Those of us who have been rendered unemployed by the Corona virus may be at less or greater risk of back pain. Why might that be, and what can you do about it?
If you have a heavy physical job then an enforced rest may actually help your tired overworked back, though in time your muscles will decrease in strength and this may lead to problems. If you already had a non-physical job, the lack of physical activity and long periods sitting is likely to weaken your muscles further, producing an unstable spine with consequent pain and fragility.
In normal times you could take your painful back to the GP, and Manual Therapists including my own profession of Chiropractic.
Due to the risks of spreading the virus, hands on types of therapy are generally unavailable at present. You can still access medical help but if you have to take long term medication to control back pain you may have unwanted effects.
My experience from 25 years in practice and studying research on the matter would suggest the answer is relatively straight forward. Pre-Corona Virus, if you did not get over your back pain by medical means then you would probably move to a “hands on” type of therapy. There is evidence and practical experience to show that manual treatments can help to restore normal biomechanics of the spine improving the function of muscles, joints and nervous system.
This is all very well and helps to pay my mortgage, but frequently the benefits of treatment don’t last. The missing component is Exercise and to a lesser extent Diet.
Exercise seems to be the most potent medicine and treatment for overall physical and mental health that we have. Exercise improves all of our bodily systems and has the potential to correct and prevent illness. What you eat also contributes a great deal to your health, but unfortunately food and diet has become such a political and commercial battleground that I would be a brave man to get involved in that debate. One thing that everybody seems to agree on is to avoid refined sugars and highly processed foods.
We all have a different idea as to what constitutes exercise. For an elderly person it might be a walk, for a youth it might be their football training. We need exercise to maintain and improve our circulatory system, our muscular strength and our nervous system, leading to better balance and stability. Lastly, of particular importance in the current situation, our mental health.
Exercise does not have to be a sport or a formal type of training; it can be gardening, walking to the shop or cleaning the house. You can get an exercise effect from vigorous physical activity which pushes you to the point of moderate exertion or mild discomfort. The exercise that people get with flat-out type effort found in various sports, will typically improve their sporting performance, but it can be at the cost of their overall health. The sporting elite suffer a good deal of joint and connective tissue injury, frequently with long term consequences. Many of our finest athletes are spent by their late thirties, with many years of pain and inflexibility ahead of them to remind them of better days.
Moderate exercise seems to be the sweet spot; you get the health benefits without the potential for long term damage.
Patients often ask “what kind of exercise should I do?”
It’s one of those questions I find hard to answer briefly. People often need to rehabilitate a particular injury and I may suggest specific exercises, or refer them to my Physiotherapy and strength and conditioning colleagues. Generally I try to find out what types of exercise the patient enjoys and work from there. A mixture of activities has the advantage of giving the body different types of challenge, which is preferable to doing the one activity day after day and risk causing overuse injuries. Examples might be gardening, walking, yoga and swimming.
Over my adult life I have tried any sport or physical activity that took my fancy. I used to train in kickboxing, weights, and cycling. Now I find myself sea swimming, walking and resistance training. I have been firmly mediocre in most of the sports I have enjoyed, but if I had only accepted perfection I would never have made many of the friendships nor had the mental and physical benefits. I have often been injured by random chance or personal stupidity, but have kept exercising and have treated many of my own weaknesses with exercise. We often exercise together as a family and make it entertaining, I want my children to develop a love for the outdoors and give them the tools to develop their physical and mental fortitude.
The important thing is to keep physically active regardless of your age or history. Most of us, of any reasonable age, have aches and pains and parts of the body that grumble. Don’t be put off by that. Try to keep active and you may surprised how much better you feel. Obviously I’m not suggesting you take unnecessary risks, if you have major problems get advice from a professional as to what you can safely do.
An observation from my practice is that my most elderly patients, who are still vigorous, robust and engaged in life, are physically very active and a moderate weight. Though luck and good genetics play a part, I think if you to want to remain healthy and capable you could follow their lead.
What if you have back pain right now and are in no mood to listen to me extol the long term benefits of exercise, what might you do?
During this lockdown I have patients calling me wanting to treat their own back pain at home looking for advice. The advice would depend on the severity and type of problem. And please take this article in the spirit in which it is intended – as general information and ideas, not specific advice for you.
If you have back Pain which is mostly muscular and not caused by trauma, a week of gentle activity and enough sleep should be all you need for the muscles to recover. A flexible ice pack applied with a layer of cloth between your skin and the pack for half an hour twice a day improves circulation and reduces inflammation. Gentle stretching and activity all help you recover.
If your back pain was caused by severe trauma talk to your Doctor, you may need examination or imaging to rule out serious damage. If your back pain persists for longer than a few weeks despite rest and anti-inflammatory medication, you may have a structural problem. This can be due to chronic muscle imbalance, faulty posture, dysfunctional spinal vertebra and pelvic segments. In some cases an internal complaint can refer pain to the back, but your Doctor or Therapist should be looking out for any indications of this. Treating these sorts of problems can be a longer term project and you will benefit from professional advice. In the meantime try gentle exercise, stretching, foam rolling (if you have one) or other back massaging tool, ice packs and medication from your pharmacist or GP depending on the severity of your symptoms.
Back and or neck pain with pain running down the upper or lower limbs suggests greater involvement of the nervous system, this is often as a result of longer term untreated structural problems as mentioned above. Common complaints can involve intervertebral disc and joint injuries with inflamed and irritated nerve roots. When a nerve that supplies the arms or the legs is irritated, you can frequently feel pain or unusual sensations in the limb that the nerve supplies. These nerve entrapment complaints frequently have a history of back pain for some time prior to their onset.
(Warning) If you experience a number of these symptoms; low back pain, symptoms down one or both legs, loss of power to the legs or sensation between the legs, any change to bowel or bladder control, you may have a potentially serious issue called Cauda Equina Syndrome. I mention this because, though rare, it is considered a medical emergency and you need to consult your Doctor pronto. This condition is caused by major compression of your spinal nerves and can leave long term disability if nor attended to rapidly.
Many of the patients I see with painful nerve entrapment have tried anti-inflammatory medication for some time without much pain relief. Sometimes patients have to be treated in a hospital setting with powerful drugs to control the pain. Speaking for my own practice, I would be looking for underlying structural problems that are provoking and inflaming the involved nerves, treatment can take some time and if unsuccessful would necessitate the patient consider more invasive medical or surgical help. In my experience exercise tends to aggravate nerve entrapment symptoms which leaves the patient in a very frustrating position. If you have these symptoms you need to discuss it with your Doctor, as the symptoms and lack of activity are very debilitating. If you find a gentle exercise activity you can do without provoking pain you could try a little each day. People sometimes find they can use an exercise cycle when they are unable to walk far. If you feel worse the next day then reduce or stop the exercise; if you feel better stick with it, just don’t increase activity too quickly.
This article is just brief ramblings based on personal experience; as such it is for your entertainment and does not constitute Medical advice, and is not necessarily backed by high quality research or representative of best practice advice given by Chiropractic or Medical authorities. For that you will have to look further and I will endeavour to have some suitable links at the end of this article.
Despite the limitations of lockdown, we can actively maintain and improve our health and take the opportunity to re-examine our direction in life. We might even benefit as individuals and re-enter the workplace and society with renewed purpose.