Video presented by Andrew Cole, MD
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I’ll frequently have patients who I’ll treat for a period of time for low back pain or low back and leg pain and we’ll go through a particular treatment with them, including the seven points you always want to make sure any good rehabilitation program has. First you want to control inflammation and pain. Then you want to work on range of motion. Then you want to work on strength training. Then you want to work on endurance and sport-specific or activity-specific training. Then you want to work on cardiovascular fitness. And those are all key points of any good musculoskeletal rehabilitation program.
Some of the other things you can do to help with back pain are ice or heat. And one or the other works with different people in different ways and one is not necessarily better than the other; it’s what works for you. There are some key points to keep in mind, though. One is you want to use them for about twenty minutes each. You don’t want to alternate them, so pick which one is best for you. If it’s ice, twenty minutes at a time. You can use the peas that come in a frozen bag and when you need it, you can form it to your low back and that’s an inexpensive way to apply cold. The other way to do it is to go out and get the plastic, gel-filled packs that are sold at most pharmacies and they can give heat or cold if you use the microwave or keep it in the freezer. The key with cold is twenty minutes at a time; every other hour is about the time limit you want. Time is important because less than that and you’re not going to get the real effect and more than that you’ll counteract the effects the ice helps with, which is to decrease swelling and inflammation. On the other hand, heat which can also be used about every two hours for twenty minutes at a time. Moist heat is better than dry heat and if you are going to use dry heat such as a heating pad, one very important thing to remember is don’t go to sleep with the heating pad on your back, even if it’s on low and fall asleep on it because the heat effect is cumulative and you can get very severe burns just from a heating pad on low that you slept on overnight. So never do that and never fall asleep on a heating pad.
Once you’ve covered those things and the exercise program that you’ve learned, back off into basic, gentle stretches and what are called isometric stretches – ones where you are tightening down the muscles, but not moving your body parts – and then gently progress through your exercise program over the next few days as your pain begins to subside. Other things you can do to help with that pain are over-the-counter anti-inflammatories, assuming you don’t have any medical problems that would contraindicate you from using them. Some of those things would include any allergies to aspirin or any of the other anti-inflammatories that may be out there or that you were given by your physician, in which case you should definitely not take any over-the-counter anti-inflammatories. If you have ulcers or reflux, you want to check with your physician first – liver or kidney problems, check with your physician first.