Back Pain – Part II: What to do?

Ok, hopefully you’ve gained some insight into why your back is spasm-ing, now what should you do about it? Well, it goes without saying, there are lots of “experts” out there with lots of advice. Are they right? At risk of sounding like a broken record – it depends…on what exactly the cause is.  But, again, more and more research points to the soft tissues (i.e. muscles / tendons / ligaments, NOT discs, bones, or spinal nerves) as the usual suspects. So here are my top tips to manage acute back pain:

  1. Don’t freak out! Unless you are having 1 of the “red flags” I mentioned in the previous post, stay calm and know that you WILL recover and the pain will most likely go away fairly soon.
  2. Get comfortable: try to find whatever position makes you have less pain / discomfort, even if just a little bit. This is sometimes tough in the beginning, because your soft tissues are sounding the alarm, and often it’s hard to get them to shut off right away. This is where a short term bout of pain medications and/or muscle relaxers can be beneficial. Position yourself to keep your painful tissues in a shortened position, not lengthened or tensioned. This will help communicate to the brain that all is ok, in hopes of getting the brain to stop guarding & protecting (i.e. spasm-ing) the muscles.
  3. Get moving: in whatever way you are able that does not significantly increase your symptoms. Study after study is showing the longer you remain inactive the longer your pain and disability will ultimately last. So, get moving, even if it’s only walking around the house or apartment initially. If you have access to a warm water pool, walking in warm water is one of the best early exercises to ease acute symptoms.
  4. Exercise & stretching: in the early stages (3-4 days up to 2-3 wks) it is risky to do exercise that loads / challenges or stretches the injured tissue(s). But it’s a trial-and-error thing. If an exercise or stretch makes it feel better, that’s a green light. If it’s worse, red light, stop, try again tomorrow. Generally, gentle non-weight loaded range of motion exercises / stretches (i.e. lying on back doing abdominal “drawing tummy in” isometrics and / or pulling knee(s) to chest stretch) are safe after a short healing period, but it depends. You just have to try  things and see how your body responds. But remember, DON’T PUSH THROUGH THE PAIN.
  5. Massage? Heat or ice? Rubs / creams? If it’s indeed muscular, anything that promotes circulation is good. So heat, muscle rubs / creams, gentle massage, even modalities like Ultrasound or Laser are all good ways to stimulate blood flow. Ice is better if there is a specific nerve that is irritated or inflamed, such as with true sciatica or carpal tunnel syndrome. Because muscles have referring pain patterns that can feel nerve-y, it can be unclear as to which is the source. This is where it’s advisable to get an expert’s opinion…especially if symptoms are not improving after a week or 2.

Physiatrists (non-surgical physical medicine specialists), Physical Therapists, Chiropractors, Acupuncturists, and even some skilled Massage Therapists can help diagnose by doing specific testing or palpating in attempt to reproduce symptoms. Once specific tissues are confirmed to be the primary cause, a plan of care can be initiated. Remember, it’s important not to wait too long to seek help. The longer symptoms remain, the longer it can take to get rid of them.

Lastly, are back belts / braces helpful? If they’re soft or flexible ones like you find at the drug store-yes. There are a lot of misconceptions out there about back braces weakening your back. That is true ONLY for rigid back braces, like the ones you would be given at the hospital for a fractured spine. The flexible, corset-style braces, like you see employees at Lowes and Home Depot wearing, will actually make you safer by helping increase your leg strength because they force more knee bend / squatting motion to pick something up rather than using your back to do it-that’s a good thing! So, spend the $20 and get one, whether you’re in recovery or prevention.

Once symptoms start to ease off and mobility is returning, gradually advancing exercises to get the abdominal and gluteal (buttocks area) muscles working is usually best, as these are supporting muscles to the back. Things like bridges (pictured here), side-lying leg raises, donkey kicks or bird dogs (pictured above) are all safe early exercises. Progressing from there should be the start of pushing, squatting, lunging, and eventually pulling & lifting – all of which should continue to be done regularly to prevent low back pain from coming back. T’ai Chi and Yoga are also excellent practices to bring awareness and knowledge of the body, all the various muscles & connective tissues, and how it’s all connected.

Written by Damon

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