Acute Low Back Pain

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2009-07-31T23:45:00.000-07:00

You wake up with back pain, how to roll over ...?

2009-07-23T22:19:00.000-07:00

Back pain is one the most common afflictions in the industrialized world.

This Friday morning, thousands of people will wake up with pain, and wondering "Just how on earth am I going to be able to move enough to get out of bed, and manage to get to the bathroom"

Here are some tips which may offer some help:

Its probable that at the actual moment, the nano second of waking, you woke up relatively pain free. Chances are that it was as soon as you went to move that the pain kicked in. It could have been that the amount of movement you did seemed insignificant. Perhaps it was just a roll of a leg, a stretch of an arm, a slight shift in bed, and bang the pain is there

The first thing your body tells you, is that muscles tend to be less active when you are relaxed.

As soon as you moved they tensed. So if you feel pain on micro movement, the best action to take it to gently unravel back to where you started, and go through a process of top-to- toe relaxation, and breathe. Its amazing how often we breath hold when we are in pain.

All body movement is caused through electrical impulses travelling to the muscles, causing them to contract, and pull on the bones, flexing the joints, and initiating patterns of movement.

What can seem to be a small movement, is in actuality, a whole systemic pattern of habitual self use, which happens at unconscious level.

What seems like a small innocuous leg roll, or arm stretch, will trigger many muscles all over your body, including some in your back, around your pelvis, front of the hip, and these will cause aggravation to the place you get pain.

So how to roll over ?

The secret here is to aim to roll onto your side, in a very soft manner. Once you are on your side, its relatively easy to drop legs over the side of the bed, and then sit up.

What must be avoided is trying to sit 'straight up', a sort of jack knife.
Worse still if someone pulls you up by the arm, bending you in the middle, this will almost certainly cause pain

The first step in rolling over is to gently bring your legs up into a standing configuration. Feet on the bed, knees bent and pointing to the ceiling.
If you can bring your legs up into standing through rolling and sliding rather than lifting feet off the bed it will cause less muscles contraction around the pelvis.
Take it slowly, in stages, stop now and again to breathe, and relax.

Once legs are bent, make sure you have arms by your sides, palms down on the bed, and push on your legs and arms to lift and turn your self over onto your hip, towards which ever side you want to go to.

This bit is really important, because this will avoid dragging your back.

Once the pelvis is turned a bit, then the next action is to bring the opposite arm to the way you are turning. So if you are rolling right, its the left arm. Bring the opposite arm off the bed, and lift it as if you are reaching out to something to your right. Its as if you want to get something off the bedside table. At the same time as you reach right, push on your left foot, and roll your head to your right.

By combining the reaching of the hand, the rolling of the head, which must stay on the bed, and the pushing on the left foot, you will roll like a log.

If you get episodes of back pain it's a really good idea to practice this way of rolling over. Not only will it get easier with practice, but also the pattern will become unconscious, and remind you that natural organic movement is less stressful.

Try these Feldenkrais podcasts for size they can help a lot

Back Pain just before the " Family Holiday "

2009-07-22T09:45:00.001-07:00

Every year at this time, at least one person will come through my clinic door, with really bad back pain, just days before their annual "Family Holiday". The holiday has probably been booked for weeks. Their kids are climbing off the wall in excitement, and now just days before what should be a great holiday, this pain has happened !

As a parent, I can empathise. and know that getting ready for a holiday can often involve a lot of rushing around trying to fit in 100 extra things like last minute clothes shopping, booking the cat in to the cattery, climbing into the loft to get down the cases, getting the car serviced, sitting down at the computer to clear as much work from the desk. All twisty, lifty, bendy straining disc squashing activities just perfect to tweak a weak back.

The moment they walk into my practice the question I know most people will ask is :
" Will I be well enough to go away ..... ?"

Most times, my advice is that the best thing they can do, is somehow still go away on that two week holiday, and relax. If they stay home alone they will have no one to help, and most likely they will be miserable. Often treatment with mobilisation, electrotherapy, and strapping, even a couple of times before departure can speed up recovery dramatically. Once they are away they can relax on a lounger, or lie on the ground just as easily on the beach or pool side soaking up some safe rays, as they can at home. Plus food is usually prepared in the hotel. In warm weather a light diet, and barbeques are easy On holiday the children will carry on as usual enjoying everything. It can be easier even for a one parent family, because there are usually other children around, entertainment, children's clubs, all sorts

To make things easy when they are away I advise them

To get some really good strong pain relief and anti inflammatory drugs from the Pharmacist to take with them. Enough to last while they are away.
If they have time I tell them to order a neoprene double pull lumbar support from Physio-Med. If not I tell them to take an extra long sarong to use as a waist wrap
If they are flying then I tell them to take a small fleece blanket which they can roll up into a thin lumbar support for the flight. Plus I ensure they understand why they must be up and walking around in departures not sitting about compressing discs.
NO LIFTING of cases or pushing trolleys
If they are going by car, then I tell them not to be driver, to recline the passenger seat back, use a lumbar support, and stop the car, get out and walk around every 90 minutes max.
To get the children involved in carrying luggage, and pack light
Finally, if they are staying somewhere with a pool, I give them exercises and advice on what to do once the acute stage settles

There are a few exceptions.
Mainly when its obvious that someone has a really severe disc problem or there are other signs which mean an urgent MRI scan or other tests are needed.

As a Physio, I can check using simple orthopaedic examination processes, such as testing reflexes, nerve stretches, changes in skin sensation.
If you have a severe bout of pain and your holiday is a week away go chat to your local physio and get some advice, so far this year I haven't had anyone who has had to cancel their trip

What is Acute Back Pain?

2007-01-15T06:05:00.000-08:00

It may seem obvious, but one place to start when we are talking about pain, is to define it.

Pain is an uncomfortable, often nasty sensation or feeling that tells you something may be wrong in your body. It is a very personal response that is both physical and emotional. Your pain belongs to you, and how you feel it, and how you grade it, comes down to your own experiences. Your pain may occur suddenly or come about slowly. It may range from mild to severe. You are the best judge of your own pain.

When you have what is called 'acute low back pain', it's often the result of some sort of trauma, or other pathology. A twist, lift, accident, or overuse problem. Some people can even cause an acute strain to their back just from the way they have slept, or sat.
Relief from acute pain is very important, and a big part of pain relief, is understanding what is causing your pain. You may know that you have twisted, slept differently, or even that the pain came on with really no reason, but when you understand the likely cause, and what is happening inside your body, you can do something about it.

It goes without saying, that most people who have severe back pain are worried about what is wrong with them. This causes stress, because we are all scared of the unknown. Stress causes us to tense up, and if you have acute back pain, you probably already have muscles in your back going in to spasm. So any stress and worry on top, will make you feel worse.
So, it will help your recovery to understand why you are getting pain. This is probably the main reason that early appointments with a qualified primary care practitioner are so important. Getting a diagnosis, knowing the likelihood of the cause, and what you can do about it, will almost certainly decrease your pain.
There are many routes to getting an opinion. Depending on which country you live in there are various first contact practitioners you can see. If you read some booklets, and listen to some opinions you will hear advice that you should go to a medical doctor first. However, what you choose to do is down to you. One choice is a UK Physiotherapist, who is trained within the orthodox medical paradigm.
In the UK, a professional Physiotherapist has a primary care role. This is quite different from the role of a Physiotherapist in many European Countries, where you can only see or be treated by a Physiotherapist after a medical referral.
In the UK a Physiotherapist has a degree level training, and since the 1970's has been an autonomous profession. So Physiotherapists are primary care practitioners. They are a first contact profession, who can sign you off work, refer you for Xray, ultrasound scan and more.
A UK health professions council registered Physiotherapist has more training in musculoskeletal medicine than the average GP.
Nowadays it is even getting more common for people to be able to get NHS paid direct access to a Physiotherapist. There are many pilot NHS projects to help people to get NHS paid professional Physiotherapist advice, without the gatekeeper role of the medical practitioner.

However, in most areas the NHS doesn't pay for this excellent service, so you will have to pay.
The good news is, that if you book with a UK Physiotherapist you will almost certainly receive a full Orthopaedic examination in the just the same manner that you would from an Orthopaedic Surgeon.
Expect to be with your Physiotherapist for an hour at the first appointment. If you want to know more visit my other blog What Do Physiotherapists Do