Elizabeth Street Presents a Series of Blogs Concentrating on Practical Tips and Advice for Common Injuries and How to in This First Series Initially Address Them.
NO.1 IMMEDIATE ACUTE LOW BACK PAIN CARE
Acute low back pain can strike at any time. Bending to unload the dishwasher, reaching behind to get something from the back seat of the car, getting up from a chair after sitting for too long or over-stretching at cricket, golf, footy or other sports.
Typically acute pain can be sudden and debilitating. The pain can be pin point or general and could radiate into buttocks and down the legs. There could be pins and needles, muscle spasm even to the point of causing your body to lock into a particular position such as listing to one side.
Many structures can be involved with the majority of injuries being either muscle or disc injuries. Rarely there can be other reasons such as infection, cancer, spinal fracture or abdominal aneurysm.
With this blog we will concentrate specifically on those acute injuries that occur as a result of a known event.
Immediate first aid for acute low back injuries includes:
1. STOP THE ACTIVITY – Sounds obvious but some of us want to complete the task. Listen to your body. When pain occurs and stays, there has been tissue damage, inflammation has occurred, and nerve tissue has been stimulated or irritated.
2. FIND A POSITION INITALLY THAT DECREASES THE PAIN – This could be standing and holding onto a wall or lying down with a pillow under your knees or lying on your side with a pillow between your knees. It could be sitting but I would suggest sitting with a support behind your back. This support could be a rolled up towel, pillow, cushion or rolled up jumper. Avoid slouching in sitting. If the injury is disc related then sitting in a slouched position will increase your pain and should be minimised or avoided.
On our website follow the link to Physio Tips and go to Lumbar Support for further assistance in find the best lumbar support for your back.
3. PAINKILLERS, ANTI-INFLAMMATORIES, MUSCLE RELAXANTS – Medication in the early stages of injury management can be extremely beneficial. Whilst many do not like taking pills there is a time and place for everything and this may be one of those times. Especially if the pain is severe and unrelenting, is waking you at night, preventing you from continuing your normal day to day activities and is creating other symptoms such as pain / pins and needles down the legs.
Whilst some of these medications are over the counter, it is a good idea to check with your Health Provider if you are able to take a specific medication. Read the information regarding the medication and seek advice if you are concerned. My advice is always take the medication as per directions on the pack.
4. ICE – In the first 24 hours. Ice applied for 15-20 minutes with a cover to avoid ice burns can be useful in dulling the pain and reducing inflammation. In the first 24 hours the ice can be applied every 2-3 hours on the injured area. If the pain is going down the legs or if there is pins and needles apply to the lower back initially to see if this settles some of the pain or pins and needles. You could also try ice on thebuttock if there is pain there. If there is no change with using the ice seek advice.
5. HEAT – After 24 hours, applying heat from a hot pack, wheat pack, hot water bottle for 10 minutes can assist in relieving low back pain. Standing in the shower with hot water running on your back for a few extra minutes, is an excellent way to loosen the back muscles allowing increased blood flow to heal injured tissue. Heating the lower back after the first 24 hours also allows exercise to occur more effectively and more pain free. If applying heat increases your pain, return to icing for a further 24 hours.
6. EXERCISE – What we mean is rehabilitative exercise not returning to a run or playing a jarring sport until otherwise directed by your Health Practitioner. Exercise in the first few days should be gentle and done to pain only. Pain should not continue for 30 minutes after you have finished. If it does, you have gone too hard and you will need to ice for 15-20 minutes every few hours for the rest of that day, returning to heat and exercise but more gentle and controlled the following day.
The initial exercises are stretches which include:
(a) Lying on back and roll knees from side to side
(b) Lying on back and stretch knee to opposite shoulder holding 5 seconds
(c ) Standing with hands in lower back and stretch side to side, circle hips and bend backwards. Each exercise should be done 10 times.
7. SUPPORTED MOVEMENT – Moving from one position to another especially after being inactive can be extremely painful. Keeping your back straight like a board when moving is initially the best answer. When moving from sitting to standing – slide forwards on the chair, use arm rests if available and come up straight using legs to bear the weight.
When moving from sitting to lying down and vice versa, move sideways keeping back straight and place weight on elbow and forearm to support the weight of your trunk.
Remember to move slowly. Expect that there may be some pain when you move but this should quickly reduce.
8. MODIFIED REST – Keep active is one of the best ways to get on the road to recovery.
Modified Rest – involves a process of changing positions and activities usually done repeatedly over the first 24-48 hours. My recommended process includes:-
(a) Sit for 20 minutes with a lumbar support
(b) Walk for 5-10 minutes
(c ) Ice or heat low back for 15-20 minutes in sitting or lying down position
(d) Exercise for 5 minutes
(e) Lie down with pillow in between legs if lying on side or lying on back –
(f) Walk for 5-10 minutes
(g) Repeat (a) to (f) for next 24 hours – 48 hours as required. for 20-30 minutes.
If in doubt, or if there is increasing pain call on 9670 3996 for assistance and further clarification.