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Figure 20. Recommended sleep positions.

Ice or Heat?:
One of the common confusions people have with self-treatment is the question of when to use ice and when to use heat. There are all sorts of recommendations out there but a simple rule of thumb is to base the decision on what the symptoms are.

If you have sharp or intense pain with or without swelling, this usually indicates that there is inflammation present, and this is a time to use ice.

On the other hand, if your symptoms are mostly stiffness or mild soreness, there is usually not significant inflammation present, and in this situation heat is a better choice. As a precaution, anytime you have experienced a trauma, or think you might have injured yourself, it is best to avoid using heat for at least 48 hours to make sure that the inflammatory response has not been activated and the inflammation has simply not had enough time to set in.

When in doubt, avoid using heat!

Although heat may feel good while it is on (because heat causes pain signals to be partially blocked from reaching the brain), heat also increases the inflammatory response of the body. Increased inflammation means increased pain when you stop using the heat.

Although ice may not feel as comfortable as heat, it is one of the best anti-inflammatory measures you can take. The short-term discomfort of applying ice usually pays off in long-term relief. Although some experts recommend alternating ice and heat (for example, 10 minutes of ice followed by 10 minutes of heat), I have not seen any particular advantage in doing this. For most situations, choosing one or the other based on the symptoms as was just discussed is usually the simplest approach and in my opinion works just as well or possibly better than trying to alternate the therapies.

Regardless of whether you are using ice or heat, you should always separate the ice or hot pack from the skin with a layer of cloth to prevent skin damage.

It is also important to avoid applying ice or heat on an area that has been recently treated with Theragesic, Icy Hot, Biofreeze, Ben Gay, or any other topical analgesic - wait until the sensation of the analgesic has completely worn off, otherwise the ice or heat could cause skin irritation or damage.

Also when using either ice or heat, you should only apply the treatment for about 10 to 15 minutes at a time, allowing the skin to return to normal temperature (to be safe, wait 1 to 2 hours) before re-applying the treatment. If you have impaired circulation or decreased skin sensitivity due to nerve damage, diabetes, etc., it is best to check with a doctor first before using ice or heat.

Topical Analgesics:
There are numerous lotions, creams and gels you can apply to temporarily reduce pain. Different people prefer different products. Some like those that create a burning sensation such as Theragesic, while others prefer the cooling effects of menthol-based products like Biofreeze or Icy Hot. Regardless of the type used, the basic effect of most of these products is to stimulate nerve endings that will distract the central nervous system’s attention away from pain. I suggest experimenting with different ones to see what works best for you.

A Home Treatment Trick From Chiropractic:
One of the chiropractic techniques mentioned in the chapter on Professional Treatment, Sacro-Occipital Technique (SOT), can be used in a very basic manner for “do-it-yourself” treatment for disc problems in the lower back and can provide nearly immediate relief of low back pain and sciatica in many cases. This method is covered in the “Easing Pain Right Now” section at the beginning of the book.

Acupressure Point Stimulation:
While in-depth acupuncture treatments are best left to professionals, a very simplified set of acupressure techniques is presented in the “Easing Pain Right Now” section at the beginning of the full version of this book.

Laser and LED Devices:
Covered in the full version of this book.

Magnetic Therapy:
Covered in the full version of this book. For ordering information, Click Here.

Oxygen:
Covered in the full version of this book.

Over The Counter (OTC) Medication:
There are a variety of OTC medications that can be used to decrease pain and/or inflammation. Because of individual variations in body chemistry, one product may be more effective than another for a given person. In general, if you do want to try an OTC medication, I suggest using one of the NSAIDs (non-steroidal anti-inflammatory drugs), because these products will reduce both pain and inflammation. Most of the OTC pain medications are NSAIDs. The one notable exception is Tylenol (acetominophen), which is strictly a pain-killer and does not reduce inflammation. Regardless of what product you use, it is important to adhere to the package dosing directions, as overdosing on these products can cause serious (potentially fatal) side-effects.

The other recommended precaution is to only use these products for a few days at a time because long-term daily use of anti-inflammatory drugs can actually interfere with healing by suppressing the body’s ability to produce collagen.

Ironically, although aspirin and ibuprofen are commonly-used to treat the symptoms of degenerative discs and degenerative spinal arthritis, these medications appears to actually speed up the progression of these conditions when used daily for extended periods of time.

Because joint cartilage is composed of collagen, the collagen-suppressing effect of these medications interferes with the repair and reconstruction of the joints, thereby accelerating degeneration, even though the medication reduces symptoms for a time.

Nutritional Supplements:
Covered in the full version of this book.

Bed Rest:
Although once the main recommendation for injuries of all kinds and still a common recommendation, extended bed rest has been shown to be counterproductive in most cases of disc injuries. While it may be necessary due to pain to lie down a lot during the first few days of an acute disc injury, it is recommended to be as mobile as possible as soon as possible. Extended bed rest results in accumulation of swelling in the injured area as well as muscle deconditioning, which ultimately delays recovery. Unless specifically prescribed by a doctor, bed rest should not extend beyond a few days.

Exercises:
The type of exercises that are recommended for disc-related problems will vary depending on the phase of the injury. During times of severe pain and inflammation, exercises should be limited to those activities that provide gentle movement to reduce the accumulation of swelling and help shift pressure off of sensitive neurological structures.

Walking and/or gentle water exercises are best when there is a lot of pain. During times of mild symptoms, or for the purposes of trying to prevent injuries, exercises should include muscle strengthening and stretching and should be customized for an individual patient’s needs and activities.

Because it is imperative that strengthening and stretching exercises be done properly to get the desired benefits and to avoid injury, it is strongly recommended that you work directly with a professional to learn the appropriate exercises at first.

Exercises for times of significant pain and inflammation: As just mentioned, by far one of the best overall exercises when there are major symptoms is walking. Walking produces joint and muscle movement and circulation sufficient to pump inflammatory fluids out of the injured area (which reduces pressure). Walking also produces minimal stress and compression on the injured area, which means there is minimal risk of further injury.

With low back disc problems, during periods of extreme inflammation, walking may cause increased pain, particularly when done for too long.

For this reason, when you have severe pain, walking should be done in short bursts of only a few minutes, with periods of rest in between.

As a general rule, it is best to lie down rather than sit between periods of walking, because sitting usually causes a lot of pressure on the discs in the low back.

Walking is beneficial in cases of cervical disc problems too, because again it improves circulation and reduces the accumulation of swelling in the injured tissues. For cervical disc problems, it is recommended to slowly and gently swing the arms as you walk.

In addition to walking, McKenzie exercises (named for physical therapist Robin McKenzie) can also be very beneficial during times of pain and inflammation (although they also have benefit as a preventive form of exercise as well). McKenzie exercises are often associated with extension (backward bending) of the spine, but in reality they are about testing for, and then exercising in, positions and stretches that alleviate or produce “centralization” of symptoms.

Centralization means that the symptoms move closer to the spine. For example, if you have low back pain with sciatica (leg pain), centralization would be where the symptoms leave or lessen in the leg, even if the pain stays the same or gets worse in the low back. Over time, in most cases the low back pain will also improve in situations where initial centralization is achieved. Because the vast majority of the time extension of the spine is beneficial in reducing or centralizing pain, McKenzie exercises are often called “McKenzie Extension Exercises”, but true McKenzie Technique actually tests for the position(s) that are beneficial for an individual patient. So, although McKenzie exercises most often do involve extension of the spine, they can involve flexion (forward bending), side bending, and/or rotation - depending on what position reduces or centralizes symptoms.

The following positions/stretches from McKenzie technique are the most common ones that are helpful. You may find other positions that work better for you. You will probably have some pain when you first move into a new position. After you get into each position, wait 30 seconds to a minute to see what happens with your symptoms.

The thing to remember is that you are looking for a position that eases the symptoms the furthest away from the spine.

So, if you have pain or tingling in your hand and you find a position that moves the pain out of the hand, even if the pain gets more intense closer to the spine, you’re doing the right thing. If you have pain in your shoulder and upper arm, a good position would be one where the symptoms left the arm and shoulder, even if the neck pain got worse.

If you have sciatica all the way to the foot, a good position would be one that moves the pain out of the foot and calf, even if it intensifies pain in the buttocks or low back. If you only had sciatica in the buttock and thigh, a good position would be one that moves the pain out of the buttock and thigh, even if it gets worse in the low back.

Any position that makes the symptoms the furthest from the spine WORSE should be avoided!

In other words, do NOT continue with any position that makes symptoms either more intense or extend further down the arm or leg.

Keep testing different positions until you find the one that does the best job of alleviating the symptoms furthest from the spine. Once you find a position that works well, hold that position for 1 to 2 minutes and then take a break for 30 seconds or so in a neutral position. Repeat the beneficial position frequently, as long as it continues to relieve the symptoms furthest from the spine.

The following are illustrated instructions for the most commonly helpful McKenzie exercises.

First, exercises for acute care are shown. “Acute” means that the symptoms started or intensified recently (within a week or so) and are usually sharp and intense.

Low Back (Acute Symptom Care):

Figure 25. Cervical extension can be done by lying on your back with a rolled up towel behind your neck. Try different positions by bending your neck to the left and right and/or rotating your head left and right, pausing for 30 seconds to a minute or so to see what happens with your symptoms, as shown in the picture on the right. Remember, you are looking for centralization and/or reduction in symptoms. For example, any position that reduces symptoms in your arm or along your shoulder blade is a beneficial position and you can stay in that position for up to several minutes at a time.

The same exercises just discussed can also be used as a preventive measure once symptoms are gone. As a general rule, if there are no significant symptoms, using just straight extension (as in Figures 8 and 10 for the low back and Figure 12 for the neck ) works quite well for preventive purposes. In addition, the following exercises can be used to rehabilitate the spine and prevent further injuries:

Rehabilitation exercises are covered in the full version of this book. To order, Click Here.

Mind-Body Healing:
One other type of “exercise” that I think bears mentioning is the use of visualization and positive affirmations to enhance healing. While this is not physical exercise, mind-body healing techniques do involve regimented mind exercises, and can be very beneficial.

When one has a health problem such as a painful disc condition, there is often a tendency for fear, anxiety, and depression to set in, and for one’s thoughts to be focused on the health problem and its symptoms. Negative emotions and focusing on symptoms can actually increase one’s perceptions of the symptoms, making things worse. In addition, negative emotions can trigger the release of stress hormones, which increase inflammation, also tending to make things worse.

On the other hand, by consciously focusing one’s thoughts on healing and feeling good, it is often possible to reduce the perception of symptoms and possibly even promote healing. The more consistent you are at imagining yourself as being healed - as if it has already happened, not as some future event - the greater the potential for healing to actually occur. This takes a bit of mental discipline, but the rewards can be well worth it. After all, if your activities have been limited by a disc problem, you probably have some extra time to devote to imagining yourself as healed.

One distinction I think is important is to be sure you give yourself positive messages of being healthy, not negative messages of not being in pain. For example, if you are using verbal affirmations, you want to use phrases like “I am happy and grateful that I am totally healthy and feel wonderful!”, as opposed to things like “I am so happy that I am no longer in pain.” The reason for this is that if you are thinking about not being in pain, the brain still has to focus on pain - tending to reinforce it. If I tell you, “Don’t think about a pink elephant.”, chances are you made a picture in your mind of a pink elephant.

For best results, you want to be focused on what you WANT - in this case, being healthy, feeling great, and doing all the great things in life you want to do. The more you can keep your mind focused on being healthy and feeling good, the greater the benefits. At first, it may be difficult to shift your focus away from your symptoms, but with some practice, it will get easier to focus on being healthy. Use positive affirmations, imagine yourself doing favorite activities and feeling great while doing them, and be grateful for the amazing healing ability of your body. Again, imagine yourself as being healthy and feeling great right now, instead of it being some future event. Most people who make the effort to do this are pleasantly surprised at the difference it makes.

An additional technique that combines acupressure with mind-body healing is discussed in the full version of this book