5 Things To Do When Your Back Goes Out

backpainHave you ever bent over to pick up something only to experience a pain like someone shoved a hot poker into your low back and then started pulling your muscles apart? Yeah, most of us have felt that at some point. Hopefully, it  never happens to you, too, but if it does, here is what you do.

  1. Stop and Breathe. You are probably feeling like your life is about to end. Most of what you are experiencing is muscle spasm. Your back muscles are trying to protect you but they have dramatically overreacted. If you can, stay where you are and do your best to let the muscles settle down. Deep breaths and relaxation will dramatically speed up the process. Have some water and wait it out.
  2. Stretch backwards. Typically, when a back goes “out” there is a disc inbetween the vertebrae that is stuck in a bulging position. Bending backwards will help squish that disc back to the center and will also shorten the spasmimg muscles. Go easy with this. Gently push into a cobra position if you are on the floor. Otherwise, brace yourself with your hands on your backside and carefully arch backwards. Do it several times in a row and often thereafter. Here is an old video for demonstration.
  3. Walk, Lie Down, Do NOT Sit. When the spasm has settled down, walk a bit. Movement will help get the blood moving which helps to settle the muscles and get the disc moving. You do not want to overdo this. Move a bit and then lie down on your back with the knees bent. The firmer the surface, the better. Sitting will be counterproductive. When you sit, you increase the pressure on the disc and stretch the muscles of the lower back.
  4. Ice. Icing helps reduce inflammation. Typically, when a back goes out, there is inflammation. The quicker you can get rid of the inflammation, the better. It is not completely out of the question to use heat. Heat will soften the spasming muscles and allow you to move. However, heat also brings more inflammation. If you decide you cannot move without heat, use it, but then move around for a while and then follow up with ice. Both heat and ice should only be used for a maximum of 20 minutes. For ice, the skin needs to get cold enough to go numb to be successful. Here are the stages of ice, so you know you are doing it right. 
  5. Go See Your Chiropractor. Once the spasms have settled down a bit, the inflammation is under control, and you are able to move, it is time to get the joints working properly and the disc back to a good shape. This is what chiropractors do best. An adjustment will get all of the joints in the area to move correctly which will allow the disc to heal properly. Get in as soon as possible before scar tissue makes that first adjustment a painful one.
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How to Treat Sprained Ankles.

Whenever I get several patients who come in with the same ailment, I always feel like the universe is telling me to write about it. When that same ailment happens to me, the hint is as subtle as a two by four to the head. Such is the case with this article.

I have had a lot of patients come in with sprained ankles lately. For me, I didn’t think it was possible to sprain my ankles anymore. The ligaments in my ankles are pretty much gone from spraining them several times playing soccer in high school and college. So much for that. I rolled it jumping on the trampoline with my kids yesterday. It usually smarts initially and that is about it. This time it continued to hurt and started swelling a little, too. So, “Doctor, heal thyself!”

Here is the protocol: First you have to remember the mnemonic PRICE. P=protect, R=rest, I=ice,  C=compress, E=elevate. I stopped jumping and walked it off. I rested with it elevated. Then, I put it in an ice bucket (protocol details below). I planned on wrapping it up but it felt stable and the swelling was down when I woke up this morning so I thought I would be alright. In fact, I walked to work today and it felt just fine.

The most important thing to do if you sprain an ankle is ice it. Ice packs on an ankle are almost useless. You just don’t get enough surface contact to penetrate to the joint. If you are going to do it, be sure to leave it on for 20 minutes. However, the best way to ice the ankle is to put it in an ice bath. Here are the steps:

1.As soon as possible after a sprained ankle get a bucket big enough to fit your foot

2. Fill it with ice about 4 inches deep

3. Fill the bucket with water deep enough to reach just below the calf muscle (higher for high ankle sprains)

4. Cover the toes with a sock if needed

5. Immerse foot for 6-10 minutes until numb.

This is not exactly fun (unless you are a masochist) so, be tough. The stages of icing are intense cold followed by aching then burning then numbness. You have to get to numbness to benefit. Some people cheat a little and put on a sock covered by a baggie. This is ok as long as the sock is not too thick and there is not an air barrier in baggie. It still has to get to numb!

If you chronically sprain your ankles like I used to, you will have to rehab them. The more you sprain a joint, the worse the proprioception or the communication between the brain and the joint. In short, it becomes dull and you are much more likely to sprain it again. I recommend standing on a wobble board for several minutes each day. That will improve the proprioception and dramatically decrease the likelihood of future sprains.

Chiropractic and the Healing Process

In this world of instant gratification, realistic expectations are often scarce. We have instant coffee, fast food, automatic deposit, etc. We demand results quickly and for most things we get them. Unfortunately, healing is not an instantaneous event. It takes time. Don’t get me wrong. I am as impatient as anyone. I like to see or experience improvement quickly. However, when it comes to healing, there is still a process.

This article was written to help you understand the healing process and what to expect on your road to recovery.

The healing process has several stages. They can be broken down into three major steps:

1. Inflammation: Whenever an injury occurs there is damage to tissue. Tissue damage causes a reaction in the body that brings chemicals to take care of the damage. It causes swelling which keeps the affected area from moving too much. The reaction also generates heat, hence the term. I like to compare inflammation to firefighters putting out a fire. They arrive quickly and start shooting water onto the fire. Though necessary, often times the damage from the water is just as bad as the damage from the fire itself. This is even more true of inflammation. If not taken care of quickly, inflammation will begin to destroy the good tissue and cause a host of other problems. For this reason, ice is a powerful tool. Controlling the swelling with compression and an anti-inflammatory diet can also be very valuable.

2. Scar Tissue Repair: After a 2-6 days of inflammation, the body starts to lay down scar tissue. Scar tissue is weak and it complicated by the fact that it is laid down quickly and haphazardly. To further the analogy of a home damaged by fire, imagine a crew going in after the water has mostly dried and quickly supporting the overall structure with whatever wood they can find. They make it more stable than it was but it is not as functional and it is certainly not as stable. Scar tissue is supposed to be a temporary process that takes 6 weeks to 6 months depending on the damage. Unfortunately, many people do not do what it takes to get beyond this stage. As a result, they easily tear the scar tissue and the process starts again. This is the cause of chronic injury.

3. Remodeling of Tissue: When scar tissue starts to act like the original tissue, the remodeling process has begun. It is critical to get to this stage if true healing is to occur. This stage can last for a long time. For some tissues, like the nervous system, the process can be so slow it is almost imperceptible. For such tissues, support therapies like hyperbaric can help. In joint,  muscle, bone, ligament, tendon, etc., proper motion and function dictate this process. You have to train the scar tissue to line up all in the same direction and act like and be in sync with the surrounding tissue. Only at this point will true healing occur.

Unrelated topic: when you make a comment on this blog, you will automatically be entered into a drawing to win free chiropractic care for April.

Ice or Heat?



I get asked quite frequently whether to use ice or heat on an aching joint. When in doubt, use ice but use it properly. I have outlined protocols for icing below. That is not to say that there are not times when heat is appropriate, but icing is almost always beneficial if done right, whereas heat can cause problems on a new or inflamed injury.

The rule of thumb is that if the injury is acute or new within the last 6 weeks or if it is an exacerbation of an injury, use ice. Heat is good for loosening up sore muscles and stiff joints. If you need to get things moving, heating for 20 minutes can be very therapeutic. Be careful though. If you heat an inflamed joint, it will feel better while it is on but the heat will increase the inflammation and not only cause more discomfort but also prolong your healing. As a precaution, I typically recommend using heat only if you are going to be moving around (ie. never before or during bed time). If you are going to use heat before bed, follow it up with ice. That way you won’t wake up feeling like you were hit by a train.

Icing is not as simple as just putting something cold on you for a little while. If done properly, it can be extremely beneficial. If done improperly, it will have little to no benefit. So, here are the rules to using ice properly.

1. Cover the affected area. Not using enough ice will not drive the inflammation away enough to make it worth the pain of icing. A nice big ice pack for big areas like the back, legs and arms is critical. Conversely, for feet and hands an ice pack might not be good at all. I usually recommend an ice bucket if the body part fits. ***I will explain those protocols below.

2. Make sure the ice penetrates. Too often, people will put a bath towel between the ice pack and the affected area. Their excuse is usually that it is too cold. They are missing the point. It is supposed to be cold! You should only use a paper towel or thin t-shirt in between.

3. Let it go numb. If the area you are icing doesn’t get numb you really haven’t done it right. When icing you should feel it get cold which should then start to burn. (Be careful not to get an actual ice burn. On rare occasion if the ice pack is too cold and it is up against sensitive skin it can burn the skin. This shouldn’t happen with most ice packs and if you have a paper towel between.) After the burning feeling, the area should start to ache until it goes numb. Once it is numb, you are done!

4. Never ice longer than 20 minutes. After 20 minutes the body sends out a signal that the area is developing frostbite and will send more blood to the area. As icing helps to drive blood/inflammation away, sending more blood in is a bad thing. If after 20 minutes the area never got numb, take it off and wait 40 minutes to ice again.

5. Wait 40 minutes before you can ice again. Make sure the affected area is back to regular body temperature before you shock it again with ice.

***Ice Bucket Protocol: Use an ice bucket for ankles/feet and hands/wrists. This is by far the best way to drive out inflammation from these areas.
1. Get a bucket big enough.
2. Put as much ice in it that will cover your affected extremity.
3. Fill it with water to the same level.
4. Cover fingers or toes with a sock.
5. Immerse the extremity.
6. Keep it moving gently to keep the water immediately surrounding from warming up.
7. Ice until numb (usually around 5 minutes).
8. Repeat once the limb is back to body temperature.