Bad back? Don’t let it get any worse…

The last issue of Bob’s Bones dealt with preventing a bad back! If, though, you need advice because your back already hurts, this sheet may have the answers you need! Before we get into all the nitty-gritty, you should keep in mind that your back is vital and delicate. If you have any serious concerns, don’t delay: seek medical advice. Whether you head off to a hospital, doctor or pop in to see us, you must take proper care of your back.

Remember, too, that Sloane Square Clinic offers a number of treatments and services to help back conditions, but that these info sheets do not replace medical advice. We can’t make a one-size-fits-all diagnosis in an email, nor be held responsible for action or inaction based on this information.

With that said, one of the things we think most helps you work out what risk you’re at with your current back pain is to consider the context of the problem. Perhaps you often suffer from something similar and know it’s painful, but not too worrisome… Likewise, if the pain comes on after you finish a long day bent double in the garden, for example, then it’s probably not a life-threatening condition of which back pain is merely a warning sign. This list of sinister – but comparatively rare – issues includes kidney trouble, spinal infections, aneurysm and some cancers. So keep the context in mind as you wonder what to do for the best!

Is it the top, the middle or the bottom? We tend to think of back pain severity in three levels… Not to take away from your discomfort – because almost all back pain feels awful – but we suggest you ask yourself if your pain is severe, moderate or mild.

If your pain is severe, or comes on without any apparent cause or warning, then take no chances: see a doctor or go to hospital to get a check-up. It doesn’t quite go without saying that if the pain follows an accident or incident, or accompanies other symptoms or pain, it’s also better to book yourself an appointment.

Now, if you consider the pain to be moderate, then a physiotherapist might be your best port of call. Bear in mind that occasionally a clinic – such as ours – offers no-strings-attached, free consultations. Take the opportunity! Most professionals really would rather prevent severe back problems than treat them… Whether you choose to go to a clinic straight away, or see how things go for a few days, keep in mind that painkillers can help in the short term – but they only mask the pain, they don’t treat it. Don’t take ibuprofen, imagine “the pain’s gone”, then do something to further strain yourself!

Finally, if you’d describe the pain you’re experiencing as ‘mild’, then it’s absolutely appropriate to keep an eye on it. Take whatever steps you feel are necessary and always err on the side of caution… But remember that most back pain goes away of its own accord in anything between a few days and a couple of weeks.

Don’t make it worse! Sounds obvious… But a large number of people with backache either try to battle on as normal, or take to their beds and sofas for days! Neither of these approaches is ideal. You need to immediately stop any activity that strains your back, but keep moving in moderation. That’s because the spine is a long ‘string’ of joints… And joints, by design, are supposed to move, and allow movement – it does them no good at all to stay ‘at rest’ for long periods of time!

Now, lying down flat actually applies the least amount of pressure on your spine… This position acts as a natural traction to the spine and is the reason most of us are usually a few millimetres taller in the morning than we are at the end of the day! But by sitting, you increase the pressure in your lumbar spine alone by about 1.7 times your body weight… And that assumes you sit properly – if you slouch that pressure increases further. So it’s better to keep as active as you can during the day, lie flat on your back at night and avoid strain…

What activities cause strain? Given that keeping moderately active is better than keeping very still, there are many activities that should be avoided as they’re likely to cause strain. Here at Sloane Square Clinic, the list of top offenders includes golf, squash, tennis and most other sports; driving, overreaching, and pushing or lifting objects…

In fact, taking a painkiller, jumping into the car and nipping down the shops for supplies before taking to bed for a few days’ telly is pretty much the worst thing you can do! How so? Well, you mask the pain so you can’t tell if you’re making it worse; your twist and sit awkwardly as you drive; you repeatedly lift and lean as you shop and fill the car boot; you carry heavy loads unevenly… And then you slouch for an extended period!

Gently does it: So… Try and get a little light exercise by walking – as little as twenty minutes helps! Don’t carry a bag or umbrella. Don’t take a massive Marmaduke-like dog out walking on a lead! Just keep upright and walk if you can. Take it easy. We keep saying it, but you must be very careful with your back. If the pain seems to be escalating, then an early visit to a clinic, physiotherapist, doctor or Walk-in Centre is better than a later one.

90-90 Rest Position: When your back hurts, it’s a little counterintuitive to start contorting into weird shapes! Nevertheless, many people benefit from lying in the so-called ’90-90′ position. Here’s how to do it…

Get a light chair and put it in the middle of the floor. Orientate the chair so that its back allows you to lie flat on the floor next to it, with your legs over the seat. In other words, lift your legs so that each of your calves rests flat on the seat; the chair back will either be to the left or right of both of your legs. Your thighs should be at a 90 degree angle to your body; your lower legs at a 90 degree angle to your thighs. Let your knees relax and part comfortably…

It looks and feels a little daft but, trust us, it often helps. You shouldn’t be using any muscles to stay in that position. Rather, with the small of your back lying flat on the floor, your thighs directed upwards and your lower legs resting horizontally, your back and hips are able to take a break from their considerable daily strain.

Rest the rest of you, too: In the 90-90 position, ensure your head rests on the floor; your arms too – let them flop down alongside your body. You’ll probably find it beneficial to stay in this position for 20 minutes or so at a time. Relax. Listen to music; a hypnotic or meditative recording; whatever… Absolutely do NOT try turning or lifting your head into a position to watch TV! Repeat the 90-90 exercise two or three more times as the day goes on.

Further Reading: Those of you who like to be prepared might want to take a look at the book ‘Treat Your Own Back’ by Robin McKenzie. It’s an excellent read and is often Anthony’s suggestion for further reading after he treats patients that come to call at the clinic! Now, you might think it’s a bit over the top to have that book before your back hurts, but remember the cub scouts’ motto: Be prepared! And have you ever seen a cub scout with a bad back? No! Us neither. What more persuasion do you need?

Hot and Cold: Can the application of hot pads or cold packs help with back pain? In short, the answer is “Only sometimes!” But we’re going to come onto that in the next issue of Bob’s Bones when we look not only at RICE – Rest, Ice, Compression and Elevation – but also Heat applications, too. See you then – and remember: this information is general advice – we can’t be held responsible for actions or inactions based on the contents… We’d love to see you in person for a proper diagnosis, though – and we sincerely hope that your back feels better fast.