Massaging bed rest

Let's start by acknowledging that a prolonged retreat to the continuous recumbent position will only aggravate your condition. The research based guidelines are unequivocal.

There remains a problem, however. Patients with very severe lumbar pain and, especially if it radiates into the leg, are simply unable to sit or stand for any length of time. This is no exaggeration; ask anyone who is suffering. Lying down is sometimes the only option.

Think of these four groups of people.

• Firstly the patient with LBP, and especially if there is also a radiating sciatica who, despite the usual treatment, know that they are not improving or are getting worse. Going to work means sitting in the car, meetings and you know perfectly well that the condition is not resolving. Part of the solution may be a few days flat on the couch with a couple cushions under the knees.
  
• The patient with very severe lumbago simply has no option. Getting into the car and driving off to work is just out of the question; but staying at home and watching television in a comfortable chair isn't a good idea either. Sitting is the primary forbidden posture for patients suffering from lumbar and leg pain; there are occasionally exceptions.
• The patient in an antalgic posture can no more stand or sit than fly to the moon. If, when you are in front of the mirror, you can see that look more like a question mark than your usual upright stance, then modified bed rest is the only option. Keep going about your normal business, and it will go down your leg, and a consultation with a neurosurgeon lies in wait. Postero medial disk herniation ...
• You have one or more of the ominous lumbar signs and you are really very anxious, and probably rightly so. Leg pain muscle testing can be done at home to see if paresis is developing in the leg. 

• Severe lower lumbar back pain
• Lower back and leg pain

Lasegue's straight leg raise and the Slump test for sciatica will be very strongly positive in these cases. These tests can be done at home to see how severe your problem is; with the straight leg raise, make sure you don't take the weight otherwise you'll get very sharp back and leg pain.

The Slump test is perhaps the safer of the two, but more difficult to interpret. 

Lower lumbar back pain

So, what then should you do?

Modified bed rest

Massaging, or what I sometimes call modified bed rest, shall not be continuous.

At least every hour, rise up 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 lying flat on your back.

Sometimes the pain can be so severe that 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 toilet, make a cup of tea or a sandwich. Get up and do something for a short period; until your back demands you return to your bed.

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

Before returning to your 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 the chair forbidden.

Strangely, lying down again, getting from standing onto your bed, may be even worse than arising. I know because 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; 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 will be doing some quite different exercises to the person with a sacroiliac syndrome. 

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 program takes only 40 seconds; perhaps a minute when you're in severe pain.

Lower back exercises

Lower back exercises done every morning before arising are an absolute necessity for the difficult lumbar or sacroiliac condition; in fact, I say that, like flossing teeth, they are for everyone. In conjunction with massaging bed rest they can and often should be done frequently.

Cold hot therapy

Cold hot therapy is often a better, and far safer solution to pain, than powerful but dangerous medication; an ice pack can easily be used in conjunction with massaging bed rest.

• 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 is very relieving.
  

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 ...

Grudgingly, I have to acknowledge there is a place for NSAIDs in the management of very severe pain.

• Massaging bed rest. Whilst lying on your side some gentle massage can be very relieving. Please note that you should not lie on the stomach during the massage. Has your spouse got good hands? A sports masseuse?

Here's a good tip whilst enduring that massaging bed rest.

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 of the pelvic tilt, one of the very best for the lower back but it can be very uncomfortable at the extremes and aggravate the condition if you go too far. Even a very slight roll is okay in the initial acute phases.

Go through with the exercise until you feel it and then reverse the movement.

There's always the temptation, once you know a condition is resolving, the massaging bed rest phase is over, and 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 rehabilitation 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 diseases like diabetes.

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. She or he simply wants to see you get properly better, not deprive you of your hard earned cents.

Do not assume it will be fine once the pain has gone.

"I injured my ankle by falling down the steps. I cancelled the follow up appointment with the orthopedist and removed my own cast as I presumed my leg would be fine.

Since then the ankle pain has been getting worse; I sat down recently and moved my ankle which made a loud crunch and since then it's been very painful and is becoming worse, even at rest."

Dear P,

I think you know what to do. Go back to the orthopedist who treated you.

Getting properly better after any fall is vital, otherwise you may be saddled with an injury that leaves a permanent mark on you.

• Ankle fracture case file ...
  

Where you given the diagnosis? Many fractures are missed on plain X-ray. I'd ask for a scan.

"Thank you for answering so quickly. I will make an appointment with the surgeon."

Please email me and inform me what the scans reveal. Foot and ankle fractures are often very difficult to see on plain xray. Frequently there's a fracture lurking. For how many weeks did you wear the POP caste?

Slipped disc symptoms

Slipped disc symptoms often include pain so severe that you couldn't possibly stand, or walk, and sitting is forbidden. So lying down for a period is the only option; just remember that there's strong research showing the prolonged bed rest for almost anything, including back pain, will usually aggravate the problem; severe trauma excepted. Massaging bed rest is sometimes needful.

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 is not well, do the right thing. The Dutch have a wonderful saying:

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

And so it is. Be wise.

Useful links

• Go from Massaging bed rest to Lower back pain home page.
• Slipped Disc rules ....
• Maintenance Care