CHIROPRACTIC HELP #33: Bed rest for lower back pain
March 21, 2013
Dear
BED REST for Lower Back Pain
Let's start by admitting that research indicates that prolonged, continuous bed rest will only aggravate your back pain.
The problem
Patients with very severe lower lumbar back pain simply are not able to sit or stand. This is not an exaggeration, I've been there myself, and I can confirm that a period of "modified" bed rest is sometimes the only option.
Three groups of patients
The first is the patient with lower back pain, and especially lower back and leg pain ... who despite various forms of treatment knows that they are not getting better. Going to work means sitting, the car, pressure, meetings and the pain is not resolving. Part of the solution may be "modified" bed rest for back pain.
The patient with very severe low back pain simply has no option. Getting into the car and driving off to work is just
out of the question. But staying at home, sitting and watching TV, isn't one of the options either. Sitting is the number one no-no for lower back and leg pain.
The patient in an "antalgic posture." If when you stand in front of the mirror you can see that look more like a question mark than your usual posture, with acute low back pain, then modified bed rest is the only option. Keep going, go about your normal business, and it will go down your leg, and a consult with a neurosurgeon lies in wait. Postero lateral disk herniation ...
So, what then is the solution?
Modified bed rest
The
bed rest shall not be continuous. At least every hour, rise from your
bed of woe and move about for a short period. First roll onto your side
and push yourself up sideways. Do not try and sit up whilst on your
back. Sometimes back pain can be so severe, the only way to get up is to
roll from your side down to a kneeling position on the floor first.
This
is a good opportunity to go to the loo, make a cup of tea or a
sandwich. Get up and do something. For a short period, until your back
demands to return to your bed.
A lumbar corset whilst standing may help you stay up a little longer.
Before
returning to bed, "perching" for a short period may be okay. Organise your computer station so you can
answer a few emails. It's half
way between sitting and standing, but maintains the lordosis and does
not produce the dramatic increase in disc pressure that makes sitting a
no-no.
Strangely, lying down again, getting from standing to your
bed, may be even worse than standing up. I know, I've been there myself.
You have to use your own initiative, and yes it's quite scary. But, with some help from your Chiropractor, these things too will pass. But, be determined to get properly better. A chronic lower back isn't fun.
Whilst lying on your back you shall regularly do gentle bed rest exercises. It's best to have professional advice, as the
patient with a slipped disc may be doing different exercises to the
patient with a sacroiliac syndrome. Lower back exercises ...
How regularly? At
least every half an hour, and even more frequently. I don't think you
can do too many. Within reason. Our basic lower back exercise programme
takes only 40 seconds, perhaps a minute when you're in severe pain.
Tip:
You should feel a good exercise but it mustn't cause pain. Go to the pain
threshold and then back off. This is particularly true for the pelvic
tilt, one of the very best exercises for lower back pain but it can be very painful at the extremes and
aggravate the condition if you go too far. Even
a very slight tilt is
okay. Until you feel it. Then stop.
Ice. Whilst lying on the bed at least twice a day use an ice pack on your back. Wrap it in a facecloth and place it for about 20-30 minutes over the painful area. Some doctors like a shorter or longer period, and perhaps followed by a moist hot pack for a shorter period. Cold hot therapy ....
Ice is not only a very effective painkiller, with no dangerous side effects, but also has an anti inflammatory effect. It decreases swelling, always a feature of severe lower back pain.
It's a good idea also to
take some anti inflammatory supplements such a freshly ground ginger or flax seed or fish oil.
Massaging bed rest. Whilst lying on your side some gentle massage can be very relieving. Please note: DO NOT LIE ON THE TUM DURING MASSAGE. Has your spouse got good hands? A sports masseuse?
CHRONIC CONDITIONS
Do everything in your power not to allow your condition to become chronic. If it's already chronic, the die is cast and there's no virtue in castigating yourself or your doctors.
But do try to prevent chronicity. Research shows for example that if you've had neck pain for six months, you'll have it for the rest of your life no matter what treatment you have. You've got six months to get it fixed. It probably applies equally to a painful ankle or lower back.
It's why, after 3-4 weeks, I recommend a good hard look at your progress. Is it time for a change of doctor? From your doctor to
a Chiropractor? From your Chiropractor to a Physiotherapist? Or simply another Chiropractor?
Worse, neglected or mismanaged spinal conditions usually begin with back or neck pain, but very frequently progress to far worse radiating nerve pain.
"I have had pain in my mid back/shoulder blade for months now, it's
manageable enough for me to work but nagging none the less. Now my right
arm (inside forearm mostly) tingles and sometimes it literally feels
like water or sweat is running down my arm... Should I be concerned?"
GET PROPERLY BETTER
There's always the temptation, once you know a condition is resolving, to try and save a few cents and forego your doctor's directions. And, yes, sometimes it's fine to do that. But usually it's not. It may mean that you are not given the proper rehab to
prevent the condition returning next month. And whilst maintenance chiropractic care remains controversial it is vital for some folk with chronic conditions. Medicine too rightly uses regular maintenance care for serious chronic conditions.
In the weeks after the pain has nearly gone many conditions remain in a vulnerable state for a period. Ongoing management, even if it involves no treatment, is often prudent. S/he simply wants to see you get properly better, not deprive you of your hard-earned cents. Don't assume it will be fine.
"I injured my ankle falling down some steps in December. I didn't go
to my follow up appointment and took off my own cast as I assumed it
would be fine.
Since then the pain seems to be getting more and more so
and I sat down the other day and made to move my ankle when it made a
loud crunch and it was very painful. And has become
worse since,
especially when resting. What should I do?"
Dear C,
I think you know what to do, C! Go back to the doctor who treated you.
Getting
properly better after any condition, or injury, is vital, otherwise
you're faced with an injury leaving a permanent mark on you.
What was
the diagnosis? Sprain? Fracture? Many fractures are missed on plain
X-ray. I'd ask for a CT scan. Or MRI if his assessment is a soft tissue
injury. But this sounds like bone.
I hope this contributes.
Dr B
Thank you for getting back to me so quickly. I will book an appointment with my doctor and ask him to arrange the
things
u suggested.
Let me know what the scans show.
Fractures in the ankle are notoriously difficult to see on plain X-ray.
So often there's a fracture lurking. How long did you wear the caste?
Dr B
Wisdom
Know that if you practise being your own doctor, there are dangers. Wisdom demands that you be prudent and if you know that all isn't well, do the right thing. The Dutch have a wonderful saying:
"He who won't hear, must feel."
And so it is. Be wise.
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"Imagine life is a game in which you are juggling five balls.
The balls are called work, family, health, friends, and integrity.
And you're keeping all of them in the air. But one day you
finally come to understand that work is a rubber ball.
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Till next month, then...
remembering that health is one of the glass balls,
Barrie Lewis DC
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