by Dr. Max Widmer, Chiropractor

Backaches are as old as man...

Backaches are among the most frequent pains which generations of people have been suffering from. Some theorists claim that backaches are a civilization disease, prompted by today’s society and our way of living. Others point to the severe degenerative changes found in the skeletons of Egyptian pharoahs which obviously indicate that even prior to the birth of Christ the Egyptians must have suffered from various back ailments. For anyone currently suffering from acute backache such theories are certainly meaningless. Their only desire is to be free of pain and back on their feet as soon as possible. The following article, with its comments and tips, are dedicated to these people, many of whom happen to be my own patients.

Antalgic posture of the lumbar spinal column to the left. Right-sided disc damage (arrow).

Tips to counter acute back pain ?

An acute lumbago or acute leg nerve pain (sciatica) usually leads to antalgic posture, or more simply, a compensatory lean, i.e. a partial blockage of the lumbar spinal column. This compensatory lean is a reflective reply to an intervertebral disc protrusion or herniation of one or more intervertebral discs. It often reveals itself in a more or less marked lateral curve of the lumbar spinal column, in other words, the body attempts to compensate for spinal damage by tensing local muscles. This compensatory lean also leads to a compensatory gait, both of which are obviously difficult to hide and thus not only directly affect the patient, but indirectly also the patient’s environment (friends, relatives, etc.).

Important: A compensatory lean is not harmful ! On the contrary, it protects the afflicted person from worse side effects !

The lumbar spinal column is not the only part of the human body which can experience a blockage. The same thing can happen to the cervical spinal column (stiff neck/Torticollis), the thoracic spinal column or to any other joint.
Tip: Listen to your body and take it easy !

Tip: Walk with crutches to help relieve strain on discs and joints.

Lying down and walking are good therapies

To alleviate the pain of backaches, lumbago or sciatica it is highly recommendable to continually alternate between lying down and walking. Until recently, patients with acute backaches were told to stay in bed for several days. However, American chiropractors managed to prove that staying in bed too long can lead to restlessness which can become a very painful experience. I advise my patients to lie down for an average of 20 to 30 minutes and then walk around for about 5 minutes. One of my female patients took this advice so literally that she even carried out this procedure during the night! And it worked. After 48 hours her condition improved considerably and as a result she could even resume her activity as a dancer in a folkloristic dance group !

When pain is acute, it is also very advisable to walk with the help of crutches. These can be rented from your chiropractor or in a drug store. And remember, you are doing this for yourself and not for other people. Pay no attention to what others may think or say (sooner or later most people have the "opportunity" of trying out crutches for themselves). Once the acute pain has disappeared you will no longer need them.

Important ! Lie down for 20 to 30 minutes and then walk around for about 5 minutes.

Tip: Prop your legs up against a support in a high bed.

The Bed

Even the best mattresses cannot cure an acute backache. Nevertheless, the following tips will make your stay in bed during the next couple of days a little more comfortable. First, and if possible, lie in a bed which is adjustable in height or which rests on a high bedstead. This makes getting in and out of bed easier, even for healthy people. In the "old days" one could literally climb down from a high bed. Today, the frameworks of beds are designed so low that many people often encounter serious problems in getting out of bed. Second, when suffering from an acute backache, you can either lie in bed sideways; or you can lie on your back, propping your thighs against some kind of support (e.g. a pillow, stool, bench or suitcase), bending your knees 90° and resting your calves and feet on top of the support. You can also use a wedge-shaped cushion. Should this increase rather than reduce the pain, try placing a small rolled up bath towl underneath your lower back. Third, when lying in bed, make sure that you change your position frequently.

Tip:Sit on an object (such as a wedge-shaped cushion with a hole in the middle) placed between the toilet seat and your thighs, while leaning slightly backwards, pressing your abdomen with your hands when stooling.

The Toilet and Bath

Unfortunately, I have never encountered any written information giving people with acute backaches advice on using the toilet and bath. Yet sitting on a toilet can pose a serious problem for such patients.
Why? Because sitting on a toilet seat stresses the vertebral discs, considering that the internal pressure of the disc doubles or triples when the body is in a sitting position compared to a standing position. People with healthy discs do not feel this. However, when the disc is already affected to the point that the cartilage ring protrudes towards the vertebral canal (known as a disc protrusion), or when the outermost fibrous ring tears, resulting in partial leakage of the soft disc core (nucleus pulposus) into the vertebral canal (disc herniation), then the shifted disc material also puts pressure on nerve tissue, i.e. on one or more nerve roots (sciatic nerve / leg nerve). Sitting thus becomes extremely painful for anyone with acute back pain and should be avoided except in "emergencies".

The following procedure is thus recommended when sitting on the toilet: Sit on the front part of the seat and lean the upper part of your body slightly backwards - provided that the compensatory position of the lumbar spinal column allows this. With your hands apply pressure to your abdomen when stooling. Tall people should also sit slightly higher on the toilet seat. For this purpose an object can be placed on the left and right side of the toilet seat, underneath the thighs. This will make it easier to sit down and especially to stand up.

Important: The higher you sit, the easier it is to stand up !

With extremely acute backaches the patient may have to use a bedpan instead of going to the toilet. Should the blockage or respective antalgic posture of the lumbar spinal column be very severe, taking a normal bath will also have to be substituted by a brief hot shower which can considerably relieve tense muscles.

Heat and Cold

A nerve inflammation is characterized by three main signs: redness (rubor), pain (dolor) and heat (calor). An inflamed nerve root does not like deep heat. A cold pack placed on the painful area of the lumbar spinal column every two hours is thus advisable when lying down. Caution: Do not leave cold packs on bare skin for longer than 10 minutes and place a handkerchief or cloth between the skin and the cold pack to protect the skin from any allergic reaction. Furthermore, do not be irritated by any leg pain (known as referred pain) which may arise as a result of sciatic nerve pain. With sciatic pain, the cold pack also belongs on the inflamed area, namely on the lumbar spinal column.

Heat applications (heat packs, hot water bottles, damp cloths and electric blankets) should not be applied before any improvement shows, and then only indirectly and very carefully. As soon as the compensatory posture is reduced and the spinal column becomes somewhat more flexible, a visit to a thermal bath or heated indoor swimming pool can work wonders. Walking in water is one of the most effective and agreeable ways of helping yourself when the backache has subdued. It is worth trying out and has the added advantage that it will help you regain confidence in your body.

Important: When pain is acute, apply cold packs every 2 hours for no longer than 10 minutes at a time. Walking in warm water is one of the best active therapies for patients with lumbago and sciatic pain after the acute pain has disappeared.

Lovemaking

One of man’s most enjoyed activities is obviously not possible with acute back pain. On the other hand, it can also be a most effective therapy as soon as a slight improvement in the back condition is noticed.

Gymnastics and Fitness Training

People who have a lumbago or sciatica attack are usually willing to do almost anything to recover as quickly as possible and to avoid any kind of relapse. For this reason many patients often ask me for advice right at the beginning of their treatment as to which exercises they should do to bring them relief. Basically it is important to recall that the compensatory lean of the lumbar spinal column in the direction of reduced pain usually protects the spinal column from even greater damage. Exercising at this acute stage is thus strictly forbidden. On the other hand, some very slight movements in the area of the lumbar spinal column - performed lying down sideways - can sometimes help. Alternately lying down and walking in the acute stage and after a slight improvement is felt are thus the best type of exercise. Consult your chiropractor for more information on the proper exercises adapted to your individual diagnosis.

Acute disc damage and the patient’s frame of mind

People who break a leg while skiing have their leg put in a cast, walk around on crutches and as a result receive much encouragement from their fellow human beings. Breaking a leg is a situation which almost everyone can understand and accept. On the other hand, people with an impacted leg nerve do not receive a cast, although they can also walk using crutches. In addition to pity they receive a thousand so-called well-meant suggestions from friends and relatives who are thoroughly convinced of having experienced the "same thing". This behavior and the many suggestions - from having an operation to visiting spiritual healers - can lead to a general a feeling of uncertainty in the patient. Since the environment - from the boss to the husband or wife - can see neither pain nor plaster, the patient’s handicap is often misunderstood or even questioned. Many people do not understand why the patient cannot work or has to take things easy.

Important: Disc patients should remain emotionally strong and exercise patience ! Recovery takes time.