The time has come, it’s time to bug out. You grab your bag, swing it — OW! Something’s just pulled in your lower back, and your situation just got markedly worse.
Back problems are the biggest source of work disability in the world already. An emergency that put a lot of people in the position of having to do physical work with which they’re not familiar would not improve this situation. I wouldn’t count on your sick leave to be of much help in an emergency, either.
Best to take care of your back to start with
Bad backs are like games of thermonuclear war: “The only way to win, is not to play.” (<– a little War Games throwback for you movie fans) . What are the best ways to avoid bad backs? The single best thing you can do (broken record time, but hey, it’s true) is keep it strong. Exercise it.
Bonus: Any weight loss you get out of the exercise also helps the back. Body fat is carried more in the front than the back; too much of it puts an unhelpful forward pull on the curve of the spine.
More tips your back will like: (1)
- Be careful how you lift heavy things: bend knees and hips rather than back, make sure your footing’s good, keep the weight close to your body.
- Watch those twisting moves. The poor imaginary soul that opened this story shouldn’t have tried to swing a heavy bag into position that way.
- If you’re carrying a bag, make it one that distributes the weight evenly between the shoulders, at the least. A frame that shifts weight onto the hips is better yet. I can testify on this one: The get-home bag I keep in my car is only about 12 lbs. I tried a hike with it one day, its one strap over my shoulder, as an experiment. The shoulder pain started about a mile in. By comparison, my hiking backpack is more like 30 lbs and doesn’t hurt even through 20 miles.
- Don’t smoke. Nicotine constricts blood vessels. The little cartilage disks between your vertebrae pout if under-supplied
Shoveling is a particularly minefield for backs, I’ve found. When the shovel handle is too short, you (ok, *I*) do way too much back bending. Now I buy longer-handled shovels. Also, if the blasted ‘snow’ is actually slush, it can freeze on the shovel scoop so when you fling the shovel to throw that snow over yon, it pulls the shovel and you after it. That’s jarring.
Snow flying off the shovel, good. Snow freezing to the shovel yanks on the back.
What do you do with a hurt back?
Ok, caveat time. I’m *still* not a physician. This isn’t me giving you advice. This is me sharing some information from the literature; that’s it.
I’m going to skip the surgical approaches. There’s a whole can of worms of debate over these, but none of it’s very relevant to the sorts of situations we prep for. Nobody stocks surgical suites in their medical bags.
The old school approach was painkillers, muscle relaxers, and a whole lot of bed rest. That approach, it turns out, was bad. (2,3) Opiate addictions were the big problem from the painkiller part (with muscle relaxer abuse also an issue). Bed rest promotes disuse atrophy and does nothing to help the problems, actually leading to more disability. Current recommendations are to get up and moving as soon as feasible.
Out with the old. What else can help a back?
I’m in a part of the country rich with people who know how to do osteopathic manipulation. Spinal manipulations didn’t help people with chronic low back pain (4), but if the problem is just something has slipped out of place, the fix from manipulation can seem downright magical. I found no peer reviewed research on that one, but I’ve had a problem that had my limping for a week completely fixed in ten minutes by a ‘good hands’ osteopath.
Chiropractors do similar kinds of manipulation. I prefer osteopaths myself; they’re actual physicians with wider training; but many people get relief from a good chiropractic session.
Osteopathic manipulation can do wonders to replace something that’s gotten out of place.
Accupuncture offered temporary relief. (4) It doesn’t take much in the way of equipment either, but it takes a lot of skill. If you know a practitioner, you could stock their favorite storage food as a trade item…
Closer to hand for most of us, TENS stimulation did help some people with chronic low back pain. You can find a piece on TENS here.
Of course, over the counter pain control drugs are also helpful. Proper use is important if you like your liver, though. You can find some thoughts on overdose problems here, and a regimen Salty’s doctor recommended to him here.
Biopsyhosocial back care
None of these answers sound great, do they? Well, we don’t have great answers for chronic back pain; that’s why it causes so much disability. The best overall improvement for quality of life for people with chronic back pain has been from what they’re calling the biopsychosocial model. (5,6) Basically, this means you address all aspects of the problem: Do what you can for the physical, but also help the person cope psychologically.
I know this sounds a bit crystal-waver, but there’s some good neurobiology underneath it. Basically, pain is designed as a warning signal. The pain itself doesn’t come from the back. The back sends signals that indicate some problem. The brain constructs the pain to warn the ‘rest of us’ (other parts of the brain) that there’s a problem.
If you can convince those under-the-surface parts of your brain that these signals coming from the back aren’t really a big deal, the brain will construct less pain. Strange but true.
This is too big a topic to get deeply into here (maybe in a later post); but the idea is that reducing the anxiety and depression that come with pain really do make you feel better. It works so well this approach is worming its way into the distinctly non-crystal-waving standard medical practice. Mindfullness-based meditation didn’t reduce the pain per se, but the people were nonetheless happier and more functional. (7)
The best prescription for a back: Exercise. Again.
Yeah. I know. Not fun. Repetitive.
Also, effective. Appropriate stretching and strengthening did more to reduce back pain and related disability than any other treatment I could find that a prepper could reasonably access in a ‘no-high-level-medical-care-available’ situation.
The good news is, this approach is always available, and it costs zero dollars.
I’m going to write another post soon on what kinds of exercise, hoping to give you a better feel of how to actually accomplish the ‘appropriate’ part.
Saving the best news for last:
Chronic back pain is, as we’ve been seeing, a thorny problem. However, most injury-induced back pain is not chronic. Most of the time, pain from an acute injury — such as the probably sprain Mr. Sling The Bag from the first paragraph probably got, will resolve by itself. Using it carefully, taking anti-inflammatory painkillers and icing periodically if its inflamed will help the sore back down the road to recovery.
Some references:
1) NHS staff. (2017) Top Ten Back Care Tips. https://www.nhs.uk/live-well/exercise/top-10-back-care-tips/
2) Waddell G. (1993). Simple low back pain: rest or active exercise?. Annals of the rheumatic diseases, 52(5), 317-9.
3) Wilkes M. S. (2000). Chronic back pain: does bed rest help?. The Western journal of medicine, 172(2), 121.
4) Rubinstein, S.M., van Middelkoop, M., Kuijpers, T. et al. Eur Spine J (2010) 19: 1213. https://doi.org/10.1007/s00586-010-1356-3
5) Kamper Steven J, Apeldoorn A T, Chiarotto A, Smeets R J E M, Ostelo R W J G, Guzman J et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis BMJ 2015; 350 :h444
6) Deyo Richard A. Biopsychosocial care for chronic back pain BMJ 2015; 350 :h538
7) Cramer, H., Haller, H., Lauche, R., and Dobos, G. Mindfulness-based stress reduction for low back pain: a systematic review. BMC Complement Altern Med. 2012; 12: 162.