The neoprene back wrap and other parts of John's acute back pain recipe

Most mortals have more than a few flaws in their design. By middle-age you know most of them. Among mine is a bad back, a familial disorder that first manifested 25 years ago when I body surfed into the shore of Huntington beach.

So beyond my mere medical experience, I have twenty years of personal experience with (mostly) non-neurological bad backs (the kind where something tears, there's bleeding, scarring and lots of muscle pain). As in drop to the floor and lie there trying to figure out how to reach the phone. Which is why I'll pass on some hard won knowledge today, with the canes at my side. Don't follow this advice without the approval of your physician; your back may differ. You might even have a serious medical problem, though most bad backs are like mine.

Here is what works for me, It's also pretty much what's in the current guidelines:

1. Cold packs. The miracle innovation here is the TRU-FIT Ice/Heat Back Wrap w/ Gel Pack. Stick a cold pack in it (you're supposed to use the cold packs designed for humans, not the frost-bite inducing packs for picnic units). Wear it. Rotate pack every 1-2 hours, so you need 3 packs. For me 2-3 days of continuous use is important. Diabetics and elderly need to be careful of cold damage. There is a weight related problem with cold packs. Fat is a great insulator (that's one of the reasons we deposit fat under our skin). The more fat you have, the less effective the cold pack is; it becomes harder to cool the deep tissues and restrict incoming blood flow. One might be tempted to use the picnic coolers (colder stuff), but you run the risk of necrosing superficial tissue, visit to the ICU, death, etc. America seriously does need a pill for obesity; I wouldn't mind one myself.

2. Canes. $22 at Walgreens. Swear by them. Good for getting off the floor and making it possible to ambulate fast. When you need to cough, you need the cane. I use two for 2 days typically, then 1 for a week or so.

3. Meds: tylenol and ibuprofen alternating for 2-3 days then as needed. Vicodin (tylenol + hydrocodone) if you have it is very valuable for the awful first night, but no more than 1-2 days of use. You need the Vicodin on hand; when this kind of back attack hits a trip to the doctor is inconceivable (way too much pain). By the time one can travel the Vicodin is no longer needed. I used to prescribe Flexeryl to patients and I suspect it works, but I don't use it myself.

4. Sleep: on a carpeted floor, maybe with one of those very thin inflatable outdoor camping mats. Not the inflatable beds, the mats used by serious hard core hikers. Keep extra cold packs in a nearby insulated container. Also meds, water bottle and, for men, a .. ummm ..."receptacle". You don't want to have to get up if you can help it!

5. Ambulation and exercise. There are religious wars around this; extension exercises are most popular now. I do whatever doesn't hurt too much and I walk as much as I can. I skate to relieve back pain, which is insane. However, if one can avoid falling, this works very well after day 3-4. A gym elliptical exercise machine is far safer and works in a similar fashion.
I start the gym, cane at my side, on day 3. Climbing stairs often works well for me, if the decent hurts a down elevator is handy. Basically if it hurts, I do something else.

Usually by day 5-7 I can do a fair bit of exercise. I don't run ever, but biking and skating can work. It if hurts I don't do it.

6. Course? Awful for about 12-24 hours. Bad for another day. By day 5-7, if no re-injury, feeling almost well. It takes 6 weeks to have a reasonably solid back. I try to avoid heavy lifting for 2-3 months but often do it earlier (heavy for me is 80lbs, I'm a wimp). If I'm exercising properly I've never hurt my back when lifting fairly heavy items properly (straight back lift). Sitting, on the other hand, is really tough on a back. I have an Aeron chair at work (legacy of startup days) and in the acute phase I lie on the ground part of the day, ambulate often, and do phone conferences while walking.

7. Prevention? It's all weight control and exercise, and a some basic back hygeine. Sitting is bad but unavoidable. Don't push things, even light things, bent over. I knew I was due for this episode because family obligations have messed up my exercise regimen. Weight training and stretching and aerobic non-impact. Running is a very bad idea for most bad backs.

The only new prevention thing I'm going to add is using the gel pack early when I've done something dumb -- before my back "goes out" in a big way. I'm hoping early action with ice, healing activity, and careful exercise will avert major ruptures.

Update 8/1/2010: Things got much tricker later. I changed my mind on what works.