This is an update to a previous blog I posted on my "back care" took kit.
As a former occupational therapist I’m no stranger to modalities. Now as a yoga therapist, I enjoy teaching others how to create their own back care tool kit to keep their bodies pain free, agile, and strong.
As of late, I am the creator and administrator of a Facebook group, Forever Fused, that I started for people, like myself, who have had spine fusions for scoliosis surgery. We get together in a virtual hub and chat about all things rods, hardware, stiff spines, and the like. It is amazing to have a resource like this and we have learned so much from each other there.
The body-mind connection is powerful and strong. I hold on to the belief that the body is always searching for its best health, or homeostasis, and we just have to listen and support the process.
Even when the system has been "disrupted" by surgery, hardware, fusion, etc the body is self-protective and highly adaptive. The body is not designed to hold on to pain in a chronic state. There is a lot of talk in the media now about pain and its origins, just run a google on "pain is in the brain, not in the tissues."
I still hold by this motto. If it flares up, it will calm down. So when “things” get exacerbated in my body, I drag myself to my meditation mat and LISTEN. I usually learn that my Type A, overachieving nature is getting the best of me again. I find I’m overworking, overexercising, or just trying to DO more than I need to. I’ve learned this 42 year old body requires a high level of self care to run at its best. I got away with a lot in my 20s and early 30s but at some point things change. For everyone. Usually the message comes loud and clear. We just have to LISTEN.
SLOW DOWN AND REST. YOU DON’T HAVE TO DO THIS ON YOUR OWN. YOU DON’T HAVE TO DO THIS JUST PERFECTLY. PACE YOURSELF. ITS OK TO REST. ITS OK TO SAY NO. ITS OK TO PUT YOU FIRST
A flare up forces me to rest more and quiet my body. I used to get very frustrated as I like to use and move my body every day, but now I welcome these times as a respite. A time to heal and be more gentle with my activities. I welcome Restorative yoga, meditation, and pranayama (breathing) practices. I walk. I alternate activity and rest, activity and rest. AND I pull out my back care toolkit. My tools in my toolbox are a necessity! Sometimes I don’t need any of them for months as my body stays flare free. But when the back or neck gets angry I’ve got my resources.
AND here they are (drumroll ) ….
* DISCLAIMER* – This is not medical advice! Always consult your doctor to design your own unique individual plan of care. This is MY plan based on years of education and working with my own body almost 30 years post extensive spine fusion for scoliosis.
1. All activities of daily living are modified and superb body mechanics are in place. Lighten the loads, pace yourself, think energy conservation and work simplification. I make sure not to lift anything much over 10 lbs and I stop bending forward. (not forever, just until things calm down). Also, little spurts of activities at a time. For example … cleaning the house. Take it in small little segments. A little something everyday so the work doesn’t pile up and stays manageable. Small daily loads of laundry instead of huge piles. Daily routines is the key.
LISTEN at the FIRST SIGN that something in your body needs RICE. Rest, ice, compression, elevation.
I can’t say this enough. The body will usually give you a “twinge” before a full blown flare. Treat aggressively and on first sign, don’t wait or blow off that little twinge or twitch. Don’t push through it. This is very important ! ALSO, when it calms down you must go another week or two with your rest plan. We always think OK “it” has calmed down, so tomorrow I will go full speed back at the gym. Nope. Doesn’t work that way. Once pain free, go another week pain free. Then ease back in slowly, very slowly. Trust me on this one.
2. I pull out my go-to resources a Physical Therapist once gave me. These are two books I hold tightly; Treat Your Own Back and Treat Your Own Neck by Robin McKenzie. I work the protocols. (*note if you have a low lumbar fusion (fused to the sacrum) or a total cervical fusion these programs will not apply).* These programs are not designed for stenosis.
3. For a low back flare I have a few things I do including the Treat Your Own Back protocol.
A. Brace it ! Compression helps A LOT. I have a few lumbar braces (drug store variations) but I really like my old fashioned Miraclesuit girdle. It is tight and has eye hooks up the front, but fits well under clothing. The compression dulls pain sensations, stabilizes my lumbar spine area just enough, and reminds me not to move too much in order to let any inflammation cool off. If I need more compression I will wrap an ACE wrap around my lumbar spine and cover it with a compression girdle.
B. Thermacare – these things stay warm all day. Don’t buy the generic it has to be the brand name. Wear one under your compression garment. There is also a patch called Icy Hot. Ice or heat ? It’s a little confusing which to use but THIS should help you sort that out a bit.
C. Supported bridge pose. This is my go-to when my low back gets cranky. I put a yoga block on the lowest level at the level of the sacrolumbar junction and rest here for 5-7 minutes throughout the day whenever I can. It provides a tiny light traction and a gentle massage if you GENTLY rock your knees side to side.
D. TENS unit. I asked my Physical Therapist to order a TENS unit for me and help me set it up properly for use. I will always pull out the TENS if my back is cranky and I find it helps for pain modulation and muscle tension.
E. Therapeutic doses of ibuprofen. Please ask your health care provider if this is right for you.
My opinion is low back pain should clear in a few days although I’ve had a few more major episodes that lasted 6 weeks. It DID go away. The major episodes occurred after lifting something (or some little person). I don’t practice vigorous vinyasa yoga with lots of up and down, side to side movements of the spine anymore. I don’t do boot camp style exercises. My exercise choices have to be designed with little excessive spine movements and low impact/compression. The more neutral I can keep my spine while exercising or in classes the better. Classes need to move slow enough so I can use really good body mechanics. I keep the spine neutral ( a few forward and back movements are fine and healthy but too much is too wearing) and keep the core engaged. NEUTRAL SPINE! Not sure about neutral spine postures ? Check this out.
Also if you must sit for long periods of time, use a lumbar roll behind the low back (The Treat Your Own Back book has resources for those) and stand up once every 30 minutes to lengthen and neutralize the spine. Or sit on a wedge where your hips are higher than your knees. Better yet adapt your workspace to stand while at the computer at least some of the time if possible. The body likes changes in movement, so try to set a timer or reminder to get up and move periodically if you have a long day of sitting.
4. For a neck/upper back flare this is what I do: * some of these can also be applied to other areas of the back *
First off I have to figure out what flares my neck and upper back and I’ve discovered it is this:
1) long periods of working at a computer at a table (or doing anything leaning over a table). I do all my extended computer work (example composing this blog) from a recliner or the bed completely propped on pillows. I don’t hold my neck up at all, I’m resting back. I realize this is hard to do in an office situation. I rarely do desk work at a desk !
2) repetitive upper body exercises such as repeatedly lifting the arms overhead over and over again, or with weights in hand. Most recently I am well tolerating weight training with low repetitions and moderate weight.
A. I use Biofreeze or its drug store variations (tiger balm). Biofreeze is a cooling gel that seems particularly good for neck pain. Keep applying that stuff throughout the day!
B. Compression ! I love compression. Just give me a little light pressure down on those upper traps and voila. So I have this, the Shoulders Back Posture Support that I will wear when needed.
C. Therapy balls. Thank you, thank you, thank you Jill Miller for introducing me to Yoga Tune Ups. I will do the tune up rolls to the upper back, neck, and shoulders throughout the day when I need to calm tight overused muscles. It’s like having a deep massage. Which speaking of massage, get thee to a massage therapist on a regular basis!
D. I had great success after a really long muscular tension type flare up getting trigger point injections. I saw a local Physical Medicine and Rehabilitation doctor (Physiatrist) and he injected my traps and rhomboids with a lidocaine substance plus added "needling." Some physical therapists are doing needling as well and it can be very effective.
D. Kinesiotape ! I was introduced to Kinesiotape in my Occupational Therapy days when we used to tape certain muscle groups as a soft splint, or to decrease muscle tone, provide support and enhance circulation. Some chiropractors and Physical Therapists will do this but I ordered my own Kinesiotape, watched a few YouTube instructionals, and trained my husband to tape me (yep). This stuff stays on from 5-7 days and is like magic for my neck (have used on lower back as well). Sometimes I have to continuously tape for a few weeks but it works for me.
E. Topical pain prescriptions. Must be prescribed by an MD. For me the verdict is still out on the efficacy of these but some people have great results. It’s a compounded cream of a few different ingredients including a muscle relaxer, anti-inflammatory, and a few other ingredients. You rub it on the affected area four times a day. Worth a try!
F. I recommend getting a physician assessment if you are dealing with a pain flare that is not settling down in a week to 10 days. It can be helpful to have the area x-rayed or even for more depth of information MRI. An MRI will show what is going on in the disc space. It can be helpful to know if you are dealing with a herniated spinal disc, degeneration, stenosis etc. X-Rays give you limited info. Push for the MRI if your pain is becoming chronic or is increasing in intensity especially if there is numbness in an arm, hand, or shooting pain going down a leg. Many times the MD will refer you to Physical Therapy for a 6-8 week course of treatment. Ask to see a PT who is a spine specialist and give it a good try.
I hope this helps you to create your own back care toolkit. It takes a lot of work and is an investment as well, but it is definitely worth it to have a plan of action when things go awry. Keep moving, keep breathing, and practice good self care. Your back will thank you !