How to Treat Acute Lumbar Back Pain

close up of a herniated disc
close up of a herniated disc
MRI Image of lumbo sacral region (Side view)
MRI Image of lumbo sacral region (Side view)
The position of spine-- it should be straight.
The position of spine-- it should be straight.


Back Pain is the number one reason for "sick leave" in the world. This would give some idea as to how common it is. Some people only get mild pain, while others get severe pain causing bed confinement. The term slip-disc is a bit confusing, it actually means that the disc has cracked or ruptured. The spinal disc serves as a shock absorber in the spine and is made of cartilage material, filled with a jelly like material inside (cervical and lumbar discs), to absorb shocks to the spine. In case of slip-disc, the pain is crippling, leaving a person unable to walk or even sit at times. Whenever there is sharp and shooting pain, it is indicative of some degree of slip-disc.

TREATMENT

The standard treatment recommended by doctors in case of Acute Back Pain is to take strict bed rest for five days, during which you can get up for toilet purpose only. (An explanation is follows later in this article). Especially when there are neuropathies involved like; sensation of some insect crawling over your feet, numbness/hot/cold/burning sensation over feet, Sciatica (pain shooting down hips and thigh), weakness in toes/feet/legs or loss of bladder or bowel control (in extreme cases). In such cases the doctor might suggest an MRI (Magnetic Resonance Imaging) for evaluation for surgery. But unless there are some serious neuropathies involved, one must take three days strict bed rest before even visiting a doctor. Most neuropathies go away after this bed rest.

TYPE OF BED

A hard bed is usually suggested, but a more ideal bed is one that has 2" wide wooden bars, fitted at a distance of 2", with a hardboard sheet (5mm) placed over it. In this case the individual bars bend according to the weight of the body and spread pressure equally onto the spine. Remember that lying on the floor puts tremendous strain every time the person has to get up to go to the toilet. Also, the hard floor tends to develop a 'bed soar' at the tailbone from as soon as 48 hours, whose pain is sometimes mixed with the back pain and the patient is unable to distinguish.

TYPE OF MATTRESS

The mattress should be made of cotton and 3" thick so, that it molds itself according to the curvature of the spine. Again to spread the pressure all over the spine instead of just the tail bone (sacrum) and between shoulder blades (lower cervical spine). Remember that a foam bed; no matter how hard it is should be avoided. While laying over a foam bed the spine moves with every breath you take, which is not good when you need to give some rest to the spine. Besides, it tends to develop a depression, at the hip area. And all that goes for spring mattress as well. Proper precautions would make you recover much earlier.

PAIN KILLERS

Pain killers whether they are Aspirin, NSAIDS (Non Steroidal Anti-inflammatory Drugs) such as Brufen / Vultran or the high strength Steroid Cortisone like Dexamethasone, have limited benefit in slip-discs. Also remember that no physiotherapy is advised during this five day period. Even after that, walking would remain as the most effective and safe exercise. There are exercises to strengthen the back, which may be carried out later on, once the pain subsides completely. The purpose of such exercises is not to reduce pain, but to strengthen the back muscles, so that the chances of any future slip disc can be minimized.

LYING POSITION AND SOME PRECAUTIONS

During day time, lie on your back with a low height pillow with arms close to the body. You can place a thin pillow under the knees. At night when you go to sleep and lie on your side, always remember that another pillow should be used to achieve exact height, in order to keep the skull in exact line with the spine. The television should be placed in line with the body so that you don't need to twist the neck or body to watch it. It should be placed at a height of around six feet above the ground so, that you don't have to bend the neck to watch it. The thumb rule is to keep the chin away from the chest.

Most people think that reading a book or newspaper is a good pass-time during this five daybed rest, but infect it increases the pain as holding something in your hands puts tremendous strain on back muscles. Taking the hand above chin level, which is what we do when we listen to a telephone, is also harmful, as it also causes strain on back muscles. Therefore, it is advised to use a speaker phone and place the cell phone over the chest.

GETTING UP FROM BED

Regarding getting up from the bed; always lie on your side first, then drop your legs from the bed and using the momentum, simultaneously get up using your lower hand to lift your body. This is the safest way to get up from the bed especially, if you happen to have a history of slip discs. The Prophet (PBUH) also advised same, except that Hadith says that lie on your right side before getting up. The reason may be that the right hand side muscles are stronger than the left hand side muscles as Muslims are advised to be right handed.

GO TO OFFICE OR TAKE STRICT BED REST

Having said that; if the pain is not intense, does not increase with walking and there are no neuropathies involved, going to work makes you forget the back pain. Provided you are allowed to sit at your desk and do nothing except talking. As at home, you will keep thinking about the back pain and the more you feel the back pain, the more you will tense the back muscles -- resulting in an increase in pain.

CAUTION

In case when the pain is intense, sciatic pain or involvement of neuropathies, there may be a possibility of disc puncture/rupture in which case sometimes, a tiny amount of disc jelly comes out and forms a lesion on the disc surface. Therefore; taking bed-rest helps that jelly to go back inside when you lie down and release pressure from the disc. Because when you sit, the weight of upper body comes down upon the lumbar discs. (It is like if you press a tooth-paste tube softly, some tooth-paste will come out, but if you release the pressure from the tube, the paste will entirely or partially, go back inside). Remember that this jelly will become hard in a few days, creating a permanent lesion that will cause compression over nearby nerves. That is why immediate bed rest is so important. So, it has to be a careful decision whether to go for strict bed rest or to go to work. If you are not sure; a two/three day strict bed rest is safer, line of action.

TYPE OF CHAIR

A chair with arm rests and orthopedic back support should be used. Take a small walk within the room every half an hour to ensure proper blood flow to the legs. While sitting; the knees should be in line or higher than the pelvic bone such that if a serving tray is placed over the thighs, it is either straight or tilted towards the body. Lowering down the chair is not advisable, but instead something can be placed to raise the feet.

DRIVING

Driving should be avoided until pain subsides. Always adjust the back of the seat at around 80 degrees and the seat should be close to the steering wheel.

POSTURE AND WHAT TO DO BEFORE DOING RISKY JOBS

Maintaining an up-right posture is what you will have to remember all your life. Avoid twisting your body when you talk to someone. Lifting up weights or bending should be avoided. Jobs like moving curtains, ironing clothes, mopping, sweeping, taking out shoes from under the bed are always risky. It is recommended that if you need to do risky jobs, do some stretching exercises before you start, just like a cricket batsman does before starting to bat. If you need to bend down such as to pick up something from the ground, bend your knees and keep the back straight in up-right position.

SOME DRUGS MAY BE THE CAUSE OF SLIP DISCS

Apart from bone diseases like osteo- arthritis, scoliosis, DDD etc, research says that, use of some drugs like; tranquilizers/sedatives, muscle relaxants, and in some cases anti-depressants may be the cause of slip discs. This is because they relax the muscles that surround the spine/spinal discs and thus make the spine vulnerable to slip discs.




Position of cervical neck while lying on side.
Position of cervical neck while lying on side.
Neck support pillow-- useful in back pain.
Neck support pillow-- useful in back pain.
Lying position at night.
Lying position at night.

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Comments 1 comment

Raja Saleem 10 months ago

well informative may Allah bless you

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