Treatment

This is the meat of it. No one can fix your back. No one. You have to do it. For a comprehensive comparative analysis of treatments, done in a scientific way, have a look at health.com. Briefly, here’s a rundown of everything I wished I knew ten months ago.

Bed Rest

No one mentions this (except the Yahoo site), but this is most important in the beginning. This period might last several weeks. In my case, I constructed a CAT 5 LAN on my hands and knees, routed from a laptop through a minihub to an NT server in another room, and so was able to get a fair amount of work done with 5 pound chunks of ice on my back while lying in bed. The main thing here is to avoid total bedrest -- you want to get up and mobile to prevent things "freezing" in position. The muscles can also lose tonicity, leading to re-injury.

Ice And Heat

This is a tough one because the process of injury necessitates different responses at different times. In general it can be said that heat provides pain relief while ice provides swelling relief. Some holistic chiropractors advise the avoidance of ice entirely. The best practice would be to follow-up every application of heat with ice in cases of muscular inflammation. Heat brings blood flow to the injured area and stimulates activity there. Ice tends to reduce swelling for the obvious reasons, but inhibits blood supply to the affected area. I might add that saunas and whirlpool baths worked much better for me than those heating pads you get from the local drug store. Atomic balm, ben gay and similar mentholated ointments didn’t seem to work for me. Capacsin, a much stronger ointment containing pepper oil gives some temporary relief.

Update 03-15-10: The latest paradigm is to avoid applying heat to inflamed areas and never to apply ice directly to any part of the body.

Pills

IBUPROFEN (Motrin or any nonsteroidal anti-inflammatory) Gram for gram the most effective pain reducer taken in high dosages. Unfortunately a study has found extended periods of high dosage increase the chances of end-stage renal failure NINE-FOLD. No joke. You need your kidneys, so taking four of those max-strength Motrin-puppies will eventually have you looking for donors. The studies charted effects of usage over four+ month periods, so you might get by rolling the dice for less than that. Maybe. Still, I know of a San Francisco bike messenger who begins his day with a handful of these guys and carries a bottle with him on his routes. Many readers have commented that Motrin was ultimately what got them through the day, and I have to admit I took handfuls of the stuff. I recall taking five maximum strength capsules in the morning, four at mid-day and another four or five at night. As time went on, it actually seemed to work better.

ACETEMENOPHEN (Tylenol) About as effective as swinging a chicken over your head. High dosages might be more effective, but this stuff wrecks your liver worse than a fifth of Old Crow.

ASPIRIN Somewhat effective in high dosages, but highly irritable to the stomach.

DOANS PILLS Useless as tits on a mule.

CATEGORY II PRESCRIPTION DRUGS (Percoset, Darvoset, etc. ) Surprisingly, these drugs are not that effective. You have to go to strictly controlled level III narcotics before things begin to feel better relative to the power punch. As for working or driving anywhere on these things, forget it. And don’t even think about drinking so much as a beer while under the influence; you could wind up very dead.

HIGH-STRENGTH MUSCLE RELAXANTS (Flexoril, Soma, carisoprodol, etc.) These force splinting muscles to stop the destructive contractions that cause pain to themselves and to surrounding tissues. Useful in the early stages. Taken orally, these tend to make ALL the muscles relax, including the involuntary muscles of the digestive system. No drinking, no driving and no moving about. Sleep is about all you can do, but sometimes that is what is needed. Can cause confusion in some people. Long term use is not a good idea. I used Flexoril with some effectiveness in the early stages, Soma during later years.

Began reusing Flexeril in recent years with more effectiveness, probably because the useage was moderated by increased knowledge of when and how to employ this muscle relaxant. Found it becomes effective when used three days in a row, but with significant residual "dopiness" long after the drug should have worn off. This drug is metabolized by the liver and processed through the kidneys so the usual contraindications are in place here Tried Soma for the more recent upper back and found it has a three hour delay with a "wammy effect" that lasts perceptibly about an hour but probably has a full 8 hours to process through the system. It appears to have less of an effect than flexeril in my personal condition. It, too, is metabolozed by the liver and processed by the kidneys. There are no known overdose deaths recorded but we have anecdotal reports of comas lasting two days when alcohol was used simultaneously. This cannot be good for you. Update 03-15-10: DO NOT MIX ALCOHOL /DRUG COCKTAILS! The typical response to muscle spasms due to trauma at Highland Emergency is to administer moderate doses of Valium, orally. If this does not work, the first reponders go to something else.

CLASS II & III PAIN RELIEVERS (tylenol III with codeine, Ultram, etc) These are never effective in dealing with the causes -- they only temporarily dull the pain. I found they can get you high enough that you don't care too much about the pain, which never goes away. Ulram had a rather strong "wammy effect". Some cause constipation, such as morphine and Vicodin. Not recommended.

Update 03-15-10: Some people swear by the Fentanyl patch, an opiate-laced gauze that allows medication to seep through the skin. This one comes with strong contra-indications for mixing with other substances.

INJECTED NERVE BLOCKS These are a new class of drugs obtainable only from a certified anesthesiologist and are typically -- in this arena -- employed for upper back and neck dysfunctions of significant severity where bone loss has occured due to trauma. Interestingly, this class is now being tried out on US casualties in the Iraq conflict and we have reports of significant success where the patient remained entirely alert and entirely pain free even as surgeons cut away massive chunks of flesh and bone from extremities. These blockers are a fascinating study in their own right, but in practical application for back pain, repeated visits are required to gain significant and temporary effect and they are very new. There is only one single researcher who has been employing this technology on Iraqi veterans.

INJECTED STEROIDS All patients reported feeling better for a period after injections, but the effects do wear off and the use of injected steroids is known to produce CP problems as well as other systemic issues. Steroids are a class of drugs, so getting this type probably is not going to help you knock Barry Bonds from his asterisked pedestal. It is pretty certain, though, that Bonds chopped a minimum of fifteen years from the end of his life by treating his pulmonary system the way he did.

ALCOHOL Allows sleep and temporary relief, but the long-term harmful effects are obvious.

HOLISTIC REMEDIES Valerian, dong quoi, sublingual arnica, topical arnica, Most of these, like valerian, are mild muscle relaxants. I would take triple the dosage to reduce the muscle splinting, and I noticed beneficial effects. Valerian and dong quoi are anti-spasmodic and will induce drowsiness. Arnica, in its cream form, had a mild temporary effect on surface tenderness. As for the tabs, you have to constantly pop 30X strength sublingual arnica tabs for it to work, but I have heard people swear by it. Arnica is often included in sports gels and arthritis remedies. The valerian had the nice side effect of being a soporific. It would take about 4 of 500 mg valerian caps to get a noticeable effect.

SEMI-HOLISTIC REMEDIES (SUPPLEMENTS: Glucosamine Sulfate, chondroitin, tumeric, flax seed, etc.

Research is inconclusive on all counts for pain relief for all but Glucosamine Sulfate, which requires a minimum dosage of 1500mg per day and a "stacking" period of between a week and a month for blood levels to accumulate. Causes stomach irritation in some 7%-10% of individuals, but otherwise no other side-effects. Many athletes swear by the stuff for handling regular workout stresses. It almost never comes in a pure form, often being mixed with other things thought to help maintain joint conditioning. I have just started taking the stuff and have noticed very little effect after a week. A topical preparation called RELEVAMINE GS claims to have an effect after only fifteen minutes, which sounds suspiciously like snake oil talk. Taking calcium and other mineral supplements will not hurt you, and may offer some assistance through improving hypotonicity, but the effects are certainly long-term.

One aspirin a day is recommended for the heart, and it probably will not hurt the back.

HOLISTIC TREATMENTS This includes virtually everything under the sun which has not been scientifically tested or proved to be effective. Some examples include Cranial therapy, Reflexology, magnetic field therapy, and a score of others. Some work for some people, but as the effectiveness cannot be documented, proven or even predicted with any assurance, you shouldn’t be spending a lot of resources on this stuff. A good massage will do more for you.

MECHANICAL SUPPORTS A back brace can be got from the local drug store for about $25.00. Get one. Wear it. It will help. In fact, it will help so well, that weaning yourself OFF of one can be difficult. I used one to get through a longish wedding and reception. It works.

Lumbar supports for chairs and automobiles vary widely in levels of effectiveness. I found that using a pillow in the car was more effective than the cheap $20.00 cushion got from Grand Auto. Chair supports vary widely in quality and angles of support. Some work. Some do not. You have to try different ones.

ACUPUNCTURE Even if it works, it does not actually resolve the cause of the pain in cases of sports injuries. It does reduce perceived pain somewhat in slightly more than half of upper back sufferers, but research on the lower back is inconclusive. All positive reports are just about as anecdotal as this white paper. For a good analysis of acupuncture’s efficacy, see healthcom.com. I did not experience significant relief from three different acupuncturists, two of them doctors of Oriental Medicine from China. An acquaintance, however, experienced significant relief from an acute episode in the upper back/neck area and experienced a nice side effect of reduced PMS symptoms.

CHEMONUCLEOLYSIS Used as an alternative to laminectomy. An enzyme is injected locally into the herniated disk. Very situational.

CHIROPRACTORS

The chiropractor has the main function of identifying real causes and ensuring that things do not get worse, and this function is the job you pay for. Any additional stuff with laying on of hands and adjustments is just icing on the cake. Typically, it is TIME that heals, and the physician in this case has the more classic medical role of assisting the healing process. Sometimes some pain relief is felt by whatever manipulations take place, but this is typically a very temporary and haphazard relief. Where one leg is longer than the other, sometimes the adjustments can begin to correct for that with shoe inserts. Ply your doctor with questions. Ask about his/her additional subspecialties. Often Chiropractors have more than one area of expertise.

Most of the mechanical and electrical devices in the doctor's office provide limited temporary relief. But consider this: you might not want a complete cessation of pain while healing, for this would be the equivalent, as one sports trainer suggested, of unhooking the oil warning light on your car while the engine was low on 10-40. The chiropractor cannot give you a pill or magically adjust you to be totally cured in one session, especially given that most back problems arose over years of conditioning. No, you cannot "adjust" yourself, as the calculated stresses cannot be self applied.

Most traditional chiropractic treatments are pretty similar. The patient goes two to three times a week until the condition stabilizes, then a regular course of visits with gradually lengthening periods between visits occurs over the next year. Typically, the first few visits provide some immediate relief, followed by some "aggravation" of tissues in the evening of the day of treatment. That means the doc makes you feel good, but then you feel pretty lousy by the evening and for part of the next day. Sometimes new symptoms occur once treatment begins.

Treatment involves physical exam and review of medical history, followed by a hands-on palpation of the affected area. The doc then bends the patient in ways previously thought unimaginable by the patient and then applies some force to produce the famous "cracking and popping" sound/feeling; this is called high velocity adjustment. Sometimes ultrasound is used on the area to help break-up scar tissue at the injury site. Electrical stimulation is applied through flat electrodes (about the side of a playing card) or through hair-thin needles inserted at specific nerve points. The sensation is of a throbbing or buzzing vibration and is not normally painful at all.

Holistic practitioners have a slightly different approach, and generally avoid high-velocity adjustments, preferring instead more subtle body-work.

Do not let an uncertified person try to adjust you. Do not try to adjust yourself. See a doctor and at least listen.

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