My Garden is in, but my Back is Out. How to Prevent Back Pain and How to Treat it with Acupuncture and Conventional Medicine

          My Garden is in, but my Back is Out. How to Prevent Back Pain and How to Treat it with Acupuncture and Conventional Medicine, Hoku Integrated Healthcare in Westshore Colwood, Victoria BC


          This month’s blog will discuss how to protect your back from injury, and what conventional medicine and acupuncture can do for you. A smaller version of this blog is in July's edition of The Rural Observer .

            In the Sooke area towards the end of June, we finally had enough warm weather to get our gardens dug, and planted. Gardening is, however, a form of seasonal exercise involving a lot of awkward positions. We are unaccustomed to shoveling, lifting, and bending for several hours a day and are just now getting quite accustomed to weeding or pruning.  If we are not careful, these repetitive motions can cause the muscles of the back to tighten up, resulting in anywhere from mild to severe back pain.

          It’s wise to use a common sense approach aimed at putting less stress on the spine when gardening. First warm up by taking a 5-10 minute brisk walk, then gently bend forward from your hips. Rub your lower back with your palms to get the blood flowing to your muscles. Avoid the marathon by gardening for only one-half hour per day. This means getting at the weeds when they are only just poking through the earth, and not a foot tall! You will be wishing you did if you have any thistles. Buttercups and dandelions can easily run amok, as do blackberries. In the past I've had blackberries that have easily grown a foot in one day, especially at the beginning of the season, and if there was a plant that could "win", it would be that one.

          Ideally, every 5 minutes, gently stretch, extending your back. Never stretch so far to cause you any pain, and don’t bounce. If you already suffer from low back pain it is suggested you see a doctor before starting any exercise program, and it is essential to have a daily stretching routine. and Healthlink BC offer specific back stretches. I highly recommend Tai Qi or yoga done on a daily basis. Always respect your body's limitations, and trust what your body is telling you. 

          When outside and busy it’s easy to become distracted by the tasks at hand, then become dehydrated, so keep a bottle of water handy. Try alternating tasks to avoid putting pressure on one area of your body for too long, and use tools that decrease bending. When lifting heavy objects, squat to pick them up and keep them close to your body. If you need to turn, do so by shuffling your feet, not by turning from the waist.

          Gardening chairs, “kneelers”, knee-pads and/or mats help you stay close to the ground. Raised beds, preferably at 3 feet, are optimal. If you are wanting to revamp your garden, perhaps look into "Square Foot Gardening". This method saves space, water, and time. It also protects your back since you don't have to over-reach to weed, or make your harvest. If you live on a hill, consider terracing.

          If pain occurs, icing (over a towel to avoid freezing your skin) is generally recommended, for up to 2 days. RICE: Rest, Ice, Compression, and Elevation after an acute injury has been the mainstay of treatment from an allopathic point of view, and I would suggest this to people with acute injuries coming into the pharmacy. When the pain starts to resolve, then alternating hot and cold compresses would then be recommended. In 48 hours, application of Hot compresses brings oxygenated blood to stiff muscles, allowing them to heal and relax. As far as I know, this is what most medical doctors, nurses, chiropractors and physical therapists still recommend. From a Traditional Chinese Medicine point of view, however, applying ice can slow down the healing process, but will provide pain relief. If over-used, ice could cause problems in the affected joint further down the road. Todd Howard, of Pacific Rim College in Victoria, BC, discusses this in his article, The Fallacy of RICE. Being trained in both approaches I take each case individually. I will recommend RICE if there is a great amount of swelling and pain, but only for the shortest time possible. Swelling is nature's way of immobilizing a joint, and of bringing the cascade of healing factors from the inflammatory process to heal the joint and surrounding muscles. I'm not saying to "just suck it up"; my advice is if you can't tolerate the pain and need to take a medication to get through it, then ice the area. If it's not that painful, then take it easy for a few days and let your body heal. See an acupuncturist. This is an area where TCM thrives. We don't apply one approach to everyone.

          Conventional medicine offers anti-inflammatories such as ibuprofen and naproxen—they should be taken with food to decrease stomach upset, and are not to be used if you are taking blood pressure medication, warfarin, or blood thinners. These drugs can cause perforation of ulcers, as well as gastrointestinal bleeding. Recent studies show that in people who have taken a non-steroidal anti-inflammatory within 12 months of having a heart attack have a higher rate of mortality. This latter effect does not include ASA, or Aspirin; acetaminophen can be used as a pain killer but does not take away any inflammation. Be sure to stay within the recommended dosage range to avoid liver toxicity. Muscle relaxants, such as Robaxacet (has acetaminophen), Robaxisal (has ASA), Robax Platinum (has ibuprofen) all contain methocarbamol which can help for muscle spasms. It tends to cause drowsiness, sedation, and dry mouth, especially when combined with codeine. Robaxin is "straight methocarbamol" and doesn't contain the other ingredients. It is available behind the counter. The most commonly used prescription muscle relaxant is cyclobenzaprine. It too tends to cause sedation, drowsiness, and dry mouth. None of the muscle relaxant products should be taken with alcohol or marijuana due to additive sedation.

        Opioids, most of which are derived from the plant Papaver somniferum all cause drowsiness, sedation, and respiratory depression; they should never be combined with alcohol, and should not be taken with other drugs with sedative effects. Codeine, in Tylenol No. 3, or oxycodone, in Percocet, are no longer being prescribed due to the Opioid crisis, where in some locations, overdose deaths due to opioids surpasses deaths due to cancer or cardiovascular disease; some physicians who know their patients well will prescribe very small amounts of codeine, or tramadol in acute pain situations, but very carefully with much supervision. There are many factors influencing this epidemic, and I could easily write an entire blog devoted to it.

        Topical pain relievers can be used—I find the menthol containing ones to be more effective than the newer low dose topical anti-antiinflammatory cream, unless at a higher prescription dose. Traumacare®, a homeopathic cream may be beneficial. 

        The number one reason people seek acupuncture is for back pain. Why? Because it works well by regulating blood flow to the painful area(s) and relaxing tight muscles, thus relieving pain. It may be combined with Tui Na (Chinese Massage) using oils such as White Flower®, or application of Zheng Gu Shui® if there is bruising. "Cupping” is often used, which creates areas of suction that relieves swelling, pain, and inflammation, without slowing down the healing process. You may have seen the round “hickeys” left by cups on some Olympic athletes, such as Michael Phelps. Athletes at this level are using any proven approach to enhance their performance, to legally gain advantage over their competitors.

            In some styles of acupuncture, needles are inserted into acu-points on or near the area. This causes a local histamine response that encourages healing through a small inflammatory response. Muscles then relax, and blood moves to the area. In other styles, such as "The Balance Method", "Master Tung Acupuncture" and "Distal Needle Acupuncture®", needles are inserted in areas further away from the pain. Acupuncture meridians in the area of your ankles, wrists, and even scalp are chosen. It is thought that this approach works by engaging the area of the midbrain responsible for releasing endorphins and enhancing blood flow to the injured areas, encouraging healing. Clinically, I will often use the distal approach as it doesn't cause further inflammation to an already hurt area, and my patients report pain relief occurring in seconds. In either approach, Tui Na and cupping can augment the treatment. 

          If you are in pain, don't needlessly suffer. Give me a call.

Angela Berscheid offers Acupuncture in Westshore Colwood, Victoria BC