The immediate management of an lower back injury is incredibly important and the correct management early can take weeks or months off your rehabilitation time. Self management of back aches and back injury is an important aspect of any rehabilitation, and the initial management of back injuries can have a huge impact in the length and quality of recovery. In the case of lower back pain, there are many different things that can be done initially to assist with management. One of the easiest things to do is to apply ice to the spine to assist with decreasing the blood flow. Although, many people prefer to use heat packs on their lower back as it feels better.
So which one should you use for your back injury? Firstly, we need to look at the benefits of heat and ice on the body so that the next time pain strikes, you know whether to head to the freezer or microwave.
Ice Ice is most effectively used in the initial management of mechanical or forceful soft tissue injuries. Many people would have heard of the R.I.C.E (or R.I.C.E.R) regime. This stands for Rest, Ice, Compression, Elevation and Referral (to Physio / Doctor). Ice, along with rest, compression and elevation is used to help decrease blood flow to the affected area. With a decreased blood flow, swelling is decreased, reducing the effects of secondary damage, back spasms and promoting a better quality and faster recovery.
In the case of lower back pain and back injury, ice is always the best bet. Preventing excessive blood flow also decreases the likelihood of scar tissue formation, which has significant impact on the quality of healing and the length of the rehabilitation. Cutting down on the rehabilitation time will help prevent acute lower back pain becoming chronic.
The Problem with Scar Tissue When a low back muscle is torn, you would expect that the body would repair the muscle and allow for full movement again. In reality, this doesn't happen. The tear, or rupture, is repaired with scar tissue. Scar tissue is made from a very brittle, inflexible fibrous material. This fibrous material binds itself to the damaged soft tissue fibers in an effort to draw the damaged fibers back together. What results is a bulky mass of fibrous scar tissue completely surrounding the injury site. In some cases it's even possible to see and feel this bulky mass under the skin around the bones of the lower back.
When scar tissue forms around an injury site, it is never as strong as the tissue it replaces. It also has a tendency to contract and deform the surrounding tissues, so not only is the strength of the tissue diminished, but flexibility of the tissue is also compromised. Using Ice will decrease the likelihood of scar tissue formation, improving the quality and integrity of the tissue and decreasing the likelihood of lower back pain.
Heat Heat is effectively used to help decrease the intensity of muscle spasm, back ache, back spasms and tightness, generally associated with more chronic long term injuries. The application of a heat pack (and to a lesser extent heat based gel creams) can improve blood flow and muscle fiber flexibility, decreasing tension and back spasms and leading to an overall decrease in back aches and pain levels. Sufferers of chronic lower back spasms, back aches and neck pain will often find the application of a heat pack allows for greater freedom of movement and decreased aching.
As mentioned before, ice is used to effectively manage swelling in an acute injury. For the first 72 hours, the use of ice is very important, just as importantly is the avoidance of heat. As discussed in the previous paragraph, heat helps to promote blood flow, and heat in the initial 72 hours will further increase bleeding and swelling. However, after these initial stages, heat can be used to effectively manage swelling and other symptoms.
Following acute soft tissue injuries, no matter how much ice used, you will generally notice a localized area of swelling around the damaged tissue. This swelling is generally a waste product following the damage of the original injury. Whilst there is still swelling around an injured area, new fresh blood flow to the area, full of important nutrients and oxygen, is hampered. The use of a heat pack on the lower back can help increase the overall blood flow. This increased blood flow will help to remove the waste products with each cycle around the body - removing the swelling and improving the availability of fresh blood. Fresh blood brings with it fresh nutrients, improving the quality of rehabilitation and decreasing scar tissue formation as discussed as above.
Picture your lower back injury like a car accident (for many people, lower back pain is like a major car accident). Multiple things occur immediately following injury to the lower back. In many cases, the initial injury is only mild to moderate, but the other issues of muscle spasm, pain inhibition, swelling and scar tissue formation lead to longer and more chronic lower back pain.
When we initially suffer a back injury and cause damage to our lower back, if we do the correct things (such as ice) then excess blood flow, swelling and secondary damage is prevented. Pain inhibition of the muscles is decreased and secondary protective back spasm is decreased. If we try and work through the pain, more systems become involved in the process, more damage is caused to an already unstable joint, more swelling occurs preventing fresh blood flow to the area, more muscles will spasm to protect a greater area, and consequently more lower back pain and suffering is felt.
Longer term, heat packs do help in decreasing back aches and back spasm and assisting in increasing blood flow and removing swelling, thereby decreasing lower back pain temporarily. However, this will generally provide short term relief only and is akin to shutting the gate after the horse has bolted.
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