IN PAIN NOW?
THE FOLLOWING IS AN EDITED EXCERPT FROM THE ANCILLARY
TOPICS CHAPTER CONTAINED IN THIS
WEBBOOK AND THE BOOK:
IT IS PROVIDED AS A HUMANITARIAN PUBLIC SERVICE GESTURE AS WELL AS A MEANS TO DEMONSTRATE THAT THIS INFORMATION IS OF GENUINE BENEFIT TO BACK PAIN, BACKACHE, AND NECK PAIN SUFFERERS, ESPECIALLY THOSE WHO FIND THAT THEY CANNOT GET RELIEF FROM OTHER PROVIDERS. THIS INFORMATION SERVES A LARGER PURPOSE BECAUSE, IF YOUR PAIN IS LESSENED BY PRACTICING THE ADVICE GIVEN BELOW, MOST PROBABLY YOU HAVE A CONDITION THAT CAN REASONABLY BE ASSUMED TO BE BENEFITED BY THE O'CONNOR TECHNIQUE (TM) AND THE INFORMATION PROVIDED BY
ACUTE PAIN MANAGEMENT STRATEGY
If you have just injured or re-injured your back and the pain is intense, you can be said to be in "acute" back pain. Trying to do MANEUVERS, exercises, or any major movements too close to the actual timing of a forceful injury sometimes is non-productive, especially if you don't know what you are doing because often the intense pain makes every movement (even the therapeutic ones) untenable. After treating many patients immediately after a severe injury, I have learned that most of them are intolerant of any movement; so I have routinely advised rest in the acutely painful situation. This advice is consistent with the bulk of other sources on back pain treatment. Only in those other sources, they do not tell you how to rest your back, they simply accept two to four days of "bed rest" as sufficient. The following is a representative example of how The O'Connor Technique (tm) advances the contemporary knowledge and advice on back pain because, not only does it tell you to put your back to rest, but it tells you how to rest it and why.
Immediately after the onset of severe, acute, pain or as soon as realistically possible, put the involved spinal segment into the position shown in the adjacent photograph. A simple rule of thumb would be to put the affected spinal segment in the most comfortable DYNAMIC POSITION. Figure 1 shows a generically stable position for most spinal pain especially the Cervical and Lumbar region. It is easily adopted by anyone who has a couch with cushions that can be moved. However, the same arrangement can be made on the floor or bed with enough pillows. Note that most of the weight is taken off of the spine by the slight reclining pose. Letting your spine assume a comfortable, slightly bent backwards position at the site of the worse pain, intentionally re-creates all the natural lordotic (concave) curves of the spine. The disc units in pain are supported and unweighted by selective positioning of pillows and cushions that put the spinal segment in an ideal DYNAMIC POSITION. The pillows provide support to unload the discs. For discogenic pain (pain originating in the discs) taking the weight off of the damaged areas of the spine takes away some of the pain; so, if this positioning gives you immediate pain relief while you are in the position, your pain is probably originating in the discs. Notice that the hips are between the separated seat cushions because this allows them to partially hang. Of course, this position can, and should, be modified slightly to accommodate the exact site of pain, and the degree to which your area of pain is bent backwards or the amount of hanging you do needs to be adjusted to your particular body habitus. If you are bent too far backwards or hang too much, the pain might not be relieved.
AT THIS JUNCTURE, OR AT ANY TIME, IF YOU EXPERIENCE:
A LOSS OF FEELING
A LOSS OF BODY
DO NOT DELAY, SEEK COMPETENT MEDICAL CONSULTATION IMMEDIATELY
If this positioning relieves your pain somewhat, then with some degree of reassurance you can convince yourself that you, indeed, are suffering due to disc-related pain; because, if your pain is due to some other source of back pain, it is unlikely to be relieved to any substantive degree by this positioning. What is most important in getting pain relief when adopting this posture is that it shows that, with proper positioning, the pain can be significantly lessened. That is an important distinction to be made. Many other sources of spinal pain are not so relieved by changes in positioning. So, when you get relief, even if only transiently while you are in that exact position, it says that you most proably don't have one of those other conditions whose pain is not relieved regardless of the position you adopt..
So, once you are in this position, relax, rest for a few moments, and re-position the pillows to achieve the highest level of comfort. The adoption of this posture and the underlying PRINCIPLES that create the pain relief are elaborated in the webook and paperback book. Why this works to relieve pain is described in the Section on DYNAMIC POSITIONING where it further elaborates how this position can also be used to actually keep the pain from returning. You will probably find that when you leave or deviate from this position, the pain returns. The book and the webbook in the PRINCIPLES and MANEUVERS Sections explain how and why to properly get out of this postion to sustain the relief.
If you choose not to acquire the information in the webbook or book that can teach you how to alleviate the pain, stay in this position as much as possible and make it your "bed rest" position for a couple of days if bed rest is determined by your medical consultant to be appropriate. Studies indicate that the bed rest period is ideally kept at around one or two days, not to exceed four days. I have found the position depicted in Figure 1 as the best Low Back Pain alleviating position for a number of reasons. One of which is that it allows you to eat, read, watch TV, etc. without the necessity of much movement.. Should it be necessary to get up, by not being in a recline, you are already half-way there when you need to accomplish an activity of daily living. Taking yourself to a bed is okay so long as pillows are correctly used to create an equivalent DYNAMIC POSITIONING; but, since you will have to eat, and being in bed is usually boring after awhile, with this position, you can sleep if necessary but remain in a position allowing some level of function. Also, the knees, you will note, are supported in a semi-flexed position. This takes a stretching pressure off of the sacral region that can aggravate Lumbar pain.
Since you should be at "bed rest" until the severe pain subsides, do everything possible to stay immobile. I do not recommend lying in bed, flat on your back or even (as some advocate) in a fetal position with a pillow between your legs. You are free to try these positions, but they usually allow the Cervical and Lumbar spine to remain relatively flexed. Depending upon which side you choose, you could be lying such that the affected disc is put in LATERAL WEIGHT-BEARING FLEXION away from the side of the herniation, which will result in greater protrusion pressure and consequently more pain if the fissure is laterally oriented.
It would be more appropriate to call the best resting postion as "couch rest" because a couch is a better place that can allow you to use pillows to position yourself so that the affected segments can be put in the ideal positon for relief and conveniently kept that way. Realistically, the back pain sufferer is managed easier if kept in the living room and remains an actively involved family member rather than shut away in the bedroom. In essence, it is no small coincidence that this position is the one adopted by astronauts, since the gravitational forces during lift-off have to be evenly distributed in keeping with the structure of the human spine. Back pain makes gravity your enemy if you haven't figured that out by now. Since this position allows you to read easily, I would recommend reading the material in this webbook, the book, if you have it, or downloading and reviewing its PRINCIPLES while you are immobilized. Should this be your first introduction to The O'Connor Technique (tm), it is recommended that you TEST YOURSELF with the vehicle downloadable free of charge within this website. It is intended to give the backache browser the opportunity to determine if their back pain is consistent with the symptoms associated with discogenic (originating in the discs) pain. If the reader follows the links from there to SELF-DIAGNOSING YOUR DISC, one should be able to be convinced that The O'Connor Technique (tm) will be beneficial and worth the effort and risk to purchase the information.
An important consideration, at this point, when you have found some relief from the intense pain, is to consider what advice you were given by others. If that advice was not as articulate or helpful as this information or did not offer any logical means to further advance your recovery, consider that the information in this webbook is unique and not available (to my knowledge) elsewhere. Other providers probably do not understand the mechanics of back pain as well as the author of MAKING YOUR BAD BACK BETTER and cannnot hope to give you substantial relief. It would behoove you to read the INTRODUCTION Section of this webook and further decide if the information is pertinent to your concern.
When the pain is so intense that you need to be immobilized, pain medicines are not only justified but usually are a necessity. A simple guideline for using medicines during back pain episodes that are brought on by trauma or lifting wrong or "over doing it," is to take only enough to control the pain. If you are familiar with The O'Connor Technique (tm) MANEUVERS to get out of pain, you can attempt the MANEUVERS that you have found successful. Then, if the pain is not immediately and dramatically alleviated, taking acetaminophen or/and narcotic pain killers during the first few days, while also taking an anti-inflammatory medicine to get control of inflammation as soon as possible, is a good way to reduce the predictable severity. However, if the pain originates in the discs, it is a mechanical problem and the only means to extinguish the pain is with a mechanical means. The MANEUVERS provide those mechanical solutions.
If the episode is severe, the events of pain frequent or prolonged, you can expect inflammation to play a role. Don't wait until it gets well-established before acting against it with the over the counter anti-inflammatory medicines like Ibuprofen, Naproxen, Aspirin, Acetominophen, etc. For severe, sudden onset pain, it is not unreasonable to take relatively powerful narcotics so long as they are decreased in dosing at the earliest possible opportunity. There is no reason to suffer just because you fear that you might get addicted. You have to get these drugs from doctors anyway, so just mention that getting addicted is a concern of yours and request that he make certain you don't over-use them. Doctors, in general, are now reluctant to prescribe powerful and effective pain relievers because the Medical Boards and the Drug Enforcement Agency DEA has so intruded upon the practice of medicine that they fear losing their license to prescribe if they happen to fall outside of some secret computer surveillance calculation. Also, some people tend to abuse these medicines when given to excess. One way of approaching this is to make it clear to your doctor that you only need them for a short time and you have no intention of requesting repeated refills. One way of approaching this reality is to consider that if your practioner is competent at relieving back pain, there probably won't be a need for repeated narcotic pain relievers.
Once you have the pain under control and are relaxed, direct your focus to, or actually feel, your back muscles that are found on either side of the midline spinous processes (the line of bony bumps that run down the middle of your back). If the muscles are hard, enlarged by a constant contraction, and unable to relax or jerk and spasm with the slightest movement, consider obtaining a muscle relaxant from your physician. By all means, if you do, do not attempt to function normally, bend over, work, drive, operate machinery, or exercise while under their influence.
If the spasm is too significant, don't attempt the MANEUVERS until the analgesics and the muscle relaxants have had time to work or your back "quiets down" with the passage of time. Attempting MANEUVERS too soon in the presence of spasm is usually unproductive. Be patient, the spasm usually doesn't persist all that long, even if you don't use muscle relaxants. In my own experience, after an acute injury or a bad exacerbation, the first day of the pain is usually the worst; and, regardless of what you do, it decreases after that because the mind becomes accustomed to the pain, the nerve fibers get exhausted from being activated so frequently, and it doesn't seem so novel to the brain after about the first 24-48 hours.
After the spasm is controlled and the acute pain is somewhat tolerable, you may assume that it is safe and prudent to carefully perform the DIAGNOSTIC CIRCUMDUCTION in an effort to convince yourself that your pain is due to displaced disc material and/or the MANEUVERS in an attempt to re-position the disc material. Of course, this is assuming also that you failed in the opportunity to prevent pain immediately by applying the previously described PRINCIPLES or did not perform a MANEUVER soon enough to get the disc material centralized prior to its extreme peripheralization. One of the major points of this book is to raise the readers' intellect to the point where these events rarely or never happen; however, I'm enough of a realist to write this section for that, possibly inevitable, occasion as well as for those who are suffering their first episode.
The sooner you accomplish a MANEUVER to put the disc material back in place, the sooner you will begin to substantially reduce the pain. If the MANEUVERS are unsuccessful in achieving a restoration of full range of motion, it can be because spasm or pain is too great to properly accomplish them. Too, fear plays a role at this point. If you have just felt the worst pain you possibly can conceive of outside of an amputation or a gunshot wound, you are most likely very reluctant to perform any movement that may reproduce that pain. All I can do at that point is ask you to trust in The O'Connor Technique (tm) as the most highly probable method of resolving the pain and slowly proceed with the most appropriate strategy, either a simple DYNAMIC POSITIONING (like the one described above) or MANEUVER. If you follow the instructions and adhere to the precautions, you are highly unlikely to come to any further harm or increased pain overall.
The MANEUVERS can be stopped when you have achieved a return to a full range of motion. However, all of the pain may not necessarily have terminated. Don't forget, in most herniation or protrusion injuries, there was sufficient force to break cartilaginous and ligamentous tissues. That is certainly enough force to tear adjacent structures and do damage to other innervated tissues like muscle, ligament, and bone. So, don't expect the pain of that trauma to immediately dissipate simply because the disc material has been returned to its ideal configuration. In my own experience, a couple weeks is not unusual to expect these damaged structures to heal to the point that they are largely pain free. That is why the use of Non-Steroidal Anti-Inflammatory medicines (like Ibuprofen, Naprosyn, Aspirin, or Acetaminophine should probably be used continuously for at least this amount of time.