Low back pain is among the most debilitating injuries in the American workforce today. Firefighters are not immune. But what can we do ourselves?
There is no magic bean for mechanical low back pain. There are a variety of choices for care for your back pain: chiropractic, massage, acupuncture, physical therapy, pain killers and muscle relaxants. Whatever your choice: Your healthcare provider cannot help you nearly as much as you can help yourself. Any treatment they do really needs to be additive to what you do yourself.
Acute Low Back Pain
Pain is often rated on a pain scale of 1-10: 1 is barely noticeable, and 10 is so bad that one is unable to move or function. The initial, extreme pain that gets people to their doctor is called the acute or inflammatory stage. Most people rate that as 7, 8, or 9 out of 10. It can be marked by localized swelling, and heat in the immediate area. Some doctors prescribe anti-inflammatory medication for that. I prefer rest, a few exercises, and ice - in that order.
The chemical bi-products of inflammation actually soften the tissues in the area. This leaves those tissues more vulnerable to tearing and long term injury. Taking soft tissues to end range by bending, lifting, and twisting can be especially damaging. So- don't push things during that time. Rest is important at this time. The objective is to break the inflammatory process, re-create flexibility, and move on to strengthen and improve coordination. This will, if all goes well, lead to less painful episodes less often.
In this article, I will talk about ways you can do the first 2 steps: reduce inflammation and re-create flexibility. Of course, you should check with your doctor to make sure there is nothing that he/she needs to treat you for or with before you undertake self care.
The Rand Study (20-plus years ago) proved that chiropractic adjustments work to reduce acute low back pain. This is certainly true in people who have an inflammation of the facet joints in that area. However, this can be a short lived quick fix. If the muscle spasm is not reduced, the motion restored, and the trunk strengthened around it, the bouts of low back pain will likely return. I am a big believer in deep tissue muscle work, manipulation or adjustment, and therapeutic exercise - all properly applied. They work when used at the right stages in the healing process.
Let's talk about what you can do on your own, though, as an adjunct, or at home to get yourself some relief. The 3 things I would have you do for acute low back pain are as follows:
See your doctor to rule out pathology. Then...
Get comfortable. This can be very difficult at this time. I find that people with low back pain often respond well to the 90-90 position. This is; hips and knees both bent to 90 degrees. Lay on your back near a sofa or ottoman. Your hips bent, and knees bent so your behind is "scooched" up close to the sofa. Your calves will be on the sofa. This will take the lordosis out of the low back and allow the facet joints a break from each other… take some of the pressure off the area. This is a great position as it is easy on your low back and you can slide an ice pack under your low back as well.
Ice is a great tool for reducing and breaking the inflammatory process. It will also slow the pain nerve's transmission signal to the brain by up to 60 meters per second for up to 12 hours. It needs to be used repeatedly, and quite often for a few days when you really hurt. Try to ice every 4 hours for the first 2-3 days of your flare up. (I know- that's a lot to ask, but, it works.)
Remember that the inflammatory process is like a camp fire. You might think it's been put out, but if you don't go back and stomp on it several times, and dump more buckets of water on it, it might just smolder for a few days and come back full bore and put you right back where you started.
The icing is great. Wait a few hours after the ice. Then do a few exercises and ice again. Wait a few hours, do the exercises and ice again, etc.
The exercises I recommend for acute low back pain are:
Pillow Pelvic Tilts: 20 Reps
In the 90-90 position, put a pillow between your knees. Suck in your stomach and hold. Squeeze the pillow and hold. Now do a pelvic tilt and press your low back down onto the floor and hold everything for 5 seconds. Do this 20 times. When you are able to move, go on to the next exercise.
Cat And Dog: 10-20 Reps
Get on your hands and knees, hands and knees shoulder width apart. Suck in your stomach. Do a pelvic tilt. Slowly push your low back up toward the ceiling. Hold for 5 seconds. Relax, let your low back arch as low as is comfortable. Let your shoulder blades sink together, and lift your chin slightly. Hold for 5 seconds. Slowly take it back up. Repeat 10-20 times.
Knees To chest, Roll In Circles: 10-20 Reps Each Way
Lay on your back. Bring your knees into your chest. Now roll the knees in a circle as if you had a pencil between your knees and were drawing a circle on the ceiling. Go 10 each direction. Increase each time until you hit 20 each way.
Drop Knees To Each Side: 1 Minute Each Way
Drop the knees on the floor next to you, knees and hips bent to 90 degrees. The outside of your bottom leg will be in the floor. The other leg will be right on top. Reach the upper body the other way. You should feel a comfortable rotation in the entire lumbar region. Relax 1 minute each way.
You may follow with icing for exactly 20 minutes in the 90-90 position.
Here is how you make the ice bag:
Put about 20 ice cubes in a freezer zip lock bag
Cover the cubes with water
Squeeze out the excess air
Zip it shut
Place directly on your low back.
When your pain has reduced to 2-3/10, you can use Ice and heat together. Use a hot shower, hot bath or hot tub with jets. Let the hot water contact the area for 10 minutes. Then, follow with these exercises:
Do each of the above exercises, plus:
Standing Lateral Flexions:
Stand with your feet twice hip width apart. Slide your left hand down the outside of your left leg to support the weight of your trunk. Take the Right hand and reach up and over your head, and lean left. Slide the left hand down, and feel the stretch in the right side of your low back. Lean slowly over, and hold for 15-30 seconds. Now go the other way.
Follow with 20 minutes of ice - again, at 90-90.
This routine of heat-stretch-ice is great for pumping inflammation out of the area, relaxing spasm, and getting new healing nutrients into the area.
Things NOT to do during this time:
Do not put unanswered heat on the area. The heat brings in excess blood and does not pump it back out again. It might feel good temporarily, but it can worsen an inflammatory process… make it linger. Always follow it with a stretch and ICE. The heat stretch ice thing really does works!
Ice Before Exercise:
Ice has it's uses. But remember that it shortens, tightens and stiffens the tissues in the area. Do not ice before you exercise. Do it afterwards.
Motions that are hard on your inflamed disc/ligaments/joint tissues:
Unsupported forward flexion, Lifting heavy objects, and twisting are all tough on your low back. Don't lift things that are a far reach away from you; keep them close to your body.
I see people in the gym doing these things:
Rotations with weighted Bar on shoulders:
Axial loading of the spine plus rotation is damaging to the disc and joint tissue. Besides, this really doesn't strengthen you at all in any productive way.
This Exercise is even worse:
Axial Load, Plus rotation, plus forward flexion is extremely compromising to your low back.
Stiff Legged Dead lefts done improperly:
Remember to keep your chin up, and your low back completely flat during this exercise. If the low back bends at all, you are already injuring yourself.
Yoga Cobra Stretch:
This is the one where your pelvis and legs are on the floor, and you press your trunk up and (hyper) extend your low back. This jams your facet joints together, and can single handedly cause a facet syndrome, and set of an episode of low back pain. Some people think this is a good stretch… for some it is, but most it's not. There are (somewhat different) extension exercises that work well in a therapeutic setting- like McKenzie exercises. However, they need to be applied by a Physical Therapist (or an exercised inclined Chiropractor) who has been trained in the technique.
Later, when lifting heavy objects:
Bend at the knees and hips
Keep your abs and gluts tight, and back flat!
Keep the heavy object close to your body
If you need to rotate, do so with your feet, entire body, not from the trunk
Be healthy. Be safe, and read next month about Trunk Stabilization.
If you have low back pain, use this month to do the things above. Then by next month you'll be ready for the next step.
If you already feel great, and want to look great, we'll talk about exercises to prevent injury, and give you great abs and obliques!
Dr. Jen Milus, DC