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CHIROPRACTIC HELP #33: Bed rest for lower back pain
March 21, 2013
Dear


BED REST for Lower Back Pain


Let's start by admitting that research indicates that prolonged, continuous bed rest will only aggravate your back pain.


The problem

Patients with very severe lower lumbar back pain simply are not able to sit or stand. This is not an exaggeration, I've been there myself, and I can confirm that a period of "modified" bed rest is sometimes the only option.


Three groups of patients

  1. The first is the patient with lower back pain, and especially lower back and leg pain ... who despite various forms of treatment knows that they are not getting better. Going to work means sitting, the car, pressure, meetings and the pain is not resolving. Part of the solution may be "modified" bed rest for back pain. 
  2. The patient with very severe low back pain simply has no option. Getting into the car and driving off to work is just out of the question. But staying at home, sitting and watching TV, isn't one of the options either. Sitting is the number one no-no for lower back and leg pain. 
  3. The patient in an "antalgic posture." If when you stand in front of the mirror you can see that look more like a question mark than your usual posture, with acute low back pain, then modified bed rest is the only option. Keep going, go about your normal business,  and it will go down your leg, and a consult with a neurosurgeon lies in wait. Postero lateral disk herniation ...


So, what then is the solution?


Modified bed rest

  • The bed rest shall not be continuous. At least every hour, rise from your bed of woe and move about for a short period. First roll onto your side and push yourself up sideways. Do not try and sit up whilst on your back. Sometimes back pain can be so severe, the only way to get up is to roll from your side down to a kneeling position on the floor first.

This is a good opportunity to go to the loo, make a cup of tea or a sandwich. Get up and do something. For a short period, until your back demands to return to your bed.

A lumbar corset whilst standing may help you stay up a little longer.

Before returning to bed, "perching" for a short period may be okay. Organise your computer station so you can answer a few emails.  It's half way between sitting and standing, but maintains the lordosis and does not produce the dramatic increase in disc pressure that makes sitting a no-no.

Strangely, lying down again, getting from standing to your bed, may be even worse than standing up. I know, I've been there myself. You have to use your own initiative, and yes it's quite scary. But, with some help from your Chiropractor, these things too will pass. But, be determined to get properly better. A chronic lower back isn't fun.


  • Whilst lying on your back you shall regularly do gentle bed rest exercises. It's best to have professional advice, as the patient with a slipped disc may be doing different exercises to the patient with a sacroiliac syndrome. Lower back exercises ...

How regularly? At least every half an hour, and even more frequently. I don't think you can do too many. Within reason. Our basic lower back exercise programme takes only 40 seconds, perhaps a minute when you're in severe pain.



Tip:

You should feel a good exercise but it mustn't cause pain. Go to the pain threshold and then back off. This is particularly true for the pelvic tilt, one of the very best exercises for lower back pain but it can be very painful at the extremes and aggravate the condition if you go too far. Even a very slight tilt is okay. Until you feel it. Then stop.



  • Ice. Whilst lying on the bed at least twice a day use an ice pack on your back. Wrap it in a facecloth and place it for about 20-30 minutes over the painful area. Some doctors like a shorter or longer period, and perhaps followed by a moist hot pack for a shorter period. Cold hot therapy ....

Ice is not only a very effective painkiller, with no dangerous side effects, but also has an anti inflammatory effect. It decreases swelling, always a feature of severe lower back pain.

It's a good idea also to take some anti inflammatory supplements such a freshly ground ginger or flax seed or fish oil. Anti inflammatory omega 3 ...


  • Massaging bed rest. Whilst lying on your side some gentle massage can be very relieving. Please note: DO NOT LIE ON THE TUM DURING MASSAGE. Has your spouse got good hands? A sports masseuse?


CHRONIC CONDITIONS

Do everything in your power not to allow your condition to become chronic. If it's already chronic, the die is cast and there's no virtue in castigating yourself or your doctors.

But do try to prevent chronicity. Research shows for example that if you've had neck pain for six months, you'll have it for the rest of your life no matter what treatment you have. You've got six months to get it fixed. It probably applies equally to a painful ankle or lower back.

It's why, after 3-4 weeks, I recommend a good hard look at your progress. Is it time for a change of doctor? From your doctor to a Chiropractor? From your Chiropractor to a Physiotherapist? Or simply another Chiropractor?

Worse, neglected or mismanaged spinal conditions usually begin with back or neck pain, but very frequently progress to far worse radiating nerve pain.



"I have had pain in my mid back/shoulder blade for months now, it's manageable enough for me to work but nagging none the less. Now my right arm (inside forearm mostly) tingles and sometimes it literally feels like water or sweat is running down my arm... Should I be concerned?"



GET PROPERLY BETTER

There's always the temptation, once you know a condition is resolving, to try and save a few cents and forego your doctor's directions. And, yes, sometimes it's fine to do that. But usually it's not. It may mean that you are not given the proper rehab to prevent the condition returning next month. And whilst maintenance chiropractic care remains controversial it is vital for some folk with chronic conditions. Medicine too rightly uses regular maintenance care for serious chronic conditions.

In the weeks after the pain has nearly gone many conditions remain in a vulnerable state for a period. Ongoing management, even if it involves no treatment, is often prudent. S/he simply wants to see you get properly better, not deprive you of your hard-earned cents. Don't assume it will be fine.


"I injured my ankle falling down some steps in December. I didn't go to my follow up appointment and took off my own cast as I assumed it would be fine.

Since then the pain seems to be getting more and more so and I sat down the other day and made to move my ankle when it made a loud crunch and it was very painful. And has become worse since, especially when resting. What should I do?"

Dear C,

I think you know what to do, C! Go back to the doctor who treated you.

Getting properly better after any condition, or injury, is vital, otherwise you're faced with an injury leaving a permanent mark on you.


What was the diagnosis? Sprain? Fracture? Many fractures are missed on plain X-ray. I'd ask for a CT scan. Or MRI if his assessment is a soft tissue injury. But this sounds like bone.

I hope this contributes.

Dr B


Thank you for getting back to me so quickly. I will book an appointment with my doctor and ask him to arrange the things u suggested.

Let me know what the scans show. Fractures in the ankle are notoriously difficult to see on plain X-ray. So often there's a fracture lurking. How long did you wear the caste?

Dr B



Wisdom

Know that if you practise being your own doctor, there are dangers. Wisdom demands that you be prudent and if you know that all isn't well, do the right thing. The Dutch have a wonderful saying:

"He who won't hear, must feel."

And so it is. Be wise.


Traffic

I would again like to thank you for the incredible support you bring to Chiropractic Help. Traffic continues to surge with 2763 visitors reading 7432 pages per day; 62,763 pages in total in the first half of March.

Feedback is important to me. If there are subjects not tackled, criticisms and praise, it all helps to make Chiropractic Help a better site. I have a thick skin, I really want to hear the negative as well as the positive.


Chiropractic books

If there's one thing I would really like to hear more of, it's those Chiropractic Books that you have found interesting. Chiros reading this, pretty please the MEDICAL and CHIROPRACTIC books that you reach for on a daily basis.

Now, in the absence of any new interesting Chiropractic books, I'm going to indulge in a little Webmaster's privilege. As you know most web sites come for free, and Chiropractic Help is no exception, including the MANY questions you ask, to which I give a measured and carefully thought out answer. I've just answered a question on Tietzes syndrome, and it took half an hour to answer. Another 11 questions await in the queue... now it's pay-back time if you find Chiropractic Help a useful site!

Not a Chiropractic book but my own fourth book, a trilogy, A Family Affair, has just been launched on Kindle. Controversial, it's about women in love, rape and abortion, children brought up without fathers. Not for the fainthearted and not everyone's cup of tea.  Here's the cover of Book I: The Bostonians


Back cover of Book I: The Bostonians

A Family Affair is the heart-warming trilogy about a family with a difference. It has two Moms, but no Dad.

Janet has a happy childhood; it’s at her Diocesan  School for Girls where she first tastes the forbidden fruit.

But Santie’s mother dies and the child is sexually abused by her father. Whilst at the Police College a gate slams shut, wiping all memory of her abused childhood from Santie’s mind, but leaving her sexually very conflicted.

After studying law, Janet and Santie’s friendship blossoms whilst doing their articles, but Janet is raped by their boss at a beach party. Deciding to keep the child, Klein-Jan is the honey in the sandwich that sweetens and cements their relationship; until the toddler is kidnapped by his father.

Darkness ensues. Eventually, in desperation, it’s suggested by their gynaecologist that they have another child. But how do two women conceive a baby?

 

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Enter Peter Thomas… is it possible for a man to be hoodwinked into siring four children and be none the wiser?

 

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Taken to Holland, Klein-Jan, now aged twenty, undertakes a journey to discover his roots.

Set in South Africa, A Family Affair is both a lighthearted and easy read, but also takes an inside look at serious issues. Women in love, rape, abortion, AIDS and the profound love of a grandmother who prays every single day for her long-lost grandson. It was from her home that KJ was kidnapped.

Priced right

Not yet bought an e-reader? It's time. Most e-books are priced at a fraction of their paperbook versions, and let's be honest, only a handful of great books are worth keeping for a second read. I was astonished how readily I converted to reading on my Kindle.

You can spend a fortune on a full colour Fire but this basic model is more than adequate.

The Bostonians, Peter's Children and The Return are priced right at $2.99c each, Amazon's lowest price.

Curious? Try this tidbit for free: Klein-Jan Jansen ...



"Imagine life is a game in which you are juggling five balls. The balls are called work, family, health, friends, and integrity. And you're keeping all of them in the air. But one day you finally come to understand that work is a rubber ball. If you drop it, it will bounce back. The other four balls –- family, health, friends, integrity -- are made of glass. If you drop one of these, it will be irrevocably scuffed, nicked, perhaps even shattered. And once you truly understand the lesson of the five balls, you will have the beginnings of balance in your life."

James Patterson


Till next month, then...

remembering that health is one of the glass balls,

Barrie Lewis DC

PS. Feel free to forward this to family and friends, your chiropractor and even your medical doctor!

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