As of Saturday, September 26, 2015
DEAR DOCTOR K: I hurt my back a few weeks ago. I’m feeling better now, but not 100 percent. How quickly should I return to normal activities? I don’t want to reinjure my back.
DEAR READER: You’re wise to be cautious. After an episode of back pain, it’s essential to properly time your return to normal activities. Too rapid a return could lead to a relapse.
But — and this is an important “but” — too timid a return can delay, or even prevent, recovery. It used to be that doctors recommended immobility and bed rest for people with a sudden back injury that was causing a lot of pain. But studies in recent years have shown that getting mobilized actually leads to better outcomes. The trick is how to get mobilized, and at what pace.
If you are recovering from back pain, it’s best to ask your doctor detailed questions about what you can do and when. In the meantime, here are a few general principles for a safe and effective recovery:
— Symptoms should be your guide. As a general rule, avoid doing anything that hurts. If you feel pain, stop the activity.
— Increase activities gradually, based on what you can tolerate. For example, you might start by doing four or five repetitions of an abdominal exercise, three times a day. If this doesn’t worsen your pain, you can increase the number of repetitions every few days — and add new exercises — as tolerated. If the exercises increase your discomfort, cut back for a while. When you’re feeling a bit better, resume the exercises and gradually increase repetitions as you can.
— Avoid twisting your trunk or making sudden off-balance movements. Try to rid your house of clutter that can trip you up.
Slippery surfaces and throw rugs are notorious for causing falls. Lifting objects while your body is in an awkward position can also cause problems. When lifting heavy objects, remember to bend at the knees.
— Exercise regularly. Even after the episode of pain has ended, regular exercise is really important in reducing the risk of recurrent back pain. Certain aerobic exercises are safer for your back than others.
These include swimming, walking or cycling (either stationary or regular). Make these exercises a part of your regular exercise routine.
Add back-strengthening exercises to strengthen the muscles that support your spine. (I’ve put examples of some back-strengthening exercises on my website, AskDoctorK.com.) Finally, add some stretching to your exercise routine. Supple, well-stretched muscles are less prone to injury.
Keep up these good habits even after your discomfort is gone. During an episode of low back pain, a person typically moves cautiously.
You’re more likely to bend the knees when picking something up, and sit down and get up with care. Such back-saving maneuvers, along with a back-strengthening exercise program, should become lifelong habits to help reduce your risk of repeat back pain.
Your doctor can prescribe treatments to help you deal with an episode of back pain — pain-killing medicines and physical therapy of various sorts. But more important is what you can do for yourself.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)