Lower back pain + new week-long teaching gig. Help?
September 11, 2010 8:42 AM   Subscribe

Intense lower back pain, and he's going to be flying out of town and standing all day (teaching) in a relatively new job all next week. It's Saturday, and he leaves for Rochester tomorrow. What can we do?

D has the kind of back for which he exercises regularly. Usually he feels great, but he has to be careful. Yesterday he suddenly felt a pang as he stepped over a threshold and had to change balance unexpectedly. Now, he feels fine if he's laying on the floor on his side, not so great standing, not so great sitting. It's generally in his lower back area, on both sides, not radiating down a leg.

Sleeping was great, and he felt no pain when he woke up until after his morning shower -- but some pain ever since then. He suspects that the pain, which is pretty bad but bearable, is worse with fatigue. It slowly got worse while standing at a meeting this morning, and got slightly better while driving home.

He flies from Raleigh to Rochester NY tomorrow morning. This is for a relatively new job that he *loves* in which he stands up in front of a class of programmers and managers (teaching about programming methodologies, FWIW). The class is Monday through Friday, and he's otherwise not used to standing all day.

Now we're considering going to an urgent care facility, to ask for -- what?

Any techniques or drug recommendations to get through traveling and teaching this week?

Can anyone recommend specific urgent care facilities or doctors in or near Chapel Hill, NC? There's one nearby on 54 which is our default.

Finally, any recommendations for someone to consult if he needs help while he's in Rochester?
posted by amtho to Health & Fitness (27 answers total) 5 users marked this as a favorite
Sounds like sciatica. If I were having those symptoms, I would be taking vitamin I (Ibuprofen)
at the maximum allowed rate, eschewing alcohol, and taking progressively longer walks.

Sitting in a hot spa, away from the force of gravity, provides temporary relief for me. As to
standing all day, it'll be very difficult. Sitting in a tall stool, or leaning over on a desk so that
your back is shaped more like a suspension bridge than a column might be ways to cope.
I've noticed that being on "all fours" (hands and knees) also brings some relief.
posted by the Real Dan at 9:00 AM on September 11, 2010

Here's what I've found useful for my back pain:

1. Fish oil supplement
2. Glucosamine/condroitin supplement (I like Schiff Move Free Advanced)
3. Ibuprofen or naproxen (I prefer naproxen because its 12-hour dosing schedule works well with...)
4. acetaminophen (6-hour dosing schedule)

An NSAID such as ibuprofen or naproxen can be taken with acetaminophen, because these classes of drugs relieve pain in different ways.

Do not take more than the recommended dose of acetaminophen and do not drink alcohol.
posted by kindall at 9:05 AM on September 11, 2010

Something that might help:

Take some socks and stuff them into each other, then loop them around so that they form something about the size, shape, and consistency of a bagel, but with a slightly larger hole.

Have your husband lie down flat on the floor (not a squishy couch or bed) with his neck supported comfortably by a pillow and his knees bent up. Have him position the sock bagel under his sacrum, and rock his knees/hips back and forth just a bit to relax onto the sock bagel until it feels right. Then he can work his legs down flat on the floor, bending and straightening his knees.

This will let the iliacus and psoas muscles relax, which ought to relieve a lot of the lower back pain, at least temporarily.

And if it hurts at any point, for godssakes stop. But it shouldn't, except for the tightness you always feel when angry muscles are relaxing.
posted by phunniemee at 9:13 AM on September 11, 2010 [4 favorites]

This is going to sound crazy but riding a bike or exercycle helped two friends almost immediately with sudden flare-ups of sciatica. I think it might be muscle relaxing in the same way that phunniemee upthread recommends. Good luck.
posted by Elsie at 9:17 AM on September 11, 2010

Response by poster: We're not sure, of course, but it might be more of a pulled muscle thing than sciatica. It's definitely not going into either leg, and it's diffuse and symmetric on both sides of the spine.

We're definitely going to the urgent care center this afternoon, but we would love to have some more clues beforehand. Thanks for the answers so far!
posted by amtho at 9:22 AM on September 11, 2010

I have a hunch it is not sciatica and more likely muscular due to the absence of leg pain, presence on both sides and its intermittent nature. Keep moving, ibuprofen alternating with acetaminophen ( they work on different pain receptors) and what ever makes him feel better. As to the plane?????. While teaching let the students know there is some back discomfort and do what he needs to do to be as comfortable as possible. Short of lying down I would imagine the students will be very accepting. I rather doubt a visit to the urgent care center will offer much other than a prescription for a controlled analgesic. Nothing wrong with that but I personally would rather risk being slightly under medicated for actual teaching times. Best of Luck and I hope pain is minimized.
posted by rmhsinc at 9:29 AM on September 11, 2010

I get inflamed muscle problems like this, and misstepping off a kerb or tripping is not uncommon in setting them off. I am afraid the bad news is it typically takes 24-48 hours for the spasm to proprly kick in. If this is the case then he might have to think about (a) not flying and (b) not making it to work this week. So think about whether it is worth giving work a warning that ths might happen, start in on the Ibuprofen and be ready to get to a doctor as soon as possible with the aim of getting more powerful anti-inflammatory and pain killing drugs as appropriate. Good luck, I hope its not too bad an edpisode.
posted by biffa at 9:30 AM on September 11, 2010

Sciatica usually radiates down the leg, so it's a good sign that that's not the case.
Ibuprofen (in the highest safe dosage) and heat for the short term. Also, he should do something fun and relaxing, because back pain often has psychosomatic components, and the prospect of a new job might be stressing him out. Is there a really silly movie that he hasn't seen for ages and that would make him laugh? Rent it, and get some good food. And try not to worry about the back too much, that makes it worse, in my experience.

Also, I'm sure his "students" would understand if he has to sit down from time to time because of his back. Lots of programmers have back problems, right?

[Long term, Vitamin D in high doses has really helped my lower back pain and sciatica. It sounds strange, I know, but give it a try.]
posted by The Toad at 9:33 AM on September 11, 2010

Oh gosh, and as far as standing up to teach in front of his students--he should do whatever HE needs to do to feel comfortable. His students either won't care at all or find it endearing (there is always that one girl who feels personally victimized by anything even slightly out of the ordinary that a teacher does, but no one likes her anyway and he shouldn't cater to the weenies).

I had a professor once teach while actually lying down on a dissection table because he had thrown his back out the night before dancing with his wife at their 50th anniversary party. I had another professor get a leg cramp in the middle of class and actually start doing lunges and ballet stretches up on the chalkboard tray without breaking lecture. As long as he's teaching the material, what he does with himself doesn't matter at all.
posted by phunniemee at 9:35 AM on September 11, 2010 [2 favorites]

BTW, In my post I said keep moving--What I should have said is keep active and moving as long as pain is tolerated. I want to second riding a bike if possible. Down under bars or straight bars put the back in an almost perfect anatomical position. With the encouragement of my surgeon I biked from Ohio to NY 7 weeks after back surgery.
posted by rmhsinc at 9:45 AM on September 11, 2010

Response by poster: Thanks, punniemee! I think it's good to encourage him to take care of himself. He also said the sock bagel sounded very interesting. Not sure whether something like ballet stretches or laying supine would be without negative consequence in the corporate environment he'll be in.

We'll try to stay mellow and ask about good pain meds.
posted by amtho at 9:47 AM on September 11, 2010

IANAD, and you should see yours. My back pain started in my back. After some time, it ended up in my legs, and could only be resolved by surgery. Granted, work interferes, and new jobs are kind of sensitive.

Basic stuff? Treat Your Own Back, which you can find on Amazon. It's from the McKenzie school of spine/sciatic treatment, and it has worked well for me. First rule: if it hurts, stop. If it is anything to do with spinal/disc issues (which can happen at any age), waiting until an action hurts to stop doing it just means you've caused damage to that part, and it will take longer to recover from.

First thing for stretching is that you have to wait. First thing in the morning is bad. Take your shower, get warmed up before you do anything. The basic safety/recovery position is face down on the floor, arms at your sides for at least five minutes. If you get symptoms (pain) in the legs, move your legs to the side (away from the pain) until the pain subsides. After you're stabilized, lifting yourself up to rest on your elbows (stretching the back) is the next step.

If that can be done without pain, the next step is flexing the leg. Exercises involve lying on the floor, then hooking a towel under one knee. Lift the leg by the knee with the towel until it's perpendicular to the body, then extend the leg outwards (again, until you feel a stretch, not pain). Switch legs and repeat. Sitting with your back extended (super posture), slowly extend one leg straight out, then relax, then extend the other leg in the same way.

For me, standing for long times can be difficult. In the class, if standing starts to cause pain, maybe it would be good to organize the class in a way that has periodic group work. That way, you can instruct the students, then have them break away, giving you a chance to grab a seat to get your back in order before you wander around to consult the groups. If you feel the need to cover for your back pain, futzing around with a grade book is a good way to look busy while sitting to rest your back.

Seriously, as soon as possible, see a doctor. I waited for a year with back pain, and by the time things got too bad to cope with, I needed surgery. Surgery is always dicey. Back surgery is doubly so.
posted by Ghidorah at 9:52 AM on September 11, 2010

Stretch stretch stretch. Nice long stretching routine in the morning and before bed, and then try to sneak in some stretches mid-day (in the bathroom or whatever).

Most people want to use heat on muscle pain, but cold is really your friend. Really cold. He needs a bigger ice pack than you can get at the drug store - I love these ColPacs. Ice is not really fun the first few times, but I promise that if he suffers through it 20 minutes a day for a few days, it will begin to really feel awesome.

You said you're going to Urgent Care - see if they will rx an arthritis pain reliever...my dad likes Relafen (available generic), I prefer Celebrex. Neither are recommended for long-term use because they can cause stomach or heart issues, but they can be a lifesaver for acute pain!

Also see if he can get a deep-tissue massage scheduled when he's in Rochester. That can help really loosen things up.
posted by radioamy at 9:56 AM on September 11, 2010

Oh and the sock bagel does sound nice...personally I use a tennis ball but I can handle a lot of pressure!
posted by radioamy at 9:57 AM on September 11, 2010

There is exactly one thing that works for me on the yearly occasions that this happens: Muscle relaxer + hydrocodone.

The first time I hurt my back, I went to see a doctor who flat out refused to prescribe narcotics for back pain. This was fine with me; I didn't really want to take a bunch of drugs anyway. So I spent months in pain, seeing physical therapists and chiropractors my doctor recommended, none of whom helped at all. During this time I couldn't sit, stand, walk, or lie down without pain. Sleep was nearly impossible, and I'd go for days without it.

Finally I went to Quick Care one day when my real doctor wasn't available, and they gave me a few muscle relaxers and some hydrocodone. Within 2 days (sleeping with my legs up) I was pain-free.

In my case, the problem is that the muscles in my lower back tense up and will not relax, and nothing will help except drugs to knock me out and keep me relaxed for 13-14 hours in the legs-elevated position. I realize that doctors hear from junkies who have "back pain" every day and want narcotics -- this is why so many doctors don't want to prescribe it. Now I just insist. They often don't believe me, but I don't care.

I've also had good (but temporary) results from a shot of cortisone along with the drugs. This might help your husband if he's leaving tomorrow.
posted by coolguymichael at 10:08 AM on September 11, 2010

I did something appalling to my back last week, sleeping on a less than comfy couch. It was so bad that the pain actually made me vomit when I tried to stand. I took 500mg of naproxen 3 days in a row and have been mysteriously healed. Obviously YMMV but I have never before recovered from (numerous) similar back pains so quickly.

(I have piriformis syndrome and SI joint problems and severe deterioration in L5.)
posted by elizardbits at 10:11 AM on September 11, 2010

Your husband's pain and it's cause probably do not lie on the same spot. Yes stretching will help, but in the right sequence. Chances are he has trigger points in his buttocks. Get rid of them first, then stretch. Stretches should not compress the lumbar vertebrae. Even hanging from a doorsill will often help. Cold packs and NSAID's help if the problem is swelling, i.e. an inflammation, not likely looking at your description.
posted by Eltulipan at 10:11 AM on September 11, 2010 [1 favorite]

When I had a similar back incident, I was given Flexeril (muscle relaxer) and Vicodin and told to NOT stretch or exercise for a week or two. The Flexeril w/o Vicodin worked well enough to allow me to function, but it was good to know I had it if I needed it.
posted by pipti at 10:34 AM on September 11, 2010

Tiger Balm or IcyHot patches are really awesome for this sort of acute pain. They make them lower back sized for just this sort of thing. Good luck, be careful with the OTC pain relievers.
posted by ch1x0r at 10:40 AM on September 11, 2010

My husband has pretty regular low back pain, and finds that a lumbar pillow makes traveling much more bearable. (This is something his doctor recommended; I don't know the specifics of why)

Might be something for you to check out, as his current state could cause him to position himself strangely in the airplane seat and set him up for more pain after the flight. Looks like Target may carry them, and some department stores, if you need to pick it up tonight.
posted by Fui Non Sum at 10:41 AM on September 11, 2010

How longleggedy is he? Make sure he has something to rest his feet on in the plane that will let him change his hip and knee angle as well as support his legs. If you're looking for something cheap, fast, and portable (if not durable) an inflatable bath pillow from the drugstore is better than nothing. Some airport shops sell foldable plastic footrests.

In the hotel, you can often ask for a bedboard if your mattress is too soft. Use extra pillows or blankets to support the knees if he is on his back, or to separate them if he is on his side. If there is a pool or hot spa, a period of weightlessness might help.

What's he got for shoes? If he absolutely has to stand for this class, can he wear something with a little give, like the dreaded Croc? It's probably easier to find a pair of those than to pick up a gel mat. If nothing else, he should take two different pairs of shoes so he can change his stance if his legs and back start feeling tired.
posted by Sallyfur at 12:11 PM on September 11, 2010

The McKenzie method, which Ghidorah mentions here has some techniques that they refer to as "first aid for lower back pain." I did them the other day for some tweaked lower back muscles, and felt better within an hour or so.

He can grab a copy of the book 7 Steps to a Pain Free Life and see descriptions and diagrams of said techniques. Otherwise, check here for written instructions on how to perform them. 1-3 are the ones to focus on for the "first aid."
posted by jenny76 at 12:19 PM on September 11, 2010

amtho: "Now we're considering going to an urgent care facility, to ask for -- what?"

Lidoderm patches are heaven-sent for me.
posted by IndigoRain at 12:20 PM on September 11, 2010

I've had a bulging disc in my back for several months, but it went sort of sideways and never put pressure on the main nerve bundle that goes to the legs. Mainly, it just felt like muscle pain to me. My doctor told me that some higher-than-you-would-guess percent of people have inflammed discs and don't even realize it... you can only tell for sure with an MRI. For me though, the main thing that aggravates it is sitting in a weird position; when going from a neutral to a bending over position the pressure on a disc can increase from something like 15 to 300 psi. There is a membrane that keeps the disk in place when uneven pressure occurs, but if it tears, you can have some pain. Usually it will heal to a degree and per my doc, stretching, good posture and being active are some of the very best things you can do to help it. An urgent care facility will most likely give him some dose of ibuprofen, which worked quite nicely for me. IANAD.
posted by Dr. ShadowMask at 2:00 PM on September 11, 2010

I do yoga exercises and the tennis ball thing to try and keep my back in good condition, but when it flares up badly enough that I need medication, my doctor prescribed a steroid pill. It had gotten bad, and I'd been on Tylenol 3, and then Vicodin, and then an shot at the ER. None of that did anything for me. But then my new doctor prescribed a generic for 'medrol dosepak' -- a steroid pill where you take a bunch the first day, and a little less every day after that. And the pain and spasms cleared up in HOURS.

Definitely not something you'd want to do all the time, but for a hail mary it works wonders for me. It flared up again a few months ago while I was on vacation, and I was afraid I wouldn't be able to drive home. So I went to urgent care, and told them what had worked before and they didn't hesitate to prescribe it again.
posted by Caravantea at 3:57 PM on September 11, 2010

In Rochester, if he wants a massage, I recommend Renewing Massage in the South Wedge.
posted by knile at 3:15 AM on September 12, 2010

One more thing, regarding the teaching. I was fresh off a pretty serious back surgery when I started teaching. One thing that helped was having a riser, or a box, or something that would hold weight. Sometimes, standing with one foot on a higher level than the other helped to stretch my back. You might want to try it out before you start a class, to see if it works for you.
posted by Ghidorah at 12:53 AM on September 13, 2010

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