Optimizing Back Pain Recovery: Best Practices

Musculoskeletal Health with Dr D. 

Optimizing Back Pain Recovery : Best Practices

In this article we will look at the best practices for optimizing back pain recovery. Despite the fact that back pain can cause a significant amount of pain and discomfort, it usually recovers spontaneously on its own. The speed of recovery depends on many variables. There is no one single magic remedy to speed up the recovery process.  However there are certain strategies that can be used for optimizing back pain recovery to help you recover faster. Understanding that you may not have control over certain aspects of your recovery process, will also allow you to create more realistic expectations and avoid undue frustrations.

Physical fitness and age

Individuals who are more physically fit and do not have other major medical conditions, generally tend to recover much faster. The body can fully focus on the healing of the injury when there are no other chronic conditions that also require attention, energy, and resources.

 

The smaller the number of raging fires present at the time of injury, the faster and more efficient the recovery process can be. Since most chronic conditions tend to accumulate over the years, age becomes an important player in the recovery process.

 

For the most part, healing is much faster in younger and healthier individuals. That is not to say, however, that growing old is always plagued with long term recovery process. A healthy and active 60-year-old individual with back strain may recover much faster than a 30-year-old sedentary obese office worker.

Prior injuries

History of prior back pain or the presence of other chronic musculoskeletal injuries plays a significant role in the recovery process. Individuals who suffer from chronic pain which is not well controlled, have gone through a process of so-called sensitization.

 

In other words, their nervous system has become more sensitive to any pain stimulus. Any new injury will, therefore, cause a lot more intense pain and take much longer to subside, despite the fact that the area of injury may be already healed.

 

Importance of early mobilization

When significant acute injury develops, bed rest may be necessary. It should be, however, limited to no more than 24 - 48 hours. Numerous studies have demonstrated the detrimental effect of prolonged bed rest on the recovery process.

 

Motion is the lotion and muscles need to move to heal. While you should not push through the pain to further aggravate your condition, gentle exercises focused on a pain-free range of motion and stretching will allow the muscles to become less stiff and maintain their flexibility.

 

Muscles that are not used, start to deteriorate very rapidly. They lose flexibility, mass, strength and become stiff. Intense pain with even small movements may then result from any attempt to use the stiff muscle since it will be pulling on the injured area.

 

Movement also creates important muscle pump which helps to increase local blood circulation. Increased blood circulation helps to flush out the inflammatory chemicals present at the site of the injury. The accumulated inflammatory chemicals irritate the nerve endings at the site of the injured area.

 

These chemicals are the primary reason for sensation of pain. Increased blood circulation also helps to supply the injured area with nutrients, oxygen and white blood cells that help to heal the injured tissue. Getting an early referral to a physical therapist to start the rehabilitation from acute injury is important for fast recovery and preventing the development of chronic conditions.

 

Application of heat versus cold

Using cold compresses for the injured muscles may be soothing in the first 24 – 48 hrs. This should be, however, followed by the application of heat to promote local blood circulation and to relax the muscle spasm.

 

Moist heat is preferred over dry heat, and moist heating pads, hot showers or baths work great. Heating pads can be applied to the injured area several times a day, but no longer than 20 minutes at a time.

 

You should never sleep on the heating pad. Exposing the injured area to the heat longer than 20 minutes at the time leads to overheating. This will trigger a protective mechanism, which may cause changes in the local vasculature and eventually decrease blood circulation in the injured area.

 

If pain prevents you from getting good night restful sleep, talk to your provider about prescribing short course of pain medication that can decrease the intensity of pain at night, while at the same time help you get better sleep.

 

Taking a muscle relaxant 30 minutes to one hour before sleep is generally a good option. However, your medical provider will be able to make more specific recommendations based on your particular condition.

Sleep and Depression

Getting a sufficient amount of sleep is important for everybody, but it is critical when recovering from an acute injury. The body heals and tissue regenerates when we sleep.

 

Insufficient sleep promotes systemic inflammation within our body, which slows down the healing and contributes to more pain perception. A minimum of seven, but preferably eight hours of sleep is recommended for optimal functioning and recovery.

 

Additionally, an insufficient amount of sleep combined with new intense pain has a strong effect on mood and may lead to depression. Whether depression results from sleep deprivation and pain or the depression has been present prior to the injury, it’s presence further intensifies pain and interferes with sleep, thus creating downward spiral leading to worse outcomes.

Complementary medicine, pain medication, and acute pain

An increasing number of patients do not wish to take any pain medication when they develop acute pain from fear of their side effects. There is an ongoing battle and numerous initiatives to fight the opioid crisis around the world.

 

Additionally, it is also true that every medication carries a risk of side effects. This, however, doesn’t mean that taking pain medication is bad and should be avoided by all means.

 

It is important to understand that there is a role for pain medication in particular when it comes to severe pain. Getting pain under control as soon as possible will prevent altering the way in which our brain deals with pain.

 

Any uncontrolled pain lasting longer than several days can sensitize the brain to pain and lower the pain threshold. This ultimately translates to experiencing painful sensation at much higher intensity with much lover stimulus. A simple gentle touch over the painful area could, therefore, lead to severe pain.

 

Complementary and alternative medicine modalities have been used successfully for the management of pain and injuries for hundreds of years. Many of them have been extensively studied and their effectiveness proven in rigorous trials.

 

Despite their popularity, however, their role is primarily in the management of chronic pain and injuries. This is largely because their main mechanism of action, by which they help to control pain and promote recovery, is through stimulating body own healing processes and pain control.

 

In other words, their primary role is to restore the body homeostasis. The subtle changes they produce over time are sufficient to create a noticeable difference when treating chronic pain or injuries.

 

It is, however, usually not enough to promote lasting pain relief in severe acute pain Click here to read more about the complementary medicine, pain medication and acute pain.

The role of Nutrition

The importance of nutrition cannot be emphasized enough when it comes to recovery from an acute injury. Providing our body with a sufficient amount of lean protein which is important for building tissue, as well as getting enough vitamin C to promote formation of collagen, is the very minimum.

 

Minimizing the intake of vegetable oils by decreasing consumption of fried foods and pastries and replacing them with monounsaturated fats from olive oil, canola oil, and avocados helps to decrease inflammatory process in the body.

 

Eating a wild salmon or other fish high in omega 3 fatty acids at least 2-3 times a week, or taking 1000- 2000 mg of mercury-free omega 3 fatty acids daily in the form of a supplement, has been also shown to decrease systemic inflammation.

 

Having fresh vegetables at least two times a day and eating 2-3 pieces of seasonal fruits will add much-needed vitamins and phytochemicals to act as powerful antioxidants.

Topical analgesic creams

Topical analgesic creams, ointments, and plasters have been used in many traditions to treat injured muscles and bones for millenniums. They have been made from a variety of herbs and other natural substances.

 

Their use not only soothes the pain but also promotes healing. A number of topical analgesic creams have been developed by the pharmaceutical industry based on these old folk remedies.

 

Most of these products contain some combination of menthol, capsaicin and salicylic acid. While these products have been marketed primarily to help to soothe the pain and aches, they also promote local blood circulation by stimulating special receptors on the skin.

 

As mentioned throughout this article, increased blood circulation in the area of pain promotes healing. The use of these products should be therefore encouraged for any musculoskeletal injury where application of topical creams is not contraindicated.

 

Before rubbing any of these products to the skin, try to apply only a small amount to observe for any skin reaction. You should also never apply these creams right before or after hot shower to avoid intense burning sensation.

 

In summary

Recovering from an acute musculoskeletal injury is a complex process. There is no one single recipe since everybody has a unique combination of factors that may either promote or hinder the recovery process.

 

In this article, we have covered only few of the most important aspects that exert a major influence on the recovery process. Optimizing sleep, physical activity, nutrition, and appropriate use of heat/cold and topical creams, can have significant effect on the speed of your recovery.

 

To learn more about complementary therapies that can be used for recovery from acute back pain, visit National Center for Complementary and Integrative Health


Back Strain: Symptoms, Causes and Treatment Strategies

Musculoskeletal Health with Dr D. 

Back Strain: Symptoms, Causes and Treatment Strategies

Back strain is probably the most common form of acute back pain. It affects the muscles and their tendons which attach them to various structures in the back. In general, muscle strain refers to a small tear in the muscle or its tendon. Most muscle strains tend to develop in the lower back area where the muscle changes into the tendon, but they can develop anywhere.

Symptoms

A strain of the back muscles mostly causes localized pain in the area of the muscle/tendon injury accompanied by stiffness, limited range of motion and difficulties maintaining straight posture. Timing is very important when it comes to muscle strain.

 

Most muscle strains usually happen while lifting something very heavy or doing a sudden movement. Many individuals experiencing back pain due to muscle strain may feel a popping sensation at the moment of the injury which usually prompts them to seek medical attention.

 

They may have difficulties straightening their back up after the onset of the pain and usually maintain a semi bent position to avoid severe pain. That is not to say that muscle strain cannot come gradually. Even in this case, however, the individual can usually remember the moment when he felt sudden uncomfortable pain in the back which became progressively worse with activities.

Most individuals will also complain of muscle cramps in the area of their lower back. Additionally, coughing and sneezing usually brings on bouts of severe pain during acute back strain. The back muscles which tend to be the most affected by muscle strain are those right next to the spine.

 

Frequently, however, the pain can also be felt around the base of the spine and in the buttock area. Occasionally, pain may radiate into the buttocks. Under normal circumstances, pain due to back strain does not radiate down to the legs.

 

Pain radiating down to the legs is usually associated with nerve compression, but it is also frequently seen as a result of trigger points in the gluteal (buttock) muscles.  Back strain is not a serious condition and most individuals with acute back strain recover spontaneously within 1 to 2 weeks.

Causes

When muscle strain is caused by a sudden movement, it is generally a result of preexisting tightness in the back muscles which has developed over a period of time. Tight muscles are less flexible. Decreased flexibility results in limited ability to respond to sudden demands for muscle extension beyond the normal daily activity.

 

Therefore when the muscle is required to suddenly extend beyond its limits, such as when catching a falling object or catching ourselves from falling down, a strain can develop in the muscle or the tendon. To prevent further injury, the body triggers protective mechanism which manifests as muscle spasm.

 

The final outcome is stiffness and significantly limited range of motion with great amount of pain when trying to move in any direction.

Back strain can, however, develop also due to muscle overuse. In this case, the muscles and/or their tendons become strained due to repetitive movements in absence of sufficient time for recovery and repair.

 

Activities involving excessive forward bending of the spine constitute one of the most common misuses of the back leading to increased vulnerability to a variety of injuries. The forward bend position stretches the muscles and tendons of the back to a point where very little control can be exercised over the spine’s position.

 

Therefore lifting objects in forward bend positions can easily strain these muscles and their tendons. Additionally, forward bend position creates an uneven pressure on the spinal discs making them significantly more prone to injury.

 

Poor posture

Poor posture is one of the main underlying causes for the development of back strain. It generally refers to either too large or too small curvature in the area of the lower back. Over a period of time, poor posture leads to muscle imbalance and strain of the muscles/tendons in the back.

 

Spending extensive period of time in uneven position such as being twisted sideways or bent forward, also puts great stress on the spinal discs predisposing them to injury.

 

Poor physical fitness

poor physical fitness, excessive weight, sedentary lifestyle and lack of flexibility are also among the leading factors predisposing individuals to back strain. The result is poorly conditioned back muscles that lack sufficient strength and endurance to respond to increased physical demand when called upon.

 

This is why sudden unexpected movement, or performance of new repetitive task requiring the use of back muscles, easily result in back strain.

 

More information is available on this page.

Summary

Main Symptoms

Sudden onset

Localized pain  & stiffness

Limited range of motion

Difficulties maintaining straight posture

Muscle cramp in the area of the lower back

Causes

Sudden movement

Tight muscles and lack of flexibility

Muscle overuse

Activities involving excessive forward bending of the spine

Lifting objects in forward bend position

Poor posture

Working in uneven position - twisted sideways or bent forward

Poor physical fitness,

Excessive weight

Sedentary lifestyle


Back Strain: Accelerate Your Recovery with These Tips

Musculoskeletal Health with Dr D. 

Back Strain: Treatment Guidelines for Back Strain

Most back strains do not require specific treatment, because they usually recover spontaneously in relatively short period of time. There are, however, certain strategies that may help you recover faster and make the process less painful. For full list of detailed recommendations on optimizing your recovery process please follow this link.

Mobility: swimming and walking

One of the most important things to keep in mind, is that during the acute phase, it is of outmost importance to stay mobile. While short term bed rest may help to relieve some of the pain initially, staying in the bed more than 24-48 hrs leads to worse outcomes and prolongs the recovery time.

While becoming more mobile is important, you will need to initially modify your daily routine to avoid high impact activities, lifting heavy objects and twisting movements. The best way start increasing physical activity is walking for few minutes several times a day and eventually transitioning to recreational swimming in a slow pace. Swimming is excellent exercise for recovery from back injuries. It’s weightless nature eliminates gravity and pressure on the spine and takes the muscles and joints through full range of motion. Both activities will keep the muscles engaged without additional strain, and get them slowly ready for more physically demanding exercises.

Heat

Heat plays important role in the treatment of back pain. It improves local blood circulation which enables the injured tissue to heal faster while decreasing muscle stiffness and pain. Applying heat to the painful area after the initial 48 hrs from the onset of the injury also helps with stretching. Additionally, heat reduces pain and makes movement easier when getting out of the bed in the morning. Heating pad should not be applied directly on the skin. While it can be used  several times a day, it should never be applied for longer than 20 minutes at a time. Never sleep on your heating pad!!

Stretching, Massage and Acupuncture

Gentle stretching of the back muscles after using heating pad is important to slowly start elongating the tight muscles. Never push beyond the level of gentle stretch. If stretching is painful, you need to pull back. Gentle massage around the painful area can be very relaxing and soothing. You do not need to spend money on massage therapist, but if you can afford it, this might be a good time to splurge on couple sessions. Getting a simple massage from your partner at least once a day for the first few days can be equally if not more effective. Alternately, you can try self-acupressure using a tennis ball while leaning against the wall and finding the tender spots in your back. Both massage and acupressure help to promote local blood circulation and loosen up the tight muscles which results in increased mobility and less pain. If acupuncture is available to you, getting few treatment sessions can be very helpful to promote relaxation of the tight muscles, increase local blood circulation and decrease pain. For more information about acupuncture please follow this link.

The role of pain medication

While pain medication will not help you to recover faster, they can help to make the process more bearable. Motrin, naproxen or Alleve can be used in mild to moderate pain, to take the edge off the pain. Stronger pain medication, prescribed by your provider, may be necessary when pain is more severe.

 

Goals for pain management

It is very important to understand, that complete pain relief is neither realistic, nor the goal of pain medication or any treatment modality discussed in this article. Pain is a protective mechanism. It makes us start paying attention to our body and prevents us from causing further damage. Additionally, there is no single best remedy. Patience in combination with several treatment strategies placed in the context of a comprehensive treatment protocol, has been shown to lead to the best and fastest recovery.

 

To learn more about complementary therapies, visit National Center for Complementary and Integrative Health


Sciatica, Symptoms, Causes and Treatment strategies

Musculoskeletal Health with Dr D. 

Sciatica

Sciatica is a type of back pain that affects the sciatic nerve. The sciatic nerve is a large nerve that exits from the spine in the area of the low back, travels down to the buttock and continues down along the back of the thighs into the feet. It is an important nerve that branches in several places in the legs and provides nerve innervation to the legs and feet.  A disc in the spine can herniate and compress the sciatic nerve causing symptoms of sciatica.

Symptoms

Patients with sciatica usually experience the familiar electric jolt like sensation propagating along the back of the thighs sometimes all the way to the feet. The sensation of pins and needles or ants crawling under the skin of the legs is also frequently described by patients experiencing sciatica. The intensity of the pain varies among the patients. Some individuals experience excruciating debilitating pain that causes them to become bedridden for a couple of days, while others have only mild pain in their back and legs. While the sciatic pain usually starts in the low back and continues down the leg along the path of the sciatic nerve, the pain is usually more intense in the legs than in the back. Sciatica generally affects only one leg at a time. It is rare to see the involvement of both legs at the same time. If this is the case, it is important to seek medical evaluation to rule out other causes for these symptoms.

Most patients complain of more significant pain when they sit down. Standing for extended periods of time is also very painful and most people prefer to lay down or slowly walk around to ease their pain. Numbness and weakness in the leg are also frequently associated with sciatica. If the sciatic nerve becomes compressed in the buttock by a muscle called piriformis, it is called piriformis syndrome. The main differentiating symptoms between sciatica and the piriformis syndrome is that painful sensation caused by piriformis syndrome propagates down the leg along the back of the thighs and only up to the knees and not past the knees. The quality of the pain is also different. Pain radiating down the legs due to the Piriformis Syndrome generally feels like a dull, achy sensation unlike the electric-like, burning sensation caused by a pinched nerve in the spine causing sciatica.

Causes

There are many reasons why someone may develop sciatica. The risk factors are similar to developing any back pain. The excessive weight which creates too much pressure on the spine, sedentary occupation with lack of movement or carrying heavy objects are some of the most important causes. Aging is an independent factor that compounds any of the above risk factors because most people become more sedentary as they get older, gain weight and become less flexible. Sciatica is however not exclusive of young healthy individuals. Many individuals in the 30s present to their health care provider’s office with symptoms of sciatica after sustaining injury from doing exercises at the gym. This is usually related to lifting heavy weights, not stretching before and after exercising, as well as not getting enough rest to allow body fully recover and regenerate.  To prevent flare-ups of sciatica it is, therefore, crucial to maintaining healthy weight and stay mobile.

Treatment Guidelines

While sciatica can be rarely caused by a bone spur or a tumor, in most cases of sudden onset of sciatica, it is related to a disc herniation.  The treatment for sciatica is therefore essentially the same as for disc herniation since both share the same underlying cause. Treatment guidelines for disc herniation can be found here.

Summary

Symptoms

Electric jolt like sensation in the back & back of the leg

“Pins and needles” sensation

Numbness and weakness in the leg

Burning sensation

Affects usually only one leg

More pain with sitting or standing

Pain is better when laying down or walking slowly

Causes

Excessive weight

Sedentary occupation & lack of movement

Carrying heavy objects

Advanced age

Lifting heavy weights


Trigger Points: The Shocking Culprits Behind Your Pain

Complementary Medicine

What are Trigger Points ?

In the mid-1960s doctor Travel introduced the term myofascial pain.  Over the years, many publications and clinical experience have shown that nearly 80% of local muscular pain can be attributed to myofascial pain. The term myofascial pain has been associated with muscle tenderness that arises from hyperirritable areas in the muscles called trigger points. Muscular pain caused by trigger points has been known to mimic symptoms of a very long list of common maladies. Pain resembling sciatica, herniated discs, joint problems, kidney stones, and even headaches can be caused by the presence of trigger points in the associated muscle groups. Dismissing the concept of trigger points when evaluating common daily pains and aches, can result in incorrect diagnosis and failure to formulate an effective treatment plan to resolve the painful condition.

What is a Trigger Point?

A trigger point is usually defined in textbooks as a painful point that can be felt as a hard nodule in the muscle. Clinically, however, a trigger point is more of an area of the muscle, not necessarily a precise point. There may be a palpable nodule, but that is not always the case. A better definition of a trigger point is an area of muscle that feels tight and ropy and usually is tender on palpation. Not every tender area within a muscle, however, is a trigger point. Several other characteristics have to be present for a tender area of the muscle to meet the criteria for the definition of a trigger point. Trigger points are therefore usually defined as areas that are tender on palpation, but also display twitch response when strumming the tight muscle band in a perpendicular direction.  Compression of the trigger point also needs to reproduce the patient’s familiar pain. In some cases, when pressure is applied to the trigger point, the pain can be felt in a distant area of the body. This phenomenon is known as referred pain. The typical example of referred pain secondary to trigger points is pain at the base of the spine or the buttock, caused by trigger points in the mid-back muscles, at the area of the lowest ribs. A new definition of trigger points, however, suggests that referral of the pain to the distal area of the body does not need to be present in order to make the diagnosis of a trigger point.

Formation of Trigger Points

When a muscle or a group of muscles is subject to repetitive overuse or sudden strain, a contraction will form in a small number of muscle fibers within the affected muscle. We refer to these small contractions as trigger points. The presence of trigger points in the muscle, shortens the length of the muscle, much like making series of knots on a piece of a string. The more knots on the string, the shorter and tighter the string becomes. This analogy can be applied to muscles that become tight due to the presence of trigger points. The shorter the muscle becomes, the more distinct ropy feeling can be appreciated when strumming perpendicularly across the affected muscle.  When a muscle becomes shorter because of the trigger points, it will start to generate greater pull on the tendons and ligaments that attach the muscle to the joints and other structures. In the case of the knee joint for example, if trigger points are present in the quad muscles, they will shorten the quad muscles. The quad muscles attach below the knee through a tendon that runs over the kneecap (patella). The shortness in the quad muscles will therefore cause the kneecap (patella) to be compressed over the underlying cartilage whenever the knee is flexed. Greater friction between the patella and the underlying cartilage will over time result in faster loss of the underlying cartilage or formation of inflammation. This condition is called a chondromalacia patella and is experienced by the individual as a deep achy pain underneath the kneecap.

What causes trigger points?

In general, trigger points tend to form in the muscle that is subject to a higher load than the muscle can tolerate. There are a variety of factors that have been noted as potential causes for the development of trigger points. The most significant of these include acute or chronic muscle overload due to poor posture or over-exercising. Direct trauma to the muscle, as well as trauma due to a car accident which leads to a whiplash, are another common cause for developing trigger points. Additionally, psychological distress, homeostatic imbalances, and certain lifestyle habits such as smoking, have been identified as important contributors to the formation of trigger points. When an area of muscle is constantly overloaded, the resulting muscle tightness in that area will compress the surrounding blood vessels. This leads to poor local blood circulation with subsequent accumulation of various metabolic by-products and chemicals which sensitize the surrounding nerve endings. The impaired metabolism and blood circulation in the muscle further impair the muscle’s ability to fully relax. Eventually, the muscle develops sustained contraction leading to the development of palpable tight and ropy areas of the muscle defined as trigger points.

Consequences of Trigger points

There are many implications of having trigger points in the skeletal muscles. The most well-known include pain, stiffness, and decreased range of motion of the affected muscles. Decreased athletic performance and pain radiation to other parts of the body are two less known facts about trigger points. Understanding how trigger points affect athletic performance is particularly important for anybody interested in maximizing the benefits of their workout routines. Many top athletes pay large sums of money to experts in myofascial release to keep their muscles free from trigger points.

 

Decreased athletic performance   

When muscles develop trigger points, their overall capacity to do their job is impaired.  Physiologically, the basic function of the muscle is to expand and contract. The presence of the trigger points causes the muscle to assume a constant shortened and contracted state, hindering the muscle’s ability to fully flex and contract. This will manifest as overall muscle weakness, decreased range of motion, feeling of stiffness, earlier fatigue, and intolerance to high-intensity workload. Muscles that have trigger points also recover much slower. The combination of all these factors interferes with athletic performance and leads to suboptimal results despite adequate training and preparation.

Pain radiation to other parts of the body

The characteristic feature of trigger points is their ability to refer pain to distal areas of the body, which makes the correct diagnosis of the true origin of the pain challenge.  Detailed pain referral pathways have been described for individual muscles and their trigger points. These referral pathways sometimes overlap, therefore a detailed search of all muscles which can refer pain to a particular area, should be conducted, to identify all the sources of the pain. An example of referred pain to the same area from a different muscle is a pain in a pinky and along the inner aspect of the hand. This referral pattern is typical for trigger points in the Latissimus dorsi. In some cases, however, the pain in the pinky and along the inner aspect of the hand can result also from the presence of trigger points in the Infraspinatus muscle.

 

Several non invasive treatment options are available to address and treat trigger points. Some of the most popular include acupuncture, dry needling and acupressure modalities. Follow these links to learn more about each one of the them.

 

To learn more about complementary therapies. Visit National Center for Complementary and Integrative Health

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