FAQ About Self Care

I have tried to provide answers to some of the more common home treatment questions that we get in the office.  Obviously these are just general guidelines.  Feel free to contact the office or email me at ddavison@nespinecare.com for specific questions.  I will do my best to help you, but for detailed questions or help you may need to make an appointment.

Ice or Heat?

This is one of the most common questions I hear in my practice.  Patients are understandably confused by varying and sometimes contradictory advice they receive from friends, neighbors, family, and even health care providers.  The reason it is confusing is that there is very little clear cut evidence available.  The best evidence supports using ice within the first 72 hours following a traumatic injury.  After the 72 hour window there is little to support or refute the use of either.  Here are the guidelines I use:

• Use ice for 15-20 minutes directly over the area of pain during the first 72 hours following an injury.  Allow enough time (at least 30 minutes) for the skin to return to normal temperature before re-applying ice.  Use a thin cloth between your skin and the ice to protect your skin. 

• Use ice for new pain, the return of pain, or if a condition gets worse.

• Heat is most helpful for low-level aches and pains and muscle stiffness.

• Moist heat is much more effective than dry heat from a heating pad.

• Heat is excellent before and during activity.  I recommend the Therma-Care pads for portable heat.  They are applied directly to the skin, are easily hidden under clothing, and are effective for work, activities such as golf, and long car/plane trips.You can wear them for up to 8 hours at a time.

Stretching:

Stretching is an important component of injury treatment and prevention.  Muscles are elastic tissue.  The inherent programming of muscle tissue promotes shortening of the tissue.  This allows our bodies to stay elastic and functional through years of wear and tear.  It is why our eleastic tissue does not become worn out like the elastic in an old sock. 

There are two reasons to stretch and each one requires a different approach.

• Pre-activity - Stretching before an activity helps the muscle perform at its best length for that day.  This is generally a short duration stretch of 30 seconds for each muscle or muscle group.  Unless you have been trained in some form of ballistic (bouncing) stretch you should stick to a static stretch...that is, slowly taking the muscle to the point of stretch and holding it.

• Muscle lengthening - While you may "have always been tight" or you may feel that you are genetically doomed to tight muscles, you can stretch and you can improve the length of your muscles.  Muscles are dynamic tissue that is constantly be remodeled, repaired, and replaced.  If you place a stress on a muscle regularly and appropriately it will get longer over time.  There is no magic here...just the normal physiologic response that soft tissue has to increased tension.  In order to lengthen a muscle over time you must increase the amount of time you hold the stretch to at least 2 minutes.  If you stretch a muscle for 2 minutes several times per week, over time it will actually become measurably longer.

Remember...muscles will find the shortest length possible and stay there based on the requirements you place on them regularly. 

What should I stretch/exercise for my low back pain?

I am providing a very general list here.  If you are unsure of how to perform any stretch or exercise you should make an appointment with me for supervised instruction.  You may also be able to find examples online.

• Tight hamstring muscles are a common component of low back pain.  The hamstring group is comprised of three different muscles in the back of the thigh.  They start from an attachment to the lower pelvis and run down the thigh to just below the knee.  When the hamstrings are too short or tight they pull the pelvic bones back and down during normal activity, causing a strain on the muscles and joints of the lower back and pelvis.  Unfortunately, when we sit the hamstrings are in a shortened position and with prolonged sitting and a lack of stretching they can become very tight. 

• Tight quadracep muscles are also a problem for the same reasons that the hamstrings can be problematic.  The quadriceps group is comprised of four muscles in the front of the thigh.  They attach to the front of the pelvis and travel down the thigh to just below the knee.  When they are overly tight they can cause an unusual strain or torque on the pelvis during walking/running.

• Weak abdominal muscles are another common cause of lower back pain.  The abdominal muscles serve as the body's natural lumbar support belt.  In fact, if you were to closely examine many of the better support belts that you might find on a contruction site or in situations where heavy lifting is required, you would see that the belts are designed to mimick the abdominal muscle structure.  The primary exercises for these muscles are variations of the abdominal crunch and pelvic tilt exercises. 

The following videos will give you good basic information about a safe stretching routine for your lower back:

 http://www.youtube.com/watch?v=RMjQUgavoY8

 http://www.youtube.com/watch?v=qYK02msRe4I

What can I do for my neck pain?

• The neck is much more complex than other areas of the spine.  There is a dramatic increase in range of motion and complexity of movement in the neck as opposed to the rest of the spine.

• Gentle stretching in all directions is helpful.  However, you should avoid rolling you head around your shoulders in circular patterns as a way to stretch.  That is a very complex set of movement patterns that is not recommended for anyone with neck pain or dysfunction.  Instead start from a neutral position facing forward and move in a single plane to the end of a motion (ie. forward, backward, side-to-side, and turning right or left)

• The most important thing that can be done at home/work to help with neck pain is usually to correct posture.  We tend to slump forward, which causes the chin to jut out and the shoulders to round forward.  This posture takes the weight off of the spine, where it is normally supported by a column of bone (the spine) and instead places the responsibility of holding the weight of the head on the small muscles of the posterior neck and upper back.  As you sit up straight the head naturally returns to its correct place above the spine and the shoulders returns to their normal position. 

 The following video links offer four safe and effective stretches that can be performed at home:

 http://www.youtube.com/watch?v=Fwlk7vk3XFo

 http://www.youtube.com/watch?v=s0MZzOYrUOE&feature=related

 http://www.youtube.com/watch?v=FcXISLEZLjo&feature=related

 http://www.youtube.com/watch?v=8jj4fyxq0a0&feature=related

Do I need and MRI? Why don't I need an MRI?

You may well need an MRI at some point.  However, it is helpful to acknowledge the uses and limitations of this diagnostic tool.  An MRI should be thought of as a roadmap for a surgeon.  It is not an effective first line screening tool for pain.  The guidelines I use for the use for the use of MRI is as follows:

• Is the clinical presentation unusual or does it point to a serious underlying condition?

• Will the outcome change the initial clinical treatment plan?

• Has the patient undergone a trial of conservative trweatment without significant improvement in the condition?

    Reasons to avoid MRI:

• An MRI is a static picture of anatomy.  Even if we see a disc bulge/herniation, bone spurs, or other ominous sounding findings, we can't be sure they are the cause of your pain.  They may play a role in the pain but knowing they are there doesn't change how you are treated initially.  Had we done an MRI a month before your pain started, chances are it would have looked the same.  We know that 35% of people without pain or a history of pain have abnormal findings, such as disc herniations, on an MRI. 

• False findings are a big problem.  It is not uncommon for the MRI to come back completely normal in the area being evaluated but to have an incidental finding somewhere else in the area.  The radiologists do not evaluate you physically.  They only have a picture.  To protect themselves they recommend further testing to rule out serious problems even though there may be no other indication of a problem.  The tests are done, much money is spent, and the tests come back normal...or the follow-up tests find another incidental finding and the merry-go-round keeps going.

• An MRI can be a very uncomfortable procedure.  If you are at all clausterphobic it can be miserable.  My favorite line from a ptient after an MRI was, "I would rather die from whatever it is they are looking for than to go through that again."  You must be lie flat on your back and be complately still for up to 45 minutes.  For someone with back pain this can be very painful.  We try to avoid putting our patients through the experience if it can be avoided.