Back Pain Guide 4
Ronald Grisanti D.C., D.A.B.C.O., D.A.C.B.N., M.S.
Treatment ConceptsOn your first visit to Dr. Grisanti, the initial decision that must be made is exactly how serious the problem is. Some problems need immediate attention - possibly even surgery. However, the vast majority of back problems do not require surgery. Once the most likely cause of your problem has been determined (your diagnosis has been made), you and Dr. Grisanti can decide on a treatment plan.
A variety of treatment options exist for different types of back pain that are effective in relieving the immediate pain. The overall goal of treatment is: to make you comfortable as quickly as possible, to design a program to reduce further degeneration, and to get you back to normal activity as soon as possible.
The more you know about how your back works and what you can do to prevent further injury, the more effective your program will be. Below are descriptions of the most common forms of treatment, along with a brief explanation of what each is designed to do.
Conservative Treatment
Dr. Grisanti often uses the term "conservative treatment" to describe any treatment option that does not involve surgery. Therefore, you may hear, or read in your records, that Dr. Grisanti is recommending a course of conservative treatment for your back problem.
Treatment for your back problem may be as simple as reassuring you that it is not a serious problem and doing nothing but watching and waiting. However, usually anyone who has a back problem that becomes symptomatic should consider some preventive measures. This usually means that you should learn more about how to protect your back and consider beginning exercises to strengthen your back. These exercises can be quick and easy to do, do not require any special equipment, and can help prevent problems later.
A variety of treatment options exist for back pain that is the result of degeneration (wear and tear) on the parts of the spine. The goal of treatment is to make you feel comfortable, reduce further degeneration, and get you back to normal activity as quickly as possible. As a last resort, and only if all other conservative treatments fail, surgery might be considered.
Rest is used to take the pressure off your spine and the muscles around your spine. You should rest in a comfortable position on a firm mattress. Placing a pillow under your knees can also help relieve pain.
Do not stay in bed for several days! Bed rest for more than two or three days can weaken the back muscles, making the problem worse instead of better.
Even though you may still feel some pain, a gradual return to normal activities is good for your muscles.
In most cases of sudden back pain, the sooner you start moving again, the sooner your back pain will resolve.
If you are sent to see a physical therapist, the first few days may be spent educating you on ways to take stress off the back while remaining as active as possible. Short periods of rest combined with brief exercises designed to reduce your pain may be suggested.
Ice: Ice makes the blood vessels in the sore area become more narrow, called vasoconstriction. This helps control inflammation that is causing pain. Some ways to put ice on include cold packs, ice bags, or ice massage. Cold packs or ice bags are generally put on the sore area for 10 to 15 minutes.
Ice massage is done by rubbing an ice cube or ice cup on a sore spot or tender point. It's as easy as freezing a small paper cup full of water. Once the water freezes, simply tear off the top inch of the cup and rub the exposed ice on the sore spot for three to five minutes, or until it feels numb.
Heat: Heat makes blood vessels get larger, called vasodilation. This action helps to flush away chemicals that are making your neck hurt. It also helps to bring in nutrients and oxygen which help the area heal. True heat in the form of a moist hot pack, a heating pad, or warm shower or bath is more beneficial than creams that merely give the feeling of heat.
Hot packs are usually placed on the sore area for 15 to 20 minutes. Special care must be taken to make sure your skin doesn't overheat and burn. It's also not a good idea to sleep with an electric hot pad at night.
Ultrasound: An ultrasound machine produces high frequency sound waves that are directed toward the sore area. Passing through the body's tissues, these waves vibrate molecules. This causes friction and warmth as the sound passes through the tissue. The rest of the sound changes to heat in the deeper tissues of the body. This heating effect helps flush the sore area and brings in a new supply of nutrient and oxygen-rich blood.
Ultrasound treatments are a way for your therapist to reach tissues that are over two inches below the surface of your skin.
Electrical Stimulation: This treatment stimulates nerves by sending an electrical current gently through your skin. Some people say it feels like sort of like a massage on their skin.
Electrical stimulation can ease pain by sending impulses that are felt instead of pain. Two respected scientists discovered a theory, called the Gait Theory. This theory says that when you feel a sensation other than pain, like rubbing, massage, or even a mild electrical impulse, your spinal column will actually "close the gate" and not let pain impulses pass to the brain.
In the case of electrical stimulation, the electrical impulses speed their way across the skin and on to the central nervous system much faster than pain. By getting there first, the electrical information "closes the gate" to pain, blocking its passage to the brain. Once the pain eases, muscles that are in spasm begin to relax, letting you move and exercise with less discomfort.
Other settings on the machine can be used to help your body release endorphins. These are natural chemicals formed within your body that behave like a strong drug in reducing the perception of pain for up to eight hours at a time.
Soft tissue mobilization/massage:
Dr. Grisanti has had over 20 years of experience and is trained in many different forms of massage and mobilization when treating the neck. Massage has been shown to calm pain and spasm by helping muscles relax, by bringing in a fresh supply of oxygen and nutrient-rich blood, and by flushing the area of chemical irritants that come from inflammation.
Soft tissue treatments can help tight muscles relax, getting them back to a normal length. This will help you begin to move with less pain and greater ease. Dr. Grisanti has special training in a variety of different ways to mobilize or massage. Myofascial release techniques help restore better movement by getting the thick layer of fascia below the skin and around muscles to "give".
Strain-counter-strain is a type of therapy that is especially helpful when tender points are causing muscles to restrict movement. The treatment is usually done in a way that the muscle is put in a special position, usually where the muscle is shortest. The position is held long enough to "reset" the nerve input to the muscle.
Another way to help soft tissues "move" is by the use of muscle energy technique. Dr. Grisanti will place your muscle in a certain position and then direct you to use your muscles against the therapist's force. As you relax, he will gradually "take up the slack", giving a stretch on the muscle.
Joint mobilization:
These are graded pressures and movements. Gentle graded pressures help lubricate joint surfaces, easing stiffness and helping you begin moving with less pain. Pain that is left unchecked can quickly escalate to an uncomfortable "cycle of pain and muscle guarding."
In other words, the pain can make your muscles go into spasm, in which your muscles try to guard the sore joints, keeping you from wanting to move your neck at all.
When movement stops, your brain gets an uninterrupted flow of pain sensation. Ouch! This leads to a cycle of even more muscle spasm and pain because your muscles try to "protect" you from painful movement. By applying gentle pressures, or mobilizations, Dr. Grisanti will begin to halt the flow of pain information, which helps muscles relax. Once your muscles begin to relax, you will begin to feel other sensations than pain.
As your pain eases, more vigorous grades of mobilization may be used to lengthen tissues around the joint helping restore better movement in your neck.
Traction: Sore joints and muscles in the neck often feel better when a traction "pull" is used. Dr. Grisanti will test at first to see if you can get relief with this type of treatment. Traction can be done in a variety of ways.
There are traction machines that allow you to relax comfortably with either a halter or cushion behind your neck. The machine is set to pull on this halter or cushion for a certain amount of time and pressure.
Manual traction is another way for Dr. Grisanti to put a graded pull on your neck. There are also traction devices that can be issued for you to use at home. The amount of pull that is used will depend on your condition. A gentle on/off pressure may be better early on to help control pain or if there is pain from arthritis. More vigorous traction can help take away pain if a joint is mildly sore or tight.
Traction
Traction can provide segmented unloading of pressure caused by disc compression and relief of pain. There are many types of traction devices on the market. Talk with your doctor or physical therapist before you use one. The old method of placing patients with back pain in traction in the hospital is not often used today. Most back specialists do not like placing patients on bed rest for that long.
Exercise
Exercise is vital to recovery and to maintaining a healthy spine. Consider it part of long-term health management and risk reduction. Regular exercise is the most basic way to combat back problems. However, if you already have an injury or damage to the spine, talk to your doctor or physical therapist before you start an exercise routine. You need to make sure the exercises you choose are effective and safe for your particular case.
Why exercise?
Scientific studies have shown that people who exercise regularly have far fewer problems with their back. It helps strengthen the muscles in your back that correspond with your spine. It can reduce your risk of falls and injuries. It can strengthen your abdomen (your belly), arms, and legs, which reduces back strain. Stretching reduces risk of muscle spasms.
In addition, weight bearing exercises help prevent loss of bone mass caused by osteoporosis, reducing your risk of compression fractures. Aerobic exercise, the type that gets your heart pumping and pulse rate up, has been shown to be a good pain reliever as well. The natural chemicals of the body that combat pain - called endorphins - are released during exercise and actually reduce your pain.
Two general guidelines for exercise are:
Smart Choices:
If you are recovering from injury, non-weight bearing activity is suggested, such as swimming and water exercise. A stationary bike or treadmill walking are also good bets, as they are put less pressure on your back than running on a hard surface. While you are recovering, avoid sports that lead to twisting, quick stops, and impact. This means holding off on racquetball, basketball, tennis, and all contact sports.
Warming Up:
Never begin exercise without properly warming up and stretching out your muscles. Proper stretching reduces the risk of injury and increases long-term flexibility.
Other Tips for a Healthy Back
Pay Attention to your Body:
If something you are doing causes your back to hurt, stop and rest or stop altogether. Whether it is a particular exercise, prolonged sitting, bending, or twisting, listen to your body's signals.
Pain is a warning. Discuss the activity with your doctor or physical therapist before proceeding.
Sit and Sleep Comfortably:
Be sure that your back and neck are properly supported when you sit or sleep. When you sit, make sure your lower back is supported. Talk to your health care provider about choosing an appropriate mattress and pillow. You can upset the alignment of your spine if a mattress is too soft, or a pillow too high.
Lose Weight:
If your weight is causing excessive pressure to your spine, weight loss can reduce your discomfort.
Lift Properly:
Do not lift heavy loads by placing the pressure on your lower back. Use your legs to lift, and always bend your knees so your arms are at the same level as the heavy object you plan to lift. This simple technique will save your back unnecessary wear and tear.
Avoid Osteoporosis:
Talk with Grisanti about combating the affects of osteoporosis - bone thinning.
Before starting any self treatment Dr. Grisanti recommends that you consider consulting with a doctor trained in functional medicine. Visit www.FunctionalMedicineUniversity.com to find doctors thoroughly trained in functional medicine
Functional medicine embraces the totality of the regulatory functions of the body. It encompasses all of the biophysical, biochemical, enzymatic, endocrine, immunological, and bioenergetic regulatory capacities.
Ronald Grisanti D.C., D.A.B.C.O., D.A.C.B.N., M.S.
