Lumbago

[yeti]

Hi,

I moved condo last week-end (nothing heavy, but many things), woke up on monday with low-back pain. Thought it'll just go away but yesterday (friday) evening the pain was barely bearable (never suffered like this before), so I decided to go to the massage salon, explaining the problem and getting their best masseuse. She focused on my legs, and did not spend more than 10 minutes taking care of my back. It seemed to be slightly better after, but I can't really tell. Today I spent the day in a car for a visa run, now it's rather painful.

So 2 questions:

- should I go back to the massage?

- should I go to swim, or should I wait for the pain to vanish before going to build back some backmuscles?

More info: I seat in an uncomfortable chair 4 hours every morning for my thai course, and then seat in my comfortable chair in front of my computer most of the afternoon. I sometimes feel better while seated, and sometimes feel better while lying on the bed.

[londonthai]

change the massage therapist - the blind one usually much better understands the body but rarely speak english.

get a good massage on a daily basis, do swim (good for any back problems), avoid sitting for longer than 30 minutes (even if it's a comfortable chair), do exercise, avoid lifting or do it with care.

hot showeres or warm bath with some epsom salts will help as well

[Orion76]

The problem with massage salons is that their staff usually have little anatomical knowledge so if you have a back injury they are likely to do more harm than good.

If the pain is really bad and doesn't go away I'd consult a physiotherapy doctor or an orthopedist before you have any more massages. The doc can give you more info about your back problem and tell you what kind of massage is safe and beneficial so you can direct the masseuse next time.

Swimming works the back muscles without putting much strain on the spine so it is a safe exercise and a good way to strengthen the back, which is beneficial if you spend a lot of time in a chair. It probably won't provide instant relief for an acute back problem but a good swim once a day will keep future back problems away.

If you don't want to see a doc then the best thing you can do is probably to lie on your back as much as possible, avoid sitting in a chair for too long and don't bend over and lift anything until you feel better. Applying heat to the sore area may provide some relief.

[Irene]

From my same experiences as yours, I will never go to a massage parlour when in pain. I read somewhere that one wrong move could make the matter worse.

Lumbago happened to me three times in the past ten years. Twice, I saw an orthopaedic doctor and was advised of leg movements ten times every now and then. Strangely enough after a few days the pain disappeared. The only pills given for the first time was only paracetemal. The second time was two years ago and I saw the same doctor, instead I had to go through professional massages for a few days with heavy billings. This hospital was recently equipped with a full-fetched equipments and personnel which could be the reasons I had to go through this sophisticated process. After a while, the pain again disappeared. (My original intention was to find out from him of the required movement that I then forgot and not to go through those high-powered equipment and well-qualified medical masseurs who are more suitable for those serious cases of near-paralysed patients).

The third time was a few weeks ago, I then decided not to see the doctor since I got the hint from him the second time that professional massage is merely to ease the pain temporary but not a cure. He even hinted that it could disappear without doing anything if you can bear the pain but it could take longer to recover. (In short, his hint was if you can bear the pain, then save your money and you don't need me. He was really professional and got along with me famously when we talked about our experience in the States). However, he advised that so long as you bear in mind of the contortion of your back with the bone close to the nerve (which is due to aging) and conduct yourself properly in lifting up your weight in a certain situation, the pain could naturally disappear. His advices were the followings:

Change your position of seating by having the back well supported by the backing of your chair (i.e. you felt the painful part being backed by stiff backing). When you get up from a chair, use your hand to lift yourself up from the seating position, (it was excruciatingly painful at first and after a few times, it became quite bearable). When you wake up, don't rush and lift up your body without any support. You should use your hand to support the weight in moving up. When you brush your teeth, support the weight with one hand and not in a floating position. When you pick up things on a floor, don't bend your body but vertically lowering down your ankle to a low position.

My third time and without seeing a doctor, I recovered within one week.During that week, I used a waist pad in tightening the painful part to ease the pain during the working hours. The pad was God-sent during those hours. That pad cost me B5000 which I used it through the doc's recommendation. But it could be far less if you get it from pharmacy shops opposite the Chula hospital.

The above is only my personal experiences and may not be applicable to you. However, definitely, if in doubt and in unbearable pain, do see a specialist who has been seeing patients of our sorts everyday. His advice is more focused to our problem.

[Irene]

The problem with massage salons is that their staff usually have little anatomical knowledge so if you have a back injury they are likely to do more harm than good.

If the pain is really bad and doesn't go away I'd consult a physiotherapy doctor or an orthopedist before you have any more massages. The doc can give you more info about your back problem and tell you what kind of massage is safe and beneficial so you can direct the masseuse next time.

Swimming works the back muscles without putting much strain on the spine so it is a safe exercise and a good way to strengthen the back, which is beneficial if you spend a lot of time in a chair. It probably won't provide instant relief for an acute back problem but a good swim once a day will keep future back problems away.

If you don't want to see a doc then the best thing you can do is probably to lie on your back as much as possible, avoid sitting in a chair for too long and don't bend over and lift anything until you feel better. Applying heat to the sore area may provide some relief.

Good advice but I am not quite sure about swimming while in pain. Perhaps walking in the water while in pain.

[FBN]

Understanding lower backache goes a long way towards treating it..

Mechanical backache arises from the small joints at the back of the vertebra (paravertebral joints). These are angled upwards and slightly inwards normally and their function is to stabilise the rotational movement of the back in the lower back area (lumbar region). The chest or thoracic part of the spine rotates as a unit as this section is "splinted" by the ribs.

A large percentage of people has a slight abnormality in this area; the paravertebral joints are angled slightly more horisontally sometimes, allowing for more movement at that particular level. The back muscles will go into spasm when "over rotation" is precipitated by overuse or excess stress through bending inappropriately or lifting heavy items the wrong way.

Bending down straight from the waist with straight legs has a leverage disadvantage of about 30:1 on the lower back. (picking up one kg of wight from this position will put a strain of roughly 30kg on the lumbar spine...)

The pain occurs when the back muscles go into spasm due to pain from overstraining a paravertebral joint.

Treatment, therefore, should be aimed at relieving the muscle spasm. Taking weight off the back by lying down with pillows behind the knees helps. Then massage or physiotherapy to try and reduce the spasm should also be done.

A good masseuse (Swedish massage NOT Thai traditional) should be able to do this. Admittedly, finding an individual with good skills is not easy but works wonders if the proper technique is applied.

Swimming in the acute phase will either not be possible and is not really indicated; it is excellent long term therapy though.

Strengthening abdominal muscles is absolutely imperative as a long term preventative measure. Avoid sit-ups from full supine position; only attempt to lift shoulders a few inches to achieve abdominal muscle work without putting further strain on the lower back.

Back pain due to disc problems are usually associated with pain or numbness down a leg. This is due to nerve root irritation by the bulging disc and should be treated with more caution and it is advised to have a expert opinion and investigations (such as MRI) done before "self-treating"...

90% of people will have lower backache at some point in time. 90% of these will clear up without any treatment given enough time. Less than 3% of all backaches may require surgery.

[yeti]

Irene: good to hear from an experienced sufferer. If it's not any better in one week I'll ask you for the contact details of your specialist. Meanwhile I'm already following most of your advices, and may look for a waist pad tomorrow.

As for swimming I got my answer: I'll wait for the pain to be gone before going back to the swimming pool.

Same goes for massage, not for now.

Thxs to you all.

[Irene]

yeti,

I just give the doctor's name in case of need. His name is Dr. Sakdi Kunluan at Samitivej Hospital at Soi 39. He is there everyday except Saturday between 10 am to 4 pm.

I hope you don't need to see him but given as a comfort and a fall-back position. Good luck! Believe me, I know how painful it can be!

[yeti]

Thanks for this .

Actually tonight it's a bit better: did nothing today except sitting on my comfortable computer chair which has a back that comes in exactly where it's needed. Never been so glad I spent nearly 10000 THB on my working chair.

[Sheryl]

As several posters have mentioned, quality of masseuses varies greatly.

All of the government hospitals and health centers offer traditional massage and all of their masseuses have been trained, particulalry with respect to low back pain as that is so common. You might try that. If it is a large hospital there will be many masseuses, ask specifically for someone with a lot of experience with lower back pain (you will see a nurse for a brief check before your massage), if it is a small hospital or health center there may be only one.

[zzdocxx]

Agree with the previous two posts.

A physical therapist or other provider who can instruct you in appropriate exercise my be invaluable.

Often degenerative changes in the disks is a predisposing factor (most of us will get this with aging). Excessive lordosis (that is, your low back having an inward curve, swayback as it were) can exacerbate the problem and result in impingement on nerves, etc. That is the reason that the exercises are important -- the aim is to basically straighten your low back by pulling your abdominal muscles "in", or tighter, and sort of pulling your butt in as well.

As for muscle spasm, sometimes application of heat for twenty minutes or so can be helpful, also massage can help with the caveat that direct pushing on the low back can increase the lordosis.

Some exercises:

1. Lying in bed on your back, pull each leg alterately to chest, fifteen times each.

2. Pull both legs to chest together, fifteen times.

3. With legs bent and feet on bed, try to push your low back into the bed (this is similar to doing a "crunch"), fifteen times.

Do these morning and night on waking and going to bed. Start out gently, don't strain or overdo it, or do anything that causes alot of pain.

Medications:

Motrin or Advil (Ibuprofen) 600mg three times a day. Take with some food as it can be hard on the stomach. If need be you can also take something to reduce stomach acid such as Zantac or Pepcid with it.

Tylenol 1gram (two extra strength tabs) three times a day. This won't do anything for the inflammation but ought to help with the pain.

Good luck!

[geriatrickid]

Sometimes back pain is a symptom of another issue. Do yourself a big favour and get a physical exam. If it's nothing, then it's time to visit a physiotherapist for some proper back maintenance and a prevention program as all the wise posters have mentioned, including Irene's suggestion of low impact water work, which has documented benefits.

[yeti]

I know exactly why I have this low-back pain: 2 months without swimming or any exercise because too much work (my work being done sitting on a chair), then carrying many things because I moved condo.

Today it's better, probably because I did not do anything at all yesterday, so that's the way to go I think.

As soon as the pain will be completely gone, then it's back to 1km swimming everyday, something I shouldn't have stopped doing.

I'll keep in mind the doctor name given by Irene, and Sheryl's advice about massage in government hospitals (never would have thought a government hospital could be the place to go for a good massage).

Thanks all for your help .

[Irene]

Just to say thank you for sharing your professional knowledge with us. I truly appreciate the input which shall be used for my future reference.

[zzdocxx]

Glad you are feeling better in any case.

[yeti]

Glad you are feeling better in any case.

So am I