LOW BACK INJURIES

How do you injure your back?

The low back can be injured in many ways, but often happens when doing things we don't usually do. If our backs aren't in good shape, our backs can be injured simply by bending over to tie our shoes. Bending over and twisting at the same time is particularly stressful on the back.

Injuries can occur to the muscles, ligaments, joints, and disks. Regardless of the site of initial injury, surrounding muscles often go into spasm to protect the injured area. These muscle spasms cause even more pain.

The vertebral disks are cushions between the vertebrae (back bones). When a disk bulges beyond its usual position, it may press on the nearby nerves resulting in pain along the course of that nerve. When pain runs down the back of the leg, it is called sciatica. There are other causes of sciatica than a ruptured disk. Sometimes it is caused by a muscle spasm.

Most people think the back is supposed to carry the entire weight. However, the spine is supposed to primarily provide stability and controlled motion of the upper body. In a healthy individual much, if not most, of the upper body weight is carried by the abdomen cavity. If the abdominal muscles are firm, the abdominal cavity is like a cylinder, a structure can support a considerable amount of weight. (Think of standing on top of an aluminum can.) When we lift something heavy, we will usually firm up our abdominal muscles, potentially 'grunting.' Weight lifters wear wide belts to help maintain this abdominal 'cylinder,' and you often see people who lift often wearing back braces. These braces are more for the belly than the back, however.

However, if the muscular walls of the abdomen are not firm, then the cylinder effect is lost and the spine will be forced to carry the entire load. Either acutely or over time, the back will finally wear out.

What should I do when I've hurt my low back?

You can use ice for the first 24-48 hours after injury. After 48 hrs you may apply heat four times a day for up to 30 minutes. (Excessive heat can cause muscles to swell and be more stiff and painful, so don't use over 30 minutes at a time.)

The most comfortable position for an injured back may be lying on your back with either a pillow under your knees or your feet up on a chair. This position takes pressure and weight off the back.

You may rest your back for 1- 2 days, but resting longer may result in muscle weakness which will slow your recovery. Walking helps loosen some of the stiffness, and will result in less pain. One should try to walk for a few minutes every hour or two, even if it is painful.

Massages can be helpful and soothing, though the injury is often deeper than one can actually put their hands on.

What medications can I take?

Over-the-counter medicines such as aspirin, ibuprofen (Advil, Nuprin, Motrin, etc), and naproxyn (Aleve) reduce inflammation and pain. (The maximum dose of ibuprofen is 800 mg 4 times a day, and naproxyn is 500 mg twice a day.) Acetaminophen (Tylenol, etc) reduces pain, but does not affect inflammation. One should never take acetaminophen in excess of the recommended dose.

Your doctor may prescribe other medications, such as muscle relaxants, more potent anti-inflammatories, and other pain medication.

What else can I do?

You must address the underlying cause of the problem. Perhaps this means losing weight, improving flexibility, improving posture and lifting 'mechanics,' changing a mattress, or changing a job.

When should I call my doctor?

You should be particularly concerned if: 1) you have pain or numbness consistently radiating below the knee, 2) your leg frequently "gives out," 3) you begin losing control of your bladder or bowels, 4) you are unable to walk, or 5) the pain medications are not helping. You should also be concerned if you have a fever or begin vomiting.

Tips for preventing back strain

What's the best position for sleeping?

The best way to sleep is on your side with your knees bent. You may put a pillow under your head to support your neck. You may also put a pillow between your knees.

If you sleep on your back, put pillows under your knees and a small pillow under your lower back. Don't sleep on your stomach unless you put a pillow under your hips.

Use a firm mattress. If your mattress is too soft, use a board of 1/2-inch plywood under the mattress to add support.

What exercises can I do to strengthen my back?

Gently stretch the back muscles by lying on your back with your knees bent, and slowly raising your left knee to your chest. Press your lower back against the floor. Hold for 5 seconds. Relax and repeat the exercise with your right knee. Do 10 of these exercises for each leg, switching legs.

It is important to improve the tone of the abdominal muscles. You can lie on your back and doing straight leg raises. You don't have to raise your heels very far off the floor, but you may raise them as far as you like. Try keeping your legs elevated for a few seconds, and then lowering them down. Repeat this exercise several times 2 or 3 times a day.

Often doing sit-ups is very stressful on the back. If you wish to do sit-ups, keep the knees bent.

Swimming and walking help the back and abdomen, and also improves one's overall fitness.

Adapted from the American Academy of Physicians