Every year half the adult population report getting back pain for at least 24 hours. About 80% of adults experience back pain at some point in their life. About 40% will relapse in the year of the initial injury and 5-10% will become chronic. A previous history of back pain doubles the chance of future episodes. Low back pain causes 40% of missed days of work, second only to the common cold. Additionally, it is the single leading cause of disability.
The spine is a complex interconnecting network of bones, facet joints, sacro-iliac joints, discs, ligaments, tendons, fascia, muscles and nerves, all of which are capable of producing pain. Sometimes the cause of pain is in a different part of the body than the symptoms. Nerves from the spinal cord go between the vertebrae and on to the arms and legs. Pressure on these nerves may cause pain, tingling, weakness or numbness in the arms and hands or the legs or feet, the location depending on which nerves the pressure is on. This is called referred pain. Sometimes the body will adapt or compensate for an injury so that the pain disappears, only to return, sometimes years later, when the compensation breaks down. This occurs when cumulative stresses of daily life or a sudden severe stress compromise the bodies adaptation abilities. Sometimes severe or chronic pain can create a tissue memory that persists even when the cause of the pain has gone, but the person continues to experience pain. Philip is an expert at identifying all causes of musculo-skeletal pain including tissue memory, referred pain and adaptation breakdown. He is safe and gentle, and usually gets rapid results.
Tips on Self-Care and Prevention of Back Pain
- Total bed rest should be avoided. Severe pain limits movement, which can slow the healing process and can lead to the development of chronic (persistent) pain. Pain relief may allow more movement, lack of which can delay recovery. Sections below have information on both pharmaceuticals and natural remedies for pain relief. However, care must be taken do to overdo activity, and often certain activities should be avoided. Philip will advise on these.
- A good exercise program can help back pain and help prevent a re-occurrence. Philip may prescribe you specific exercises based on your personal bio-mechanics and injured tissues. An exercise that benefits one person with back pain could harm another person with similar symptoms.
- Posture and gait. With some back injuries you will find that you can't stand or walk straight. This is the bodies intelligence taking the weight off inflamed weight bearing tissues. Go with it and do not try to force yourself to be straight as this can aggravate things. You may find a walking stick helps. You will become straighter as your back heals.
- Sitting can aggravate some types of back pain. If this is the case, keep sitting and driving to the minimum and use a firm chair with lumbar support. When possible rest lying down with your knees bent.
- Ice is not recommended for low back pain. Although ice can help reduce inflammation, it also increases muscle tone, which is not helpful.
- Heat, such as a hot water bottle, heat pad or wheat bag, can be useful to help relieve tight painful muscles, but it should not be too hot, or applied for too long, as heat can increase inflammation, causing an aggravation of the underlying injury. As a guide, the temperature should not be over 60 degrees, and should not be applied for more than 30 minutes, with a 30 minute break between applications. Alternating hot and cold has been proven to be ineffective.
- A warm bath with a handful of Epsom salts is very relaxing and can give relief from back or neck pain. Epsom salts can be purchased from a pharmacy. They are magnesium sulphate. Some of the magnesium is absorbed into your muscles and helps relax them. Dissolve a couple of handfuls of the salts in some hot water in the bottom of the bath and stir until dissolved. Then add both hot and cold water until you have a warm but not too hot bath, and lie back and have a soak for twenty minutes. After your bath drink plenty of fluids.
- If you are overweight, loose weight. Being overweight affects the alignment of your spine and puts extra pressure on your discs. The more overweight people are, the more likely they are to have back pain. At any one time, 2.9% of adults of normal weight will have back pain. This rises to 5.2% in the overweight and 11.6% in the obese.
- Lifting: Don't lift objects that are too heavy for you. If you attempt to lift something, bend your knees and your hips, keeping your back straight, and lift with your knees and your hips with your stomach muscles tight. Keep the object close to you, don't stoop over to lift. Don’t twist while lifting.
- Beds: Individual needs vary. If the mattress is too soft or too hard, many people will experience backache. A mattress needs to allow the more prominent parts of the body to sink in and support the more hollow parts. If the mattress is too hard the person will have to sleep twisted in order to present a flat surface to the mattress. A worn or poor quality mattress will sag. A firm base is preferable. If you have a box spring base, a piece of plywood between the base and mattress will help. A mattress pad will help soften a mattress that is too firm.
- Stretching exercises such as yoga have been shown to decrease the incidence of back pain. A supple spine is less likely to be strained. Stiff joints will degenerate more quickly. Stretchable hamstring muscle give good hip movements, which save the back when bending and lifting.
- Exercising on an unstable surface helps strengthen the stabiliser muscles, which are also the muscles that help prevent injury. Examples are exercise balls, skateboards, surfboards, snowboards and skis. If resistance training in a gym, it is best to sit or lie on an exercise ball rather than be supported by a bench, and to use free weights, or to move weights via a cable, as then the stabiliser muscles will be used. To strengthen large muscles without also strengthening the stabilisers is to invite injury.
Self-management has been proven to be most effective for persistent pain, to find out how, read either of these booklets:
Paracetamol (Panadol, Paracare) can be taken at the same time as an anti-inflammatory such as ibuprofen (Nurofen, I-Profen, Act-3) or diclofenac (Voltaren). You can buy paracetamol combined with ibuprofen (Nuromol, Maxigesic). Codeine can be taken at the same time for a stronger effect. Codeine can be purchased from a pharmacy combined with paracetamol (Panadeine, Panadeine Extra, Panafen Plus, Paracode), and you can take one of the anti-inflammatories above at the same time. Do not exceed the recommended dose and talk to your GP if you are pregnant, taking other medicines, still in pain after one week, or have any side effects.
Magnesium is a natural muscle relaxant. Although Epsom salts are magnesium sulphate, it is not a good idea to take them orally as they are poorly absorbed and often cause diarrhea. Magnesium is best taken in a chelated form for good absorption and bio-availability. Magnesium glycinate and citrate are good forms. You should take about 150 mg of magnesium (elemental weight), twice a day. Long term supplementation of just magnesium can lead to calcium depletion and osteopenia or osteoporosis (different degrees of low bone density). Do not take magnesium for more than one month unless part of a comprehensive nutritional program formulated by an expert such as Philip. Magnesium cream can be applied externally for as long as you like.
Philip can give you advice on these nutritional supplements and can obtain high quality supplements for you (Thorne Research and Metagenics).
Natural Anti Inflammatories
The following herbs, enzymes and oils taken orally may help reduce inflammation:
Curcuma longa (turmeric extract)
Boswellia serrata (frankincense)
Zinzibar officianale (ginger)
Harpagophytum procumbens (devil’s claw)
Protolytic enzymes such as papain and bromelain
Omega 3 fatty acids (fish oil/marine lipids)
Joint Repair Supplements
The following nutritional supplements may help repair damaged joints:
Collagen (type 2)
MSM (methyl sulfonyl methane)
Massaging the painful area with a cream or or oil containing some or all of the following herbs may be helpful:
Ruta graveolens (common rue)
Rhus toxicodendron (poison ivy)
Stellaria media (chickweed)
Arnica montana (leopard's bane)
Symphytum officinale (comfrey)
Lavendula angustafolia (lavender)