FAQs

SOME SIMPLE RULES TO SPEED RECOVERY

By Dr. Fagerstrom

One of the most frequent questions we get day in and day out is the heat or ice question. At times it is not 100% certain which is best, but I’m going to hopefully simplify the decision making process in a way which you can remember.

PAIN BASICS: In our muscle and skeletal system we have different basic types of pain nerve endings which sense either compression or stretch and then fire off a pain signal. Some are slow to fire and others are quick, and some are slow to adapt while others are quick. So if you miss a stair and jam your lower back you might have some pain right away and more a few hours later.

Another basic is the closer a nerve ending is to the surface, the easier it is for the brain to locate the source. Consider a mosquito bite for example and you know exactly where to swat. With a toothache it is often hard to know exactly which tooth is aching. When you have a belly ache lots of times it hurts in a general region, as is true with your low back pain. The deeper the more general and less precise.

PAIN/SPASM CYCLE: Pain produces muscle changes in how we stand and move, which most of the time leads to stress on other muscles, tendons, ligaments and joints and subsequent muscle spasm and fatigue. Muscles which are too tight demand more nutrition to do their work, and at the same time the tightness crimps down on the blood supply and drainage system. Pain produces postural inefficiencies which cause more pain, more spasm, more congestion of waste products, more pain, and on and on. This is called a negative feedback cycle and tends to self perpetuate. Another example in nature of a negative feedback cycle is the forest fire. A bigger fire creates more wind which creates more fire, more wind, more fire, and so on.

PAIN IS A BIOCHEMICAL EVENT: Our life processes are essentially electrical and chemical. The reason medications aid in controlling pain is that pain is a chemical process. If we can alter the chemistry of pain we can help control it. Control of pain is super important because of the cycle described above.

ICE BASICS: If you know you have hurt yourself, that is, you suspect there is tissue damage...you pull a muscle or miss a step or fall, etc. then ice yourself for twenty or thirty minutes at a time. Do not ice for an hour or two, and repeat. You can continue this pattern for the first day or two safely. Think of the two “I” words: ICE goes with INJURY. And to repeat: twenty to thirty minutes on... an hour or two off.

Ice will slow chemistry which in turn will slow pain impulses. Think of the battery in your car. When it’s cold your nearly worn out battery won’t turn the car over very well , but the old battery works fine in the summer. The same is true with your pain nerve endings. They will fire less frequently when they are cold. In the event you can think of no real injury but you are hurting its safe to ice as described above for pain relief.

HEAT BASICS: Heat dilates blood vessels and brings blood into the painful area. Its advised to NOT use heat on an injured area even though heat feels good to the skin and muscles. In the event of injury and tissue damage heat increases swelling and will increase recovery time. Putting heat on an injury works about as well as trying to put out a fire with kerosene. The increased blood supply will feed inflammation just as the kerosene will increase the flames.

If you are just sore for some unknown reason then heat might be best. Heat can loosen up tight muscles, ligaments, and tendons. Think of the two R words ...SORE goes with WARM . The pattern is the same: 20- 30 minutes on and an hour or two off. It’s also considered safe a couple of days after an injury to begin heat.

WHEN NOT SURE: Use ice. Ice can never harm and usually is helpful because it relieves pain. Sometimes it will make a tight muscle even tighter and if that happens, switch to heat.

COMMON SENSE: Whatever you choose, just ask yourself after a couple of applications....did it do any good? And if you conclude that things seem worse, then try the opposite. Remember ICE -INJURY;.... SORE....WARM. And of course, please feel free to call anytime and ask for home care advice.

You’ve hurt yourself and iced it, or just are sore and used warm .....what else can you do to help yourself recover the quickest?

Lets consider the low back first. Compression forces on the low back are increased in the sitting position, and reduced when standing or lying. If we could assign a relative scale, in a lying posture a “1" would be given, standing the scale would go to “2.5" and in a sitting posture the scale would go to “5". Repetitive bending at the waist with arms outstretched or rotation of the torso would be even worse.

Usually lying on the side with the feet curled up (a fetal position) is most comfortable, or lying flat on your back with knees bent at 90 degrees. Sitting in a recliner is usually better than sitting upright, but the angles of a car seat tend to be worse than an upright kitchen chair.

Changing postures from sitting to standing or lying to standing is always tough. It has to do with the angle of the pelvis, spine, and hips and how the angles change when postures change. It is never fun to change postures and when it hurts you shouldn’t get too alarmed. It is just the way it is.

When you change postures and you get sharp pain there is often a corresponding reflex which makes you want to collapse. This is a normal protective response (although dangerous) for which you need to be prepared. It is a good idea to get up slowly and be ready to support and steady yourself with a wall, nearby furniture, a cane or crutch, or whatever. Again you should not get too alarmed by the collapsing reflex. It is just the way it is.

Usually with low back pain it is possible to find a posture which is fairly comfortable. It’s important to get in that posture and avoid pain because of the pain-spasm cycle discussed earlier. If you use your will power to attempt to work through your pain it often will just get worse and be more difficult to fix.

With neck pain it is often impossible to find a posture which is pain free. A bad neck can hurt while sitting upright, standing, or lying. Again it is important to find the best position because of the pain-spasm cycle.

The Medical College at Ohio State University received a grant of our taxpayer monies and published a study about a year ago relative back pain episodes. The conclusion was that the resulting postural compensation, adaptation, and altered gait and stance from back pain frequently cause as much pain and need for rehabilitation as the original injury.

I could have saved them some time and effort and money on that one. That is a fundamental principle of chiropractic biomechanics and practice. Just a month ago I got a sore big right toe from a treadmill workout with a steep incline. Instead of stopping I kept going to try to work through it and ended up with a sore left hip. Was I surprised? Not at all,.... by trying to keep weight off the toe some other body structure had to pick up the mechanical slack. Compensation and adaption are by in large a subconscious process and controlled by reflexes.

This is a true story. I had a fellow in pretty good shape for his age of 70 come in with a low back pain which had bothered him for a couple of weeks. It was getting worse. He denied any accidents or injuries. I worked on him and he left. The next day he called and he was a lot worse.

After his adjustment he played cards for three hours. When he stood up he said he could hardly straighten up, so he struggled into the car and drove home and then sat with a heating pad for several hours. The next morning he could hardly get out of bed.

Home care could have made a big difference. Ideally he would have avoided sitting, and used intermittent heat in a lying posture. After a couple of applications if he felt he was getting no benefit he should have iced intermittently. The sitting and constant heat helped make him worse.

One last thing: we human beings are oriented to the sun so that whether we have a sore throat or a bad low back things tend to be bad first thing in the morning. When the sun is high in the sky, things tend to be some better. And a couple hours after sun down things can get worse again. It is important to consider time of day and how you feel and compare mornings to mornings, afternoons to afternoons, and nighttimes to nighttimes. Often I see patients who feel quite a bit better during the day, then wake up stiff in the morning and get discouraged. They shouldn’t. It is just the way it is.