Tuesday, May 27, 2008

Take it easy after a flareup

For many people chronic back pain varies significantly over time. You'll have good days, good weeks, and good months, just like you'll have bad days, weeks, and months. Usually the bad periods are caused by some sort of unfortunate event (for me, air-travel is the most dependable cause of a flareup). When you have a flareup there is a perverse desire to start doing exercises and stretches right away - the very exercises and stretches you should have been doing before you injured yourself to reduce the chance of a flareup.

I've found it's very important to resist this urge. Once you have an inflamed back the surest way to make it worse is to stretch or do other unusual exercises. For instance, the two times I've tried yoga while my back was hurting, I've ended up in significantly worse pain afterwards. The same is true of times when I've tried to get aggressive with my physical therapy exercises. It appears that injuring yourself is much easier once there is some sort of acute inflammation, and many things that might normally be helpful are actually quite harmful.

This may be the reason why bed rest used to be prescribed by physical therapists. That is not the solution either. Moderate exercise actually speeds up recovery. The trick seems to be that doing the sort of movements you make every day is OK, because you know how to do them in a non-stressful way. This may be because you know from years of experience exactly what those movements should feel like, and therefor can detect almost instantly when a particular mode of movement is too much, and needs to be adjusted. For instance, going on short walks actually makes my back feel better, at least when I make sure to move very slowly, taking extreme care that each step is pain free (or at least as pain-free as possible). Because I'm far from a yoga expert, I cannot make the same sorts of judgments about the safety of the yoga poses.

So the question is, when to start doing those exercises that you so desperately want to start again, in order to help your back? The key point, I think, is that those exercises are not meant to help you recover from an acute problem, but rather to strengthen you so as to prevent future problems. So there's no hurry to start them when you are still in the acute stage of a flareup. I would advise waiting until your pain level is no longer getter better on its own, which suggests that the acute phase of the injury is over. Since pain tends to vary a lot, day to day, a good way to asses this is to ask yourself if you are significantly better (or worse) today than you were a week ago. If you can go a week without any change in pain level, then it is time to start, very cautiously, with your exercises, stretches, etc. Otherwise, what will undoubtedly happen is that you'll start to feel better, and after a day or two, launch yourself into some sort of activity which seems like it should be safe, only to find yourself in much pain later that day.

Saturday, May 17, 2008

sleeping positions

It can be really difficult to find a comfortable position to sleep when you have back pain. There are several possibilities you might try; the only way to know which works best is by experimentation.

You can sleep on your back if you have some pillows under your legs. How good this is for you probably depends on exactly which disks are having problems though. I personally find this most comfortable when I have two pillows placed just under the knees. If you don't have pillows then this position puts a lot of strain on your lower back, which can be partially reduced by spreading your legs, or bending one knee and sticking your foot under the other knee, kind of like a pillow.

You might also try sleeping on your back, but using a lumbar role just above the belt-line. Sometimes this feels good to me, but usually only when I'm in a lot of pain already. It can be tricky to keep the roll in place. One option is to use a rolled up towel, draped across the bed, or perhaps even tied around your waist (I've never gotten that to work, myself) .

Sleeping on your stomach is also pretty good; I find it's much harder on my neck, but my back likes it. It's good for short naps, especially since I don't find it hurts my neck too much then, and really relaxes my back.

In general, however, the position which I find comfortable most often is sleeping on my side, with a relatively thin pillow tucked between my knees. I almost never wake up in pain after sleeping in this position.

I encourage everybody to experiment with all the different sleeping postures. Also keep in mind that what feels good today may change tomorrow - I've switched between sleeping on my side and other postures several times, usually depending on how bad the pain is. Don't get too set in your ways, and be willing to try changing things around once in a while.

Sleeping surface - air mattresses and foam mattresses for cheap

There are many ads on TV and the radio for various mattresses targeted at people with back pain. I don't have $1000-$3000 to spend on such things, but I have found a pretty comfortable couple of solutions that cost far less.

I slept on a cheap air mattress from Walmart (the $15 kind, though amazon sells it for more) for about 4 years (actually, they wear out about once a year, so I've been thru a few of these now). Although I haven't tried a huge range of beds to compare it to, so far the air mattress is the least comfortable when I get into it at night, and yet, I awake with less back pain than with most other mattress I've tried. It's a trade-off I'm willing to accept. Given the low price I think everybody should at least give it a try. One of the big benefits of air mattresses are that you can try different levels of inflation and determine how hard/stiff you want your mattress to be. You may find that a really stiff mattress feels too hard when you go to sleep, but leaves you with the least pain in the morning.

Note that paying more for an air-mattress doesn't necessarily mean it will be better. The more deluxe models often have two chambers, one on top of the other, which means it's pretty much guaranteed to sag.

Air mattresses don't work so well if two people are sleeping in the bed, however. To replace my air-mattress I looked into foam beds, and found a model from IKEA which has about the same level of stiffness, but better suited to my current needs. It was only $250, but a bit of a leap of faith, since it cannot be returned (at least in California). I'd say that it's actually more comfortable than an air mattress on the whole, since it feels good when you get into it at night, and I don't tend to wake up in pain either, even for just one person, though it's not as adjustable, since you can't pump it up when you want an extra firm night's rest. At the least, it's tied for the comfort level of the air mattress which was my previous most-favorite mattress. Unfortunately, it's made of polyurethane foam, so it won't last forever, but after about 2 years it's about as firm as it was new. IKEA claims 10+ years of potential service, but I doubt that is accurate if you use it ever night.

I still use the air mattress once in a while - whenever I go on a trip. It's nice knowing that no matter where I stay, there will be a very comfortable mattress waiting for me in my suitcase.

Friday, May 16, 2008

Lumbar support

The McKenzie book stresses the importance of good posture and good lumbar support. They sell a polyurethane lumbar role, which you place just above the beltline when you sit. This can make sitting more comfortable. There are other more low tech (and high tech) lumbar supports however, with various advantages. Here's a complete list:
  1. Mckenzie Lumbar Roll Pro: strap makes it easy to carry. Made of foam that is soft and small enough that you can use it for extended periods of time without strain. Con: sometimes it is not big enough to provide sufficient support. The foam wears out after a while (expect to replace it every year).
  2. Paper towel role. I prefer the smaller size that typically costs about $1. For its cost, it's actually quite effective, and since it doesn't compress as much as the McKenzie role, it can be better in some situations (such as in a car with very poor lumbar support in the seats). Be sure to keep the wrapper on so it holds together. I usually keep a spare in my car, in case I'm caught without my Mckenzie roll.
  3. 2 pound bag of frozen peas. Aside from the fact that they melt and the bag will eventually leak, there's no better lumbar support. The peas are just right combination of cold, size, and flexibility. But, at most the bag will last an hour before it will urgently need to be put back into the freezer. I like to use these at home, such as when sitting down for a meal. You can reuse the bag if you freeze it again, but after enough reuses the peas will tend to freeze into a solid brick, which doesn't work so well. I find that the bag leaks a lot less if you wrap it in one or two plastic shopping bags.
  4. Rubbermaid ice blanket ($2.50 at Target). Frozen peas are great, but they melt. The ice blanket does too, but without the mess. The package is not as flexible as a bag of peas, so it may be slightly less good ergonomically. On the other hand, having a package that lasts half a day, and doesn't need to be refrozen immediately is a big advantage. I like to combine one whole blanket with 2/3rds of a blanket, and then wrap the whole thing in about 4 plastic grocery bags, as otherwise it gets way too cold.

Thursday, May 1, 2008

Digital snake oil

The internet is full of ads for quick cures for chronic back pain. Intellectually, it's easy to see that most if not all of these must be false. The reason is that chronic back pain effects millions of people. If there really was a quick (and don't forget easy) cure that worked for everybody, it would spread in popularity. Perhaps not quickly, depending on how crazy it sounds, but good results cannot be ignored. Even if medical professionals were too conservative to try it, people reading the BBSes and web forums would, and word would spread fairly quickly after some tipping point in popularity.

Emotionally, however, it's easy to hope that whatever scam you are reading about is a real cure. I found the following article about one such scam fairly helpful, however, in shoring up my belief that these get healthy quick ads are in fact scams. First, check out the website. Then read the review. PS, if you really are curious enough to sign up for the emails, be sure to use a disposable email address, such as offered by spamgourmet. I got at least 1o messages from these people before the address I fed them expired.