First of all don’t panic!! Whilst extremely painful, the vast majority of acute back or neck episodes are very short lived. Especially if you look after it properly in the initial stages. The first few days are very important to ensure that the problem does not last long or become an on again, off again chronic problem.
Firstly what to do. The best thing to do is to CHANGE YOUR PLANS FOR THE NEXT 2-3 DAYS. Accept the fact that you are just going to have to take it easy and that screamingly important project, meeting, whatever is now not as important as getting back on your feet again. I can’t count the number of times that I have treated someone for what should be a simple and transient condition but because the patient decided to go and landscape or sit at a desk all day at work, their bodies natural healing mechanisms never had a chance to work properly. This often results in months of low grade pain with frequent acute episodes.
Bed rest for the first day definitely and most likely the next day as well. You also want to have regular but BRIEF periods of movement. This means about 5-10 mins each hour. If you can get up and walk around then do so. Often you will loosen up a little as you move around but then go and lie down again anyway. If you overdo it, you will get sharp stabbing pains again.
If you can’t walk around, do some pelvic tilts:
- Contract the abdominal muscles and draw the pubic bone to the front of the ribs (like a mini “crunch” exercise). You will feel the lumbar spine flatten slightly. Do about 10-20 repetitions.
- Then do a sideways tilt, where you squeeze the abdominals at the sides so the side of the pelvis goes to the side of the ribs. Again about 10-20 reps.
- Repeat until you have done a total of about 5 minutes
If the pain is in the rib cage or thoracic region then lightly rock your body to get a rotation through the area then do some extensions (as if you are flattening the spine) again for about 5 minutes.
For a painful neck spasm, rotate the neck in both directions. One side will definitely feel easier than the other side.
Please note that these are just small movements, not large enough to work hard into the spasm. You are trying to create a little movement, NOT exercising and “working through the pain”!!!
In the initial stages, cool/cold packs work better than heat packs. There is often some confusion here. Heat makes the area feel better but also increases the inflammation response whereas cold packs don’t feel as good but the result in faster healing. This is the aim, fast healing.
Use a bag of frozen peas that everyone should have in the freezer for moments like these (and for general sports injuries). Place on the area where you feel the pain is coming from for 20 minutes and then take it off and DON’T use again for 2 hours. Work this cycle as often as possible for the first 2 days. The frozen pack may often be too cold to put on the skin directly (the aim is to cool, not freeze the area) so wrap it in a towel that is thick enough so it is just a little uncomfortable. You can take the cool pack off during the 20 mins if it gets too cold but put it back again as soon as you are able.
Ring and make an appointment but aim to get in at the end of the day AFTER the injury or even the next day. Ideally we want about 1-2 days to have passed before we start moving you around on the table. We have found that this gets by far the best result as you are getting a treatment as the inflammation cycle is starting to slow down. The purpose of osteopathic treatment is to enhance the bodies natural healing response. If you get treated straight away when the injury occurs, the inflammation response is still increasing and this is why you don’t seem to get much initial relief.
Another reason that I often don’t like to treat people immediately following the injury is that patients often use this as an excuse to get straight back to work rather than taking an appropriate rest. This usually ironically results in more treatment being required and whilst it does pay for my training trips to China, it’s also incredibly frustrating for both patients and myself!!
Of course talk to your doctor and/or pharmacist about appropriate pain medication. Note I said appropriate, please don’t get angry with them if they won’t prescribe the equivalent of morphine! After all they also know that, as unpleasant as the pain is, when properly managed it will subside substantially after a few days.
That is about it for management. For those of you who want to know what is actually happening, please read on.....
What you have (in the vast majority of cases) are just simple muscle and joint strains. Your back hasn’t actually “gone out” of joint at all. The small but strong muscles around the joint are in spasm and pulling the joint in one direction more powerfully than in the other directions. This means that the joint is held in a restricted position and can’t move through its normal range of motion. The joint itself still has normal integrity.
What‘s important to know is that the muscles that hold us upright against gravity work a bit differently than say your biceps in your upper arm. The biceps is designed to lift a heavy load and then have a nice long rest before being used again. Because of this function, it uses a large number of it’s “motor units” in a single lift and it’s also why if you go to the gym, it takes no time to get them bulging for the beach. Your postural muscles that hold you upright against gravity are also able to brace your body for these heavy lists. However because they work all the time usually just holding your body upright, the muscles share the load. So at any one time, some parts of the muscle are working and other parts are taking a break.
Patients mostly walk in and say that they “put their back out” just putting on a pair of socks or doing a simple bend to pick up something off the floor! When questioned, I find in every case that someone was doing some heavy work in the week leading up to the acute episode. In our area this is usually cleaning a stable, doing gardening or spending longer than usual in the office chair. This puts some of these postural muscles under a heavier than normal load. So the muscles are already a little tired and the body is busy removing the build up of waste products and drawing in extra nutrients and repairing any small areas of damage.
All this is completely normal and happens every day, in this case the micro damage is a little more than normal. When you bend down to put your socks on, you do a full bend at the waist to get down to your feet (or lift your foot which creates the same bend anyway) and a small section of the postural muscles goes under a heavy load. Usually this is no problem for your body as when you straighten again, another group of motor units just takes on the load. But this time is a little different, all the other motor units are taking a break too so the area of heavy load goes into a spasm to force you to stop loading it.
You have just discovered another difference between these postural muscles and the other muscles such as your biceps. When the biceps gets tired, it just stops working and fails to lift anymore. The postural muscles can’t really do this as lets face it - you won’t stop moving about unless forced to - so that’s just what your body does by creating a muscle spasm. The spasm is designed to protect the other muscles around it.
So why is this 2-3 days of rest so important? This is the normal inflammatory period for your body. If you get an ache or pain from a muscle or joint sprain and it goes away within a few days, then your body is operating exactly as it should. Of course this may indicate a need to strengthen the area so as to prevent a re-occurrence but it does not necessarily mean that there is something very wrong that you should be overly concerned about.
Without trying to be too technical, inflammation occurs with any trauma. It is just the amount of inflammation that varies depending on the severity of the injury. When a tissue is injured it releases substances that open spaces in the blood vessel walls to get extra fluid into the area and also draws in the special cells produced by the immune system that come in and clean up the damage and others that repair the damaged tissues. This is why the area gets hot and swollen. Your body will tend to over react to an injury rather than under react and this is why rest and good management becomes important to get the fastest possible healing time.
When people don’t rest and just try to work through the pain, the body keeps this active inflammation going. It will do it’s best to get you moving as quickly as possible but it just isn’t able to finish the job. This is why if an injury isn’t managed well, it just seems to keep going on and on and on.....
Truthfully, just taking a short rest for a couple of days will make a massive difference in the time to full recovery. The world really will keep on turning without you, try not too worry too much about taking some necessary time out!
Perhaps the most important reason to manage an acute injury properly is not the acute pain - even though it is a horrible experience. The big problem is where acute pain becomes chronic pain. This is where the body doesn’t shut the inflammation process off completely and/or the pain pattern is cemented into the nervous system.
The progress of acute pain to chronic pain is important so we will leave this for another blog posting.
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