GHG Quick Guide To First Aid For Your Lower Back

1. My back is aching and it is very painful. Should I sit down, lie down or stand up? In what position will I be more comfortable?
   In general if your back is aching you should be careful to do each sitting, lying or standing actions in equal measures so that you are not over doing one or the other. However, another general rule is if you don�t use it you will lose strength and flexibility in it.
   
   Therefore, do each activity in equal measures but how you do them is very important. You must remember to have good posture no matter what you decide to do and this means keeping the natural curves of the spine to their shape and supporting them at all times either with your own muscle tone or by external supports such as pillows and back supports.When you are sitting it is important to note that the structures in your lower back and especially the lowest disc is under three times more pressure than when you are standing so please take heed of the advice below.
   
   If you are sitting then you must NOT slouch and please do try to avoid an overly soft sofa, try to sit in an upright supportive chair with your bottom right to the back of the seat. Put a good support like a rolled up towel or pillow in the small of your back (lower curve of the spine) and then keep your knees and ankles at 90 degrees so that your feet are flat on the ground.When attempting to sit in your car you should take into account that most car manufacturers have gone to great lengths to make their car seats ergonomic for your back. Look for these controls on your car seat and adjust accordingly. The rules are as written above, you should have a good support into the lower curve of your spine and if the seat has no adjustment then use a pillow or good back support. products for you to purchase Your bottom and knees should be level with each other, with your shoulders resting against the back of the seat without overstretching the arms to reach the steering wheel. For more advice regarding the car please read question 17 below.
   
   If you are lying down the natural curves of the spine should be supported by whatever you are lying on. Stiffness and soreness, due to protection of the area by tight muscles, occurs when there is no support and the spine is allowed to overly stretch in the wrong directions. Therefore you can lie on your back on the floor with your head and neck supported by a thin pillow and your knees bent so that your feet are flat on the floor, you can also lie on your back on the floor but with the lower part of your legs i.e. your calves resting on a chair.
   
   You can also lie on your side on a well supported mattress that does not sag, making sure that your pillow under your head does not push your head up towards the ceiling or is too small so that your head falls towards the mattress, it should be supportive enough to keep your spine in a straight line from top to bottom. You may also put a thin pillow between your knees if you feel that there is too much twist in your spine in this position. In general it is best to try and avoid lying on your tummy as this tends to put strain on the lower back muscles and forces you to twist your neck to one side or the other in an extreme position. Some patients may find lying on their front a relief, this is quite possible however, it is best to consult your GHG practitioner for further advice.
   
   When standing and your back is in pain you should avoid wearing shoes where the heel is overtly higher than the ball of your foot i.e. high heeled shoes. Your shoes should be comfortable, shock absorbent and as level as possible. This all leads to your foot, ankle and leg muscles all being comfortable and not over stretched which then leads to a more comfortable back and spine. The next consideration should be to stand on both feet with weight equally distributed between both, many people have a habit of standing on one hip or leg and this should be avoided as much as possible because this makes the pelvis tilt to one side and the spine will start to produce curves where there should be none instead of holding the spine straight.
   
   Now to put all this together stand with both feet shoulder width apart with equal weight distribution and then start to feel where your weight is mostly impacting under your feet. Feel whether it is on the balls of your feet or if it is concentrated under your heels, the pressure should be felt directly at the mid point of the arches of your feet, so you can concentrate your weight into the balls of your feet then adjust yourself so that it concentrates under your heels and then you can find your middle point by going between the two. This is where you should be.
   
   When you have found this, your legs should now begin to feel more comfortable and you should start to try to gently clench your stomach muscles and your buttock muscles so that your back starts to feel more supported and try to keep your head and neck upright and relaxed all the while keeping your shoulders level and square.
   
   
2. My back is aching and I can�t get up. How do I get up?
   You may find that you feel a lot of aching, stiffness and soreness happens in the mornings upon waking, this is usually due to inflammation. This may even happen if you decide to lie down for short periods during the day, either way the first thing to do is to try and slowly turn onto one side then apply an ice pack from the freezer for 5 minutes or so. When you have done this, use your upper arm and hand to push against what you are lying on and at the same time as you come up swing your legs off the edge of the bed. When you are sitting take a moment to steady yourself and then holding onto something stand up without leaning forwards.If you are the only person in the house you can do these instructions without using the ice pack first, but then go and get the ice pack and apply to the appropriate area.
   
   
3. The GHG aftercare sheet often advises heat and ice aftercare treatment. Which one shall I do this time?
   
   • Only heat aftercare treatment
     As a general rule you should use heat treatment when you have a gripping pain or an ache accompanied by spasms. Also heat is more effective when the pain has been there for more than 5-6 days as the acute inflammation has probably reduced by this time. Use either a hot water bottle or a heat pad wrapped in a thin tea towel and apply to the appropriate area for between 15-30 minutes every 1-2 hours.If the heat pack makes the pain worse please use an ice pack and call us for further advice.
   • Only ice aftercare treatment
     As a general rule you should use ice treatment when there is a throbbing pain, soreness or heat on the given area and also if the injury has either just occurred or has occurred within the previous 3-5 days.
     Place an ice pack/packet of peas from the freezer wrapped in a thin tea towel on the area of concern/area of throbbing pain for 10-15 minutes every 1-2 hours.
     If the ice pack makes the pain worse please use a heat pack and call us for further advice.
   • Both ice and heat aftercare treatment
     Many patients visiting the GHG find that a combination of the two disciplines above has the best effect. Therefore if there is any confusion in your mind please try this. First apply an ice pack as explained above for between 5-10 minutes on the given area and then immediately after place a heat pack as explained above again on the given area for 5-10 minutes, then stop. Wait 30-60 minutes and repeat this cycle again and keep doing so until you have seen a GHG practitioner or obtained more specific advice.
     
     
   Please Note:More appropriate instructions for your particular ailment will be advised once you have seen your GHG practitioner.
   
   
4. My back is aching, will pain killers help me and if so what should I take?
   If your pain is unbearable then you should think about taking some kind of pain relief. If your pain is bearable try to find a comfortable position until you take an appointment with a GHG practitioner. Either way the following guidelines will help you.
   
   The name painkillers are given to the set of drugs which basically relieve pain, however they do not generally fix the problem. They are usually taken if the pain gets worse during the day and paracetamol is the only one available over the counter at your pharmacy, all others which are stronger are available either from your NHS registered GP or from your GHG private GP.
   
   There are also anti-inflammatory drugs known as non steroidal anti-inflammatory drugs (NSAIDS). These drugs are taken to control swelling and inflammation of an injured area but do not generally fix the problem. They are usually required by people who suffer from pain which is worse in the mornings and after rest i.e. sitting. They are generally unsuitable for patients with certain conditions such as asthma, however aspirin and ibuprofen based drugs can be bought over the counter at your pharmacy, all other stronger NSAIDS can be prescribed by your NHS registered GP or by your GHG private GP
   
   Please Note: Please call the GHG or seek medical advice if you are unsure of what to take.
   
   
5. Shall I contact my NHS GP, GHG Private GP or visit accident and emergency?
   If your pain is absolutely unbearable then you should take some kind of pain relief either by consulting the appropriate section on this website or by calling NHS Direct if you reside in the UK.
   
   You can contact your NHS GP or your GHG Private GP if you are taking other drugs for other conditions to see if they allow you to take painkillers, this advice can also be sought from your pharmacist.
   
   You should contact your NHS GP or your GHG Private GP if you are suffering from loss of control of your bowels with back pain or if you have trouble passing urine, difficulty starting, increased frequency, dribbling or loss of control of passing urine. Also contact your NHS GP or your GHG Private GP if you are experiencing any weakness in either or both of your legs or any numbness or loss of feeling under and around your bottom. Then you should talk to NHS Direct in order to gain advice about your medication or whether you should go to the accident and emergency unit at your local hospital.
   
   
6. If I manage to sit down, what would help me be more comfortable?
   When sitting it is advisable to try to maintain or keep the natural curves of the spine supported. The best way to do this is to avoid sitting on an overly soft sofa without support and slouching your back.
   
   The best way to sit is in an upright chair with a pillow or rolled up towel in the small of your back (lower curve of your back) with your knees and ankles at 90 degrees with your feet flat on the floor.
   
   Please Note:Do not try and bend forward whilst you are sitting.
   
   
7. I am pregnant and I am in pain do I need to do anything special?
   It is especially important to get advice and treatment as soon as possible from your GHG practitioner because this is a very important time for you and your baby and it should pass as smoothly and pain free as possible. The more relaxed and comfortable you are, the more comfortable and relaxed your baby will be so please do not delay.
   
   Sometimes your baby may be lying on particular nerves and structures inside your body and you may find that turning on one side or the other relieves the pressure that you are feeling. If this is so that is great news, however, that is not always the case and pain can arise from quite a few sources especially given that during your pregnancy you may have to carry up to an extra two stone in weight and at the same time have to deal with certain structures i.e. ligaments becoming more stretchy in preparation for the birth. If you take into account that your life carries on as usual around all of these things then you must start to pay special attention to your special time.
   
   You will find that you cannot in general lie on your front and it may also be uncomfortable to lie on your back so the best thing is to lie on a supportive mattress with a supportive pillow under your head and neck. You will find that it will be helpful to put a thin pillow between your bent knees to stop your spine from rotating and twisting round, you will also find that putting a thin pillow under your belly/baby will support the weight of the baby and will stop you rolling forward.
   
   Painkillers are generally not advised and should be avoided unless and until an NHS GP or your GHG private GP has been consulted.All active pursuits around the house or work should be kept to a manageable level and you should use your knees and legs to bend from if picking something from the floor or low surface.
   
   If you have other children you should avoid picking them up and also avoid picking other heavy objects, household chores such as vacuuming should be avoided also.Please read other sections of this website for more general information which will apply to you.
   
   Please Note:All here at the GHG wish you and your forthcoming baby all the health and luck in the world for your future.
   
   
8. Should I go to work tomorrow or not?
   If you are in a lot of pain and if you feel that what you will do at work will aggravate your condition or make it worse then it is best advised not to go in. If however, your activities at home are the same as you would do at work then it might be advisable to go into work with a view to leaving if the pain becomes worse.
   
   Sometimes the stress of being at work can make the condition worse and it may be advisable to take some time off in order to recuperate fully and then go back to work when you can fully undertake your duties.
   
   Sometimes the enjoyment, distraction and self worth of being at work and part of your team and social network can play its part in aiding your recovery.
   
   Please take time to ponder over these points and seek advice from your GHG practitioner.
   
   
9. I am panicking, any ideas to calm me down?
   When you are ill or in pain one of the major factors at play is fear and this can feed your anxiety and stress levels which will make your pain worse. The first step is to understand your pain by educating yourself and going through the appropriate sections of this website to gain knowledge. When you have done this and started some self help, the next step is to bring your breathing under control. In panic your breathing becomes short and shallow and you have to change that and make it long and deep. So start by getting into as comfortable a position as you can and breathe through the nose slowly, softly and gently, in and out. Then begin to take longer breaths so that you take 7 seconds to breathe fully in and 7 seconds to breathe fully out and please do not rush this. Start to then be aware of where you are breathing from and try to breathe through your tummy, 7 seconds in and 7 seconds out. Try to put some relaxing music on in the background to help with this.
   
   
10. My whole family depend upon me how will I cook and wash up today?
    There are some things that just cannot be avoided and here at the GHG rather than just give out impractical advice that tells you to stop everything you do we understand that life has to go on. Having said that you should definitely try to avoid vacuuming as this is usually done bending forward with a twisting action with occasional lifting; this may put an undue strain on your spine and is best avoided and rather delegated instead.
    
    If your family just cannot do without your lovely food then it is best to prepare the food on surfaces high enough that you do not have to bend even a small amount. Some preparation can even be done in a comfortable sitting position outlined in question number 1. When standing in the kitchen it is best to try and wear non slip level footwear with your weight distributed evenly and use two hands to stir if you need to, you can also stir with one hand and place the other hand on a work surface to stabilise yourself. You may also find that placing one foot in front of the other with your knees bent, gives you more stability and may be more comfortable whilst you cook. You may also have to wash the dishes and the same posture would apply with one foot in front of the other with your knees bent so that you do not put too much strain in your spine. If you are intending to use a dishwasher you have to take your time and place one item at a time whilst bending your knees to get down.
    
    If you need to take pans or items from the refrigerator that are quite low then do so by bending your knees and taking the weight on your arms and not your spine.
    
    
11. Why is my back hurting?
    Have you ever heard of body language? This is basically a way of saying that your body is a reflection of what you are thinking and how you are feeling at any given time. Right now your body is talking to you and telling you it needs attention and that you have to restrict yourself in what ever you are doing until you get better.
    
    You really should give your body some respect and listen to it.
    
    Pain can come from many different things such as trapped nerves, very tight muscles or inflammation and swelling in an area where there is no room for anything extra other than what is normally already there, thus putting pressure on all those structures around it. Either way, there has been a level of damage to any one or more structures and the damage could be very light or perhaps more severe and as a result your body has reacted in a very proper and sensible way. Your body believes that if it stops you from doing certain things and activities then you will not be able to damage it any further, hence when you want to do things that your body does not want you to do, you feel pain.
    
    This is a protective stance that your body has taken and it is wholly appropriate and if you follow the general advice within this website and also visit your GHG practitioner you can be given a more specific reason and diagnosis for your particular ailment.
    
    
12. I�m worried I�ve damaged my back permanently?
    This is a very valid question and there is going to be a certain amount of worry associated with having pain. Most fear or worry comes from NOT knowing what the actual problem is and when you visit your GHG practitioner they will explain your particular injury and the way forward.
    
    Most back problems arise because something is doing too much or too little and creating more pressure on one structure than another. Therefore the first thing to address is the foundation of your body which is your skeletal system or your spine, this foundation has to be made to work properly and efficiently again. Directly attached to this foundation are your muscles, these then have to be addressed and made to work efficiently if they have not been doing so. Once these factors have been addressed you can then go on to strengthen your muscular system to a level where it can cope with the demand you place on it.
    
    Once you have had a back pain you become very aware of yourself and this is not a bad thing, this means that in the future you will heed the warning signs, like aches and pains that you would have previously dismissed, and you will then seek professional advice on a regular basis. This will mean that you take your health seriously and you will be entering the domain of prevention rather than cure.
    
    Therefore, in summary, the aim is not to get into a mindset of �always having a bad back�, instead get into the mindset that you are much more vigilant and serious about maintaining your health and your strength for the long term and your future. Please be rest assured that your GHG practitioner will guide you along the way.
    
    
13. How do I keep my back strong?
    When you have overcome your injury by having taken some treatment, your GHG practitioner will advise the correct exercises for you and your back specifically.
    
    Generally speaking, the best way to keep your back strong is to use it but not to an extreme, so activities such as walking, swimming and gentle keep fit are excellent for keeping your back strong. Remember the key is regularity not intensity, so do these activities regularly but not intensely.
    
    If you do not have a back problem and would like to keep your back strong then a sensible way to begin would be to have a back assessment at your nearest GHG clinic and make sure that your spine and foundation is mobile and flexible and that the exercises that you are going to embark upon are right for you at that time.
    
    Please note there is a section on the website with Mr Gaur�s daily exercises for a strong back.
    
    
14. Should I exercise my back? If so which exercises shall I do and how often?
    You may be asking this question while your back is hurting or while it is recuperating from an injury, in which case the answer is yes it is important to try and keep some movement in your back because otherwise it will seize up. Some time ago it was thought that you should lie on your back for ages and ages in order to recuperate, this is now proven to not work. If your back is excruciatingly painful then, of course, take some rest but not for more than two or three days within which time you should start feeling better and be able to start moving again, even if it is slowly.
    
    When you start to move, if it hurts then take a deep breath and relax and then continue to try the movement again. If any exercise makes the pain worse then either do the movements more slowly or stop doing them altogether.
    
    These exercises are for gently mobilising and stretching your back. You can do these between 2-4 times daily depending upon opportunity and severity of your condition:
    1. Lie flat on your back on the floor, always move one leg up at a time keeping the other leg flat down. Bend one knee up and hold it underneath the knee joint with both hands, now pull the knee up towards your chest and hold for 30 seconds. Then lower your knee back down slowly until it is flat on the floor. Now repeat this with the other leg. You can do this twice for each leg.
    2. Lie flat on your back on the floor and now bend one knee up and hold it underneath the knee joint, whilst supporting this leg bring up the other knee and place your other hand underneath that knee joint. Now clasp your fingers together underneath both knee joints, so that you are not straining the knees, and gently pull your knees to your chest so that you feel a stretch in your back. Hold it there, without hurting your back, for 30 seconds, then relax the stretch by relaxing your arms for 15 seconds and then pull your knees to your chest again for a further 30 seconds whilst rocking your back.
       
    3. Lie flat on your back with your arms stretched out reaching away from your body and your knees bent up with your feet flat on the floor. Now let both your knees gently fall to one side and hold this position for 30 seconds, then let both your knees gently fall to the other side and again hold for 30 seconds. You can do this twice on each side.
       
    4. Lie flat on your back with both knees bent up with your feet flat on the floor. Now put one hand on your tummy and feel your stomach muscles whilst you tighten them so that your lower back flattens onto the floor making sure that there is no gap between your lower back and the floor (You can check this by placing the other hand under your lower back). Hold this position for 3 seconds and then relax for 5 seconds and keep repeating this 10-20 times.
       
       
15. Can I have physical relations with my partner?
    The key to this answer again lies in if you don�t use it you lose it but don�t overdo it.When you have a back problem your mood can become low and can affect your confidence and self esteem. When having physical relations one starts to lift ones mood and some self esteem returns. There is also an element of gentle exercise involved here which is also good for promoting blood supply to the lower back. When suffering from an injury or illness of this nature one can become quite inward focusing and forget that there is a dynamic with the people around us so there is much to be said for making sure that you are not neglecting yourself or your partner or either of your needs. When you show each other affection togetherness ensues and at this slightly vulnerable time if your partner feels attended to and cared for then a much better mutual understanding can be attained. Their support at this time is immeasurable, remember if you give a little you may receive a lot in return.
    
    Please make sure that you are not over vigorous and well within your comfort level, but overall please communicate with your partner and explore comfortable options.
    
    
16. Will I need surgery?
    It is understandable that when you are in pain your thoughts may start to think more negatively than positively, in this instance please be rest assured that most back problems do not require surgery. The vast majority of back problems can be addressed by non-surgical treatment and most medical practitioners will guide you away from these as much as they can.
    
    However, in extreme cases there may be requirement for surgical intervention and this should not be undertaken lightly. Firstly there should be a number of tests taken such as X-rays and MRI scans and then there should be discussion between yourself, your orthopaedic surgeon and GHG practitioner making sure that all other avenues have been addressed.
    
    
17. How should I get in and out of my car and how should I sit in my car as I have made an appointment to visit the GHG today/tomorrow?
    If you find that you have to drive then firstly make sure that you have a lumbar (lower back) support or small pillow against the back of the car seat supporting the small of your back. Please take this with you to your car before you get in order to save the extra journey in case you have to go back indoors.
    
    Open your car door as wide as possible and with one hand on the door and one hand on the roof of the car lower your bottom onto your car seat, when you are sitting slowly and gently bring one leg and then the other into the car. Once in the car please make sure that your lower back is supported with the cushion and make sure that you do not have to stretch for the steering wheel or the floor pedals.
    
    Please drive as smoothly and gently as possible, allowing as much time as possible so that you do not have to rush for your appointment, brake smoothly and carefully.
    
    In order to get out of your car open your car door as wide as possible and gently swing both legs out, put your hands out onto the car for support and whilst putting your weight on your legs and arms lift yourself out.
    
    Please Note:You should make sure that any medication you may be taking allows you to operate machinery and is non drowsy.