positions that work best for most people are on the side in a slightly fetal position with a pillow between the knees, or flat on the back with the legs raised. The second position really encourages the lower back muscles to relax because it takes all the strain of gravity off them. These are also generally the best positions for sleeping at night.

• During the day, get up every hour or couple of hours to walk around a little and arch your back backward, to prime the body for a gradual return to full activity. You can also try some light stretching, by pulling each knee up to your chest for a moment or two. Go just to the point where you feel the strain about to become intense, stop there, and take two or three slow, controlled breaths. This is also a good idea if you find you can't sleep through the whole night, which is often the case when a low back injury is fresh.

• Avoid chair-sitting.

• Avoid lifting anything heavy.

• Instead of walking and stretching in the initial recovery phase, seniors should substitute riding a stationary bicycle. Seniors may also find chair-sitting comfortable, because their low back pain usually comes from stenosis, or narrowing of the spine, rather than from a strained muscle or herniated disc. See Chapter 2 for more on these age-related differences.

• If you have access to a pool, aquatherapy can speed your recovery. Your buoyancy in the water will take all the pressure off the low back.

In the first twenty-four to forty-eight hours after a low back injury, apply ice to tender areas two to three times a day for ten to fifteen minutes at a time, in order to lessen inflammation. Keeping the ice on for longer won't give you any added benefit; it reaches its maximum efficacy after about ten minutes.

After twenty-four hours apply moist heat in the shower or with a heating pad for up to thirty minutes at a time as desired. Unlike cold, gentle warmth may continue to provide an increased benefit if it is applied for a longer period of time.

After twenty-four to forty-eight hours, use heat and ice in sequence. As a general rule, apply heat in the morning and before physical therapy or other activity; apply ice after activity and in the evening at dinnertime or bedtime. But some people get more relief from heat, whereas others get more from ice, so modify the sequence to fit your own needs.

Apply liniments and rubs like Tiger Balm, Sportscreme, and BENGAY to soothe injured areas. The "active" ingredients in such products are usually some form of rubbing alcohol, and they never penetrate below skin level. But the act of applying the rub, or having a partner or relative do so for you, can itself be calming and beneficial from an emotional and psycho-physiological point of view.

As the pain of your injury decreases, gradually increase your activity following the guidelines in Chapter 6 and begin Back Rx Series A.

Copyright © 2004 Vijay Vad, M.D.

About the Author

Dr. Vijay Vad is a sports medicine physician and researcher specializing in minimally invasive arthritis therapies at the prestigious Hospital for Special Surgery in Manhattan and a professor at Weill Medical College of Cornell University. He is also the physician for the PGA golf tour and the ATP tennis tour.