Treat Your Own Back Injury
The second most common cause of missed days of work in the United States is back pain (the common cold is the first). Nearly everyone will experience low back pain at some point in their lives. I am often asked by my patients (and friends and family) what I recommend they can do to "treat" their back pain when an injury occurs.
If you hurt your back and have any of the following five symptoms, seek medical attention immediately. If in doubt, always err on the side of caution.
- Pain, tingling, or numbness radiating down one or both legs or arms.
- Loss of bowel or bladder control.
- Numbness in a saddle distribution around your inner thighs and buttocks.
- Weakness in one or both of your legs or arms.
- Severe pain and difficulty with simple activities of daily living.
Strains or sprains of the low back can be treated following the R.I.C.E. principles within the first 48 hours after the injury.
Rest
Rest your back and avoid any activities that aggravate the injured area. That typically means no bending or twisting, and finding a position of comfort. The best positioning is to put the spine in a "neutral" posture, one which normalizes the curves in your spine and provides the least stress to the strained or injured tissue. One of the most common relief postures is to lie on your side, with the injured side (if there is one)up, with a pillow between your legs and your knees slightly bent. This position places very little pressure on the discs in your back and keeps you from placing one leg over the other, which rotates your back and increases stress. This position is especially helpful when you are sleeping. Often, once you are relaxed and sleeping on your side, one leg will slide in front of or behind the other causing the lower back to rotate. You instinctively do this because no one us likes to have their knee joints touching each other. The pillow between the legs keeps this from occurring. This rotation can strain back structures like ligaments that are recovering from a strain and prolong your recovery. Another good rest position is to lie on your back with two pillows under your knees. This position tilts the lower back posteriorly and creates a more neutral spine.
The key is to find which of these positions causes your back to relax the most and take breaks of 15 or 20 minutes during the day in this position to allow for recovery. Sitting is the worst position with a back strain. Avoid a sitting position for the first 48 hours as much as possible and change positions every 30 minutes if you can.
Ice
Ice is the best natural anti-inflammatory and reduces the body's response to injury. In the first 48 hours after straining your back, the injured tissue sends signals to your brain not to move the injured area so it can heal. Your brain tightens up the affected muscles in the form of spasm that hurts and creates more pain. Inflammation develops as your body tries to heal the injured tissue, and more pain leads to more spasm. This cycle continues until you find a way to stop it. Icing for 15 minutes frequently during the day will reduce the inflammatory process and muscle spasm. Always use a thin towel or pillow case between your skin and the ice. Never place the ice directly on your skin to avoid damaging the skin. Frozen peas or frozen corn make great ice packs. Apply the ice while you are in a position of comfort if at all possible. Do not apply ice while you are in a sitting position! Apply ice to the injured area until your skin is pink and then take a break. It is better to apply the ice more often and alternate with breaks to avoid skin irritation. Do not apply the ice continuously. Some people like to use heat on the affected area as it may feel good. You can utilize heat, as long as you realize the results are only superficial and heat does not penetrate like ice does. Make sure, once again, you are in a good position when you use the heat and be cautious with your skin. Allow the skin to "thaw out" after icing before you apply the heat.
Compression
In the lower back, compression in the form of a lumbo-sacral corset can be very helpful in your recovery from a strain. I recommend the Velcro closure models available at most drug stores. It does not need to have metal stays in the back, just thick fabric which digs into you if you try to bend. A double Velcro closure is the best kind which has elastic that you can pull tight. In the first 48 hours after injury, use the corset to keep you from bending or twisting. It is a great reminder not to aggravate your injured back. I recommend you discontinue bracing with a corset after 48 hours. Prolonged use of a corset causes the abdominal muscles to shut down and you can quickly lose your abdominal support system.
Elevation
In cases of severe back pain, elevating the legs from a back lying position with a bolster or footstool is often the only position that provides relief. Physical therapists, refer to this as the "90/90" position, with the hips flexed to 90 degrees and knees bent to 90 degrees, while supported by something. We have good positioning bolsters in the clinic or you can use a footstool and a pillow or lie on the floor and put your legs up on a chair or the couch. The key is to rest your back without pain as this will expedite the healing process.
Practicing these R.I.C.E. principles immediately after a back injury will greatly increase your comfort as you heal and significantly shorter your recovery time.
Jim Flood, MSPT is co-owner of Personally Fit, a fitness/physical therapy center located in Rancho Bernardo. He has been in clinical practice for over 20 years. He can be reached at jflood@ personallyfitonline.com
