At the end of my rope with back pain - how do you deal?

[RedHorses]

Thanks @Kyrabee and @sheltoneb. I’m actually doing a lot better this week after four treatments and several rides last week. I managed to stop the Tylenol and drop back to my usual level of ibuprofen… and ice - always ice. The increasing speed of recovery from relapses is a good sign according to my doctor. This one had everything going against me - increased stress and physical demands at work, very reduced riding, and the holiday break in treatment.

I start the online Dressage Rider Training this week and feel like I’m capable of doing it. Hopefully the core work will help me maintain forward progress (and limit future relapses).

I also bought a new mattress that is supposed to be best for people with back pain. It’s coming tomorrow according to the email I got today.

I’m going to keep everyone’s suggestions in mind. It’s funny the blind spots we have - I’ve known about the pain patches for years and yet it never occurred to me to try one. I’m checking out the TENS units as well…

[GucciJumper]

My Mini TENS unit does help some but chiro work definitely helps. Ever since I messed up my hip, my back is always causing issues. I go at least once a month. I can tell when it’s been too long.

I also bought one of those yoga wheels and it really helps me with stretching. Stretching always helps it as well.

[Willesdon]

@RedHorses

… I also bought a new mattress that is supposed to be best for people with back pain. It’s coming tomorrow according to the email I got today.
…
It’s funny the blind spots we have .

I’m glad to hear that things are steadily improving. As to blind spots… please, don’t move your new mattress yourself!

[RedHorses]

I got help! I’m looking forward to trying it out!

[McGurk]

@RedHorses,

You didn’t mention a specific diagnosis, but your symptoms sound like mine, so I’m just going to list things that have and haven’t worked for me. Your mileage may vary!

I have two bulging discs, degenerative disc disease, arthritis and ankylosing spondylolysis. When it’s acute, I have a burning pain in my lower back that is worse when walking or standing, better when sitting or laying down. Couldn’t walk a block at its worst. Once I am ON the horse, riding is okay, for the first hour or so, but just the bringing the horse in, grooming and tacking up had me at my limit. Putting the horse away and walking back to the house was very, very difficult. And yes, when it was at its worst, I would collapse.

Things that help, roughly in order:
Retiring from my job so I can focus on my fitness and health.
Exercising in a heated salt water pool, with strength training and a lot of stretching. Magic!
Stretching.
Physical Therapy including manual traction.
Spinal epidural injections (results vary depending on where the injections are placed. Got much better results from the second round.)
Acupuncture (strictly palliative, but allowed me to go on a riding trip I couldn’t have otherwise.)
Losing weight and getting fitter.
Routine use of diclofenac and tramadol (I have lots of other arthritis related issues.)
Very expensive back brace. (Took pressure off my back, but hot, uncomfortable and awkward.)
Ridiculously expensive pillow (keeps me sleeping on my side with spine aligned.)

Things that didn’t help or weren’t worth it:
Gabapentin (made me stupid and didn’t do anything for pain.)
Stronger narcotic painkillers (Oxycodone and Hydrocodone.) Only somewhat helpful with pain, not worth the side effects. Helpful to sleep at night.
A wide variety of self prescribed back braces.
Chiropractic. (helped other stuff, didn’t help the back)
Massage. (helped only briefly)
Topicals.
Arthritis supplements. (MSM, glucosamine, tumeric, etc.)

Things that I haven’t tried yet that are on the table:
TENS (I used one during PT for a differenct injury and they’re quite effective.)
Spinal nerve ablation.
Laminectomy/fusion. (Putting off as long as possible, maybe forever.)

If you’re not already seeing a chronic pain specialist, I would recommend it. Chronic pain is EXHAUSTING and it sucks the joy out of a ton of everyday activities.

Wishing you less pain and more joy.

[RedHorses]

Thanks for sharing this, McGurk. I had x-rays way back in March last year and they didn’t show anything that might need surgery.

It’s turned out that riding within a few hours after a treatment makes a huge difference to how much benefit I get and how long those benefits last. But yes, sometimes it’s tough getting to the point of riding and some days the timing just doesn’t work. The horse chiropractor always seems to come right after I get a treatment. I managed to squeeze in a 15min bareback walk yesterday on my super horse before his adjustment. No riding today as they get the day after an adjustment off.

I’m working on the weight and fitness too. That heated salt water pool exercise sounds great!

Retirement isn’t possible, but a new job is definitely on the table this year. If not for the pandemic that might have happened last year.

[McGurk]

Forgot to mention - The TENS (Transcutaneous electrical nerve stimulation) units that I am familiar with work by scrambling the electrical signal from your nerves to your brain. So nothing about the origin of your pain changes, you just are preventing your brain from receiving the message. Doesn’t have anything to do with muscles, except, of course, that your muscles relax when your brain is no longer receiving the pain message. (Some units also have a muscle stimulator, but I am not familar with them.) Lining up the pads correctly so the correct nerves are jammed/scrambled is key to the TENS effectiveness. There’s also a tail or halo to the effect; the pain doesn’t return immediately when you shut the unit off. It takes a little while for the nerves to start resending the message.

I used one during PT to do range of motion exercises and it was very effective; I could do much more with the TENS that without, and regained more ROM than was predicted. They would not let me take one home because they correctly assessed me as someone who would over exert myself.

Might be worth trying.

[S1969]

@RedHorses

Thanks @Kyrabee and @sheltoneb. I’m actually doing a lot better this week after four treatments and several rides last week. I managed to stop the Tylenol and drop back to my usual level of ibuprofen… and ice - always ice. The increasing speed of recovery from relapses is a good sign according to my doctor. This one had everything going against me - increased stress and physical demands at work, very reduced riding, and the holiday break in treatment.

I start the online Dressage Rider Training this week and feel like I’m capable of doing it. Hopefully the core work will help me maintain forward progress (and limit future relapses).

I also bought a new mattress that is supposed to be best for people with back pain. It’s coming tomorrow according to the email I got today.

I’m going to keep everyone’s suggestions in mind. It’s funny the blind spots we have - I’ve known about the pain patches for years and yet it never occurred to me to try one. I’m checking out the TENS units as well…

What kind of treatment are you receiving?

Backs don’t just “give out” - it’s either muscular injury, or disc/spine injury. But many times the injury is because of weakness, usually in the core.

Are you getting PT? I have a compressed disc and certain things can exacerbate it. But it is almost always doing something that is too heavy, and/or the wrong direction. The only real way for me to avoid back pain is to make sure I have good core strength so I don’t injure it again. Once you have an injury, you have to let it heal.

Any kind of back issue that has been persistent for nearly a year needs a second opinion. Either the dx is wrong, or the treatment is wrong.

[RedHorses]

@S1969

@RedHorses

I started treatment at the end of March. I am comfortable with the diagnosis and treatment plan, I am aware that it’s something that takes times, and that it’s neither linear nor predictable. My six month assessment in October showed a 60% improvement in the physical markers (and there’s no guarantee of getting to 100%). Apart from the relapses I’ve had some good periods of feeling great and capable of anything.

I’m not sure what you meant by “persistent” given the last sentence quoted above. Wouldn’t a compressed disc be persistent, or do they actually decompress back to normal?

I use “gave out” as most people seem to do as a shortcut for “moved wrong”, “lifted/carried/shifted something too heavy, possibly with poor form and/or pushed the physical structures of the back beyond their load limit which may have been reduced by a timespan of compensating for other injuries”. Something like that.

@McGurk can I ask what kind of pillow it is? I keep buying pillows that don’t work when sleeping on my side, or only work for a few weeks before compressing too much to give enough support. I switch between sleeping on my side and my back during the night and every pillow I’ve tried that claims to work for both positions doesn’t.

The new mattress is interesting. My impression is that it is very firm but I don’t have pressure points on hip and shoulder. I don’t feel like I’m sinking into it yet obviously the foam is conforming to my body, allowing me to be comfortably aligned. It’s a hybrid memory foam and coil spring mattress. The memory foam is responsive, meaning it returns to shape quickly, so I can change position without feeling like I’m falling into the low spots from the previous position. I’ve had it a week and the instructions say to give it 30 days to adjust to the foam if you’re coming off a coil spring mattress. I woke up every time I moved the first couple of nights. I’m not about to shout “Best sleep ever!” from the rooftops yet, but I think I ache less when I get up.

[S1969]

@RedHorses

I’m not sure what you meant by “persistent” given the last sentence quoted above. Wouldn’t a compressed disc be persistent, or do they actually decompress back to normal?

I use “gave out” as most people seem to do as a shortcut for “moved wrong”, “lifted/carried/shifted something too heavy, possibly with poor form and/or pushed the physical structures of the back beyond their load limit which may have been reduced by a timespan of compensating for other injuries”. Something like that.

Ok, to be more specific then…sure, I still have a back “issue” but I don’t have back pain, because I went to PT and continue to do core strength work to protect it. So, back pain that is persistent for months needs to be reevaluated - it is not normal to just live through pain, especially if you are saying surgery is not necessary. (But yes, discs can be reshaped; some PT is deliberately done to try to gently move the bulging portion of a disc back into place.)

It’s still not clear to me whether you have a muscular injury or a disc issue, since either could be affected by moving wrong. I’m not sure why you don’t want to give more details about the injury or the treatment. You said you had 60% improvement – in range of motion? Reduction of pain?

Lots of treatment can be useful - PT, massage therapy, chiropractic, acupuncture, etc., but they don’t always address the underlying issue properly. And, in the case of backs - it is unlikely any of them will be effective enough without PT, since muscle weakness is a link to most back injuries (other than traumatic).

Regardless - persistent pain for months on end? I’d get a 2nd opinion. And if this were the Horse Care forum, people would be saying “time for a new vet.”

[McGurk]

This is the whole pillow “system” -

MedCline Shoulder Relief System

And this is just the body pillow part, which is significantly cheaper -

Therapeutic Body Pillows | MedCline

When I travel, I just bring the body pillow and leave the wedge at home and still sleep comfortably.

[RedHorses]

@S1969

Regardless - persistent pain for months on end? I’d get a 2nd opinion

As I stated in my first post I am comfortable with the diagnosis and treatment plan, and fully aware that it will take time to get as good as it’s going to get. I specifically put that in to avoid the rabbit hole digression of armchair diagnosis and treatment that inevitably follows such. I am making progress and accept that there will be great improvements, sometimes in short periods, plateaus and setbacks. I have kept a journal right from the visit to the first doctor and I have notes on treatment, answers to the questions I’ve asked along the way, what my pain was like on any given day, what I used to manage it, and what I was capable of doing with what degree of pain that day.

Not to diminish anyone else’s experience - when I started this thread I was really struggling with the cumulative stress of the last year in addition to the extra demands December always brings, and I was questioning how much more I was capable of handling. That stress made dealing with the physical pain of my latest relapse (for lack of a better word) more of a mental challenge than the previous one (as well as proving a pattern).

I needed some encouragement (which I got) and hoped for some strategies that would help manage the pain when it got past my usual pain management (which I also got). As a bonus I got some ideas for things to try to hopefully prevent or reduce the severity of the next relapse.

My diagnostic and treatment specifics are irrelevant in this context.

[WinsomeTK]

I have had chronic back pain since a multiple vertebrae fracture back in 2013, then a lumbar sprain in 2016 at work (I’m a vet tech). I’ve been referred by my gp to a chronic pain program that uses a multimodal approach - meds, pt, but most importantly care for your MENTAL HEALTH as pain 24/7 eats you away (eta - I see a psychotherapist). My back isn’t ever going to get better, all I can do is try to exercise to help (stretching, walks, riding to some extent) and change the way I perceive the pain.

[paintedpony]

Consider an inflatable decompression belt. It is strapped on firmly while deflated, then wearer uses a bicycle like pump to inflate the belt. Firm support and a gentle upward pressure can provide relief, and allow increased mobility until wearer increases the strength of supporting muscles. It is only intended to be worn for intervals, not continuously, but does ease discomfort when you are in distress. Check out - Dr Ho’s (drhonow.com)

[theresak]

My back flares up a few times a year, but it always seems like I have a bad case around/after Thanksgiving every year. This time, my horse spooked and spun and I knew instantly he threw my back out - but it had been “fragile” that day and I didn’t do anything about it…

Strong core is probably #1, so I can take some of the work away from my back and use other muscles to compensate. Core muscles include everything from shoulders to knees, and I find strong glutes and lower abs really help.

I sleep with 2 pillows, one is a firm foam pillow and I’m almost always on my side. A square pillow between my knees helps my back a ton.

Stretching my hamstrings, which are very tight, aggravates my back. I do specific stretches from PT for my sciatic and glutes. And when my back is out, using a foam roller on the side of my glutes and even a firm ball to get the piriformis gives me a lot of relief. Even thought it’s hard to remember, if I move between standing, office chair, and yoga ball, it helps a lot. Even just changing my leg position while sitting helps. Sitting at my desk and sitting on the couch at night are the worst for my back.

In the winter, I don’t ice my back as that just makes my muscles tighter - I find a heating pad a lot better and will use those disposable heat pads on my back for several hours. They often help me loosen up when I finally get away from my desk and start walking.

My mom swears by naproxen for her back but I find Ibuprofen works better for me - however, I need to take at regularly for at least 3 days in order for my muscles to start loosening up.

With my worst back flare, I had tingling in the bottom of my foot and sciatica for 6 months but it went away gradually until one day, I realized it was gone. This year I threw my back out the Sunday after Thanksgiving and although I’m not in constant pain, I still have to be really aware whenever my back feels stiff or tight and start some Ibuprofen, do my PT stretches, and be careful.

[walkers60]

I use the cream as i find it penetrates deeper and last longer. Its only 4% lidocaine OTC but you can get prescription compound for 5% with an anti depressant med , a cream that may works wonders. More importantly it lets you have a deep night sleep which really helps with pain. Also a hot tub really lets your muscles relax.
However as an experienced pain treatment professional I read some of these post and I don’t think 1. you are getting a good diagnostic workup
2. look at Tiger woods, the new back surgeries are small and you may have one every few yrs. My friends already have 5, these are outpt and when you have a good surgeon your back to your life in a few days.They can keep you functional for a few yrs and then boom may need another little twist.
Sadly those with true spinal stenosis better enjoy your life as much as possible now as that is painful and progressive disease. Sorry
And make them gives you Opioids, few people get addicted that’s oxycontin not percodan. Otherwise you have no life.