Treatment tips
Note: If you’d like to use any of the advice mentioned, please consult me first, as I cannot accept responsibility for any injury caused when my tips are followed incorrectly.
Traumatic back pain, or acute back pain that refers to your leg(s)
It would be unsafe / irresponsible for me to 'blindly' comment on this type of back pain via a website, without seeing you. Consult your GP or A&E or NHS Direct (www.nhsdirect.nhs.uk - 0845 4647). If you're unsure what you should do, please contact me to discuss.
Acute (non-traumatic) back pain that does not radiate to your leg(s)
Keep moving. The worst thing to do now is to go to bed, or rest, and not move. However, as movement can cause more pain, try to 'pace' your activities. For example, if sitting for more than 5 minutes causes more pain, then sit for 4 minutes and then move, but sit again before moving causes increased pain, then sit for 4 minutes and move again, and so on.
Take painkillers. Although many people say they 'don't like taking pills', lack of movement and grossly abnormal movement (due to pain) will slow your healing. Follow the advice of your pharmacist or GP to ensure you are taking the right painkillers at the right dose. If they are not effective, then visit your GP or pharmacist again and let them know.
Good spinal posture when sitting is essential to offload strain on sensitive tissues, but even in perfect posture you must continue to 'pace' your sitting or standing activities (see below).
Good spinal posture (seated and standing)
Low Back: Standing or sitting, tilt your pelvis as far forward as you can, then as far backwards as you can, then rest in the middle of these two positions. If you are seated you will then be sitting directly over your seat bones. Place a rolled up towel between your lower back and the chair cushion to ensure you are able to remain in this position without slumping. Do not cross your legs. If you are standing then make sure you have even weight through both feet.
Shoulders: Make sure your shoulders are relaxed down (avoid shoulders back, chest out posture).
Neck: Gently lengthen your neck towards the ceiling, this may cause a gentle chin tuck or nod.
Summary – sit over your seat bones and place a lumbar support behind you to maintain this position. Keep your shoulders relaxed down and gently lengthen your neck.
N.B.- Good posture means your moving muscles should be relaxed. As you cannot feel your postural muscles working then you should not feel as if you are working at holding an improved posture. Employ red dot frequency and pacing (see below) to ensure success in correcting your posture and/or reducing your back pain.
Pacing
Most activities we do while awake are done either sitting, standing or walking. Consider how long you can do sitting, standing and walking activities on a ‘bad day’ before they cause you to feel (more) pain. Throughout your day change the activity BEFORE your pain starts or gets worse. Employ the same ‘bad day’ time limits whether it is a good or bad day.
For example, if on a bad day you can sit for 20 minutes before your pain gets worse then, whether it is a good or bad day, after 18 minutes change to a standing or walking activity. But only do that activity for as long as you can. Then, BEFORE it increases your pain, change to a different of the three types of activity.
Summary
– Only do activities that cause you to feel (more) pain for as long as you can, then change to another BEFORE they cause your pain to start or increase.
Back strengthening exercise
Pelvic floor exercise: gently tense the muscles that would slow the flow during urinating and simultaneously maintain normal breathing for 10 seconds, every minute of your waking day in all activities (follow the red dot frequency – see below). At the same time gently tense your low tummy muscle (trouser zip muscle) maintaining normal breathing with red dot frequency.
Red dot frequency
Find something that happens constantly throughout your day and use it to remind you to correct your posture (if you are not moving) and do your pelvic floor exercise (see above). For example, every time you see the colour red.
Chronic back pain
(more than 6 months history)
Whether the onset of your symptoms was slow and gradual or sudden, in most instances pain will ease with time. The strategies described above, employed early on, will assist pain resolution in non-traumatic circumstances. With chronic pain these strategies are every bit as important, as pain sensitive spinal structures are often a source of ongoing pain if they are being constantly strained. Constant strain may be the result of abnormal movements adopted as a result of the initial pain. This causes an imbalance in the strength and function relationship between spinal support and spinal motion muscles. Physiotherapy assessment will identify if this situation is present and which specific exercises will help correct the imbalance.
There are some instances where degenerative changes in spinal structures will be the source of chronic pain. Although such changes are irreversible, exercise to surrounding support structures can reduce pain severity and frequency significantly.
Avoid limping if you can
This may be unavoidable in certain circumstances where there are limitations in joint movement or muscle function. Altered movement may delay healing in the damaged tissues, but will cause abnormal strain on damaged tissue and surrounding joints. After trauma, if limping is unavoidable, then a walking aid may be appropriate. If you have been limping then this may become a habit even after the pain has cleared. You will benefit from instruction on the proper use of walking aids and gait symmetry.
Swollen, inflamed joints
Inflammation contains pain provoking chemicals and occurs wherever the body senses a healing response is necessary. For example, after trauma, repetitive strain or with certain central or auto-immune pathologies such as Rheumatoid Arthritis. There are several strategies depending on where swelling is situated: ice, certain medications, compression bandage, support taping, elevation, immersion in water, protection from strain (eg use of walking aids, splints, joint immobilization), rest or relative rest. For details contact me to discuss.
Broken bones pre-cast /plaster of paris (POP) removal
If you have an arm or leg fracture, you may benefit from strengthening or movement exercises for the surrounding muscles or joints. In the arm, fractures to the elbow, wrist or hand may cause unnecessary disuse of the whole arm. This could cause problems in other areas, eg a frozen shoulder. Fractures of the leg may mean you cannot bear weight normally, and leg muscles will weaken quickly as a result. The right exercises can prevent unnecessary problems.
Cast / plaster of paris (POP) removal
If you are just out of a cast following a bone fracture, your orthopaedic doctor should inform you if there are any limitations to normal movement and for how long this should be enforced. This may be because of complications such as non-union or delayed union. He may be happy for you to return to all normal movements immediately, or he may want you to continue with some protection of that area (eg use of crutches and partial weight bearing with a broken ankle, or wrist brace after a broken wrist). Whatever the case, the earlier you are allowed to move the injured area the better. Movement after injury and immobilization will tend to be painful.
Treatment for scars
Early scar management advice should be provided by your surgeon or the hospital team, including arrangements for removal of stitches. Once the wound is dry and the stitches are out then a gentle dry massage around and on the scar will help to avoid adhesions (scar tissue sticking different soft tissues together).
Whiplash
Consult your GP or A&E after a whiplash injury, and follow their advice. If they reassure you that it is not serious then it is essential that you start moving your neck and arms early on. This may be painful but to avoid movement at this stage may cause long term painful muscle spasm and tightness, weakness in support muscles, and pain on movement long after the damaged tissues have healed. Postural correction and movement into discomfort where pain is limiting movement (see ‘explaining pain’ and ‘good pain’) are necessary.
Good Pain (How do you know you are not doing too much?)
I will let you know when it is safe to employ this strategy. However, after injury movement can be painful, eg whiplash. If the injury required immobilization eg a fractured wrist, then as well as the healing pain there may be additional pain from moving tight and stiff joints and muscles. As long as there are no specific limitations to movement that your doctor wants observed, then moving the affected body part in a normal way in the painful / stiff direction is desirable as long as the pain eases within a short time of stopping the movement.
Why is movement so important after injury?
Soft tissue lesions repair with scar tissue, which is not the same as the original damaged tissue. The injured body tissues were a certain length, strength and organised in a particular direction. The new scar tissue being laid down does not know how long, strong and what in direction it needs to be organised. This information is provided by the way we move during the healing phase. The stress and strain of NORMAL movement helps the new scar tissue to have adequate length, strength and form in a similar direction to the original tissue, which gives the optimal healing result. Movement also keeps muscles strong and long and joints supple. The level of stress and strain has to correspond with the stage of healing tissue. Too much stress early on and healing will be undone, too little stress and sub-optimal scar tissue is laid down. This is why exercises need to be initiated at the appropriate level of effort & joint range of motion and progressed appropriately over a period of time.
Fractures of bone heal with new bone, but the above information applies in tandem with the Orthopaedic doctors instructions.
Age related painful joints – Osteoarthritis (OA)
In the same way that we age on the outside (grey hair, wrinkles, etc) we also age on the inside. Wear and tear of the joints is called Osteoarthritis (OA), and can present with painful, hot, swollen (inflamed) joints. Changes may be seen on Xray. Pain from the affected joint will mean we naturally try to avoid movement, but this leads to joint stiffness and muscle weakness, which further strains the joint. The most common joints which may require replacement surgery are the hips and knees. However, OA can affect almost any joint in the body, including the spine. Exercise of the muscles which support the joints involved can reduce or prevent pain. Moving the affected joints regularly as far as comfort allows will help to prevent joint stiffness.
OA hips
Strengthen the muscles which extend your hips (move your thighs backwards, ie Gluteus maximus) and those that abduct your hips (move your hips out sideways, ie Gluteus medius). Both these muscles become weak with hip OA pain, but strengthening can greatly reduce pain. If you are considering hip replacement surgery then strengthening of the muscles before surgery will make post-operative rehabilitation much easier.
OA knees
Strengthening of the Quadriceps muscles (those on the front of the thigh which straighten the knee) and Gluteus maximus & medius will help to support the knee joint and thereby reduce knee strain and pain. The quadriceps may be weak as they straighten the knee (eg climbing stairs) or controlling knee bending (eg descending the stairs) or both. Either weakness will respond to specific strengthening exercises as long as the knees are not too swollen or painful. Weak hip muscles will directly cause increased knee joint strain.