So You've Tweaked Your Low Back; Part One, What Happened

So You've Tweaked Your Low Back;
Part One- What Happened
The following 2 blogs are a summary of most everything you need to know about low back pain.  To prevent more damage it is very important to care for these injuries properly.  In the first blog I will cover some of the anatomy and physiology of injury that explains proper care.  In the second I will finish with more principles of rehabilitation so you can understand what will get your roots back under you, avoiding chronic pain, disability and drug dependence. 

Garden side view 2013 Having a “bad back” led me to study Chiropractic.  I’d always had a low backache that came and went; but I was quite surprised to see on an x ray 10 years ago that my lowest disc was almost gone!  “Severe Degenerative Disc Disease” was the diagnosis.  I knew that other discs were vulnerable too.  Last Fall I tweaked my low back worse than I ever had; while pulling out frost-damaged veggies. 
Just before an injury is your opportunity to avoid it all together; by listening to your body you can avoid throwing your back out; you may need it!  I had received several clues before I made that fatal reach for tomatoes last fall.  My back had been achy, especially with sitting, my legs had felt very tight, my gut was somewhat spastic, and I’d had some emotional outbursts.  All these issues were evidence of low back vulnerability.  You see, the same distortion patterns that cause the injury are often made worse by the body’s reaction to the injury!
Thank God for pain!  Pain is our saving guide; it tells us when we are damaging ourselves.  The subtle pain I had before the injury was now blown into a blaring paralyzing jolt with any movement.  I could see how this pain could easily drive one to the local emergency room to endure 4 hours in a cold hard chair for pain pills.  Then to be left on my one’s with a good chance for a lifetime of partial disability and opioid addiction!  Although I would have the company of some 20 million Americans, this outcome was not acceptable to me. 
I knew that the next few days and weeks were critical; a few simple actions could save my discs or blow them.   All the things I learned in my Rehab Certification courses back in the 90’s came back in living color.  First I got on the ground to relieve the stress of gravity. 
REHAB PRINCIPLE I:  The pain is from damaged discs and joints. 
Since we are designed vertically, the lowest discs get all the upper body weight; and do most of the bending and twisting.  When one’s bowling ball head is not accurately balanced over their sacral foundation, pressure increases in the lower discs.  The ligaments that hold the bones together are under adverse tension.  Any false move will cause them to tear, and all the nerve endings in them will make you think you are in a life-threatening situation of pain.  Let me assure you it is not life threatening but it can get as bad loss of bowel and bladder function, or a lifetime of searing leg pain.  The muscles are supposed protect the joints, but reaction to pain or stress confuses their balance. 
REHAB PRINCIPLE II:  Flexion is bad; extension is good.
Flexing a joint means bending or closing it. Flexion is the normal reaction to an injury; if you step on something sharp your hip and waist will flex to pull away.  Flexing muscles are turned on after an injury or a stressor and extensors are turned off. 
Flexion bends you forward and extension makes you upright and tall.  A bit of lower back extension curve is called “neutral spine.”  This curve is very protective and you should be careful to keep it in all postures and movements.
Flexion (especially sitting and bending) after an injury, along with twisting and reaching are dangerous because they increase pressure in the disc and tear the ligaments more.  The feedback of pain will be immediate or later, after driving a car, cleaning house, or sitting over a computer.  Ignoring the pain creates more injury, more pain and a deeper rut to get out of. 
At this point lying on the floor is the best move; but avoid twisting when getting in and out of this position.  Lying on your back with knees bent can restore front to back alignment by bringing the head back over the chest, opening the chest and diaphragm by supporting and relaxing the tight spinal muscles (extension).
Since the damaged disc is generally jammed backwards between the flexing vertebrae, lying prone or face down, on the floor is a wonderful way to persuade it to come back into extension with gentle traction.  You can use this to open (extend) the hips.  Eventually you can raise yourself a bit on the elbows as the hips open.
Gently expanding the painful range while encouraging the spine in its range of flexion and extension can be done safely doing the “cat and cow” stretch.  Get on all fours, and arch your back up while tucking the chin and tail (a C shaped curve).  Then drop the low back curve down into extension gently, while lifting the head level with the shoulders, keeping the chin tucked and pulling the shoulder blades down and back. 

Camp Fire

 REHAB PRINCIPLE III: Inflammation is behind the pain.

The cardinal signs of inflammation are: redness, heat, swelling and pain.  Inflammation is the first step in healing; but it tends to get carried away.  Inflammation is the immune system’s response to tissue damage and it is mediated by the blood vessels.  This acute phase of healing is very destructive as oxidative or burning chemicals are leaked into the area to clean up the damaged tissues.  During this time (1-3 days) the damaged tissues are very fragile and guarded by pain. 
When inflammation causes too much swelling it can hamper circulation and proper healing.  When inflammation is extended beyond the acute phase it can be very damaging and lead to chronic pain.  That is why ice is so important; do it frequently for 20 minutes at a time.  Ice is the best anti-inflammatory and an analgesic (pain reliever).  It has no side effects.  NSAIDS like Advil have many detrimental effects on the liver, kidney, and digestive system.  Also they can allow one to ignore the pain in this critical time.
An anti-inflammatory diet is very important for proper healing.  Having plenty of the good fats like fish oil, olive oil and coconut oil, in your tissues will lower your inflammatory response.  Typical French fry and chip oils in your tissues will increase the fire. 
Avoid inflammatory foods like sweets, alcohol, coffee, and refined flours.  Eat loads of vegetables and eat frequently to avoid blood sugar fluctuations.  Stay well hydrated. 
Stay tuned for part two, packed with more critical information on healing and avoiding more injury. 


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