by Dr. Brian S. Seaman, DC, FRCCSS(C), FICC

Have you ever had back pain? This malady affects many Canadians during their lifetime. Did you know that nearly two-thirds (64%) of Canadians report experiencing back pain in the past year? Of those, almost 7/10 (69%) characterized their pain as being moderate to severe. In almost one-third of the cases (29%), the pain lasted a month or more. (Source: Environics, May 2003).
It is truly amazing how back pain is so prevalent in our society. It costs Canada an estimated 8 billion dollars annually in direct and indirect costs (Coyte et al. Arthritis Care Res. 1998). Much has been written about preventing back pain by exercising, proper body mechanics, maintaining an appropriate body weight, and adequate warm-up before strenuous activity to name just a few. But what should you do if you experience an acute episode of back pain and spasms?
The most obvious is to stop the activity that may be causing it. Don’t try to "work through it" – it will only make matters worse.
Rest your back – lie down; don’t sit. Sitting actually increases the pressure on the discs of your lower back. If that is the source of your problem, you can again make it worse.
Ice versus heat – This is an age old question and source of ongoing debate. If your back has spasms due to an injury or inflammation of a joint, nerve or disc, heat can actually make it worse. Yes, heat is more comfortable and soothing but ice therapy or cold packs will reduce the irritation and inflammation of the involved tissues and help to control the pain. If the spasms are resulting from these injuries, ice will be the answer.
Here is a good example of heat versus ice with an acute condition – sunburn. If you got a bit too much sun last Summer and happened to get in the shower, which would feel better on your skin – cold water? Or hot water? That’s right, cold or cool water helps to ease the irritation and inflammation of sunburned skin. Heat will irritate the skin and increase your pain level.
Heating pads can also be dangerous. I have seen second degree burns on patients’ backs as a result of falling asleep on heating pads which were much too hot.
Gentle stretching – Emphasize gentle. Muscles spasm for a reason – in reaction to an injury or to protect the back from further injury. If you are not sure which stretches are appropriate, consult with your health care professional.
Golf balls versus tennis balls – while golf and tennis can cause back pain, these balls can be used to help relax the muscles. Be cautious if you have not done this before and if painful, or seems to tighten the back muscles, discontinue this immediately. If there is a larger area of muscle involved, use tennis balls – golf balls work better for smaller muscle groups. Get in a position so that you can vary the pressure on your back with the ball, simply by changing your body position. Tennis balls on an exercise pad, or on the bed will help to minimize the pressure and may be a good way to start especially if you have not done this before. Shift the ball around to four or five areas of the spasm, leaving it in each spot for no longer than 30 seconds. Again be cautious with this approach.
Sleep and rest – Rest will help the body heal. Lying on your back with your knees bent (with a pillow underneath your knees) or on your side with a pillow between your knees (again knees bent) will help to relax the muscle and reduce the strain on the area. Many patients also find it comfortable to lie on their side with a body pillow in front of them, and place the top arm and top leg over the body pillow. This essentially places you in a well supported _ prone position which is usually quite comfortable for the back.
Back supports – these vary considerably in effectiveness and design. Unless you have a support which you have used before with success, it would be best to consult with your health care professional as to whether one would be of any benefit, and if so, which design.
Car seats and chairs – We all have to sit sometime but you have to limit the time spent doing this when you do have back pain and spasms. Sitting increases the pressure in the lower back. Also, a soft chair or car seat does not provide proper support for your pelvis and therefore increases the strain on your lower back. There are a number of various back supports, and firm seat cushions which will help to provide better support.
So there you are, a few quick tips on dealing with back pain and spasms. It is very important to keep in mind that these hints are just emergency first aid tips only. If the back pain or spasms persist for more than 24-48 hours, you should consult with your health care professional. Your health care professional will examine you and determine the best approach, not only for dealing with that acute episode, but more importantly, designing a strategy to prevent future episodes.

Originally Published in Active Woman Canada, January 2004

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