------------------------------------------------------------ TRAUMA ------------------------------------------------------------ In a previous chapter we touched briefly on two primary causes of back pain: chronic trauma and sudden trauma. Let's dwell for a moment on sudden trauma. Some injuries to the back may not result in an immediate fracture to the bony vertebrae but instead result in tearing of the muscles and ligaments or perhaps a rupture of an intervertebral disc. Sudden twisting, inappropriate lifting or a Saturday game of backyard football could be the culprits in these varying scenarios. Sudden pain is the usual result. The painful spasm of a muscle is one of the results of this sort of sudden trauma. In simplest terms, spasm is the sudden, rigid involuntary contraction of a muscle. The cause is usually a sudden trauma although it can also result from prolonged or chronic trauma as well, such as poor posture. These strained and "knotted" muscles hurt and seem to refuse any attempt at relaxation. In retrospect this "rigid reaction" to trauma may have been an evolutionary attempt by the body to "splint" or bind the injured area in a rigid manner to prevent further damage. However, if the spasm remains for too long it can produce more severe pain than the original injury and sometimes additional injury. Curiously, it is the weak muscle, lacking in tone or the over- tense, constricted muscle that can cause the most pain when sudden trauma occurs. A flexible, supple back is usually capable of withstanding sudden trauma. After surgery, bed rest and recovery from the traumatic episode sometimes involves strengthening and flexibility exercises which are usually prescribed by most physicians and orthopedic surgeons. Sometimes a physician will administer other treatments in an attempt to relieve pain resulting from sudden back trauma. Injections of Novocaine or Xylocaine anesthetics are possible. Cortisone injections have also been used with modest success in the past. Usually these injections are made directly into the muscle which is affected by spasm. The idea is to relax the muscle, discontinue the state of spasm and relieve the pain. These injections are not held to be completely effective by all clinicians. There is some disagreement in the medical community on the topic of muscle injections to relieve pain and promote healing in cases of back trauma. The use of hot or cold in the treatment of sudden trauma to the back is also an area of medical disagreement. One school of thought suggests that cold should be applied for the first 24 hours following injury to minimize swelling. After this mild heat should be used to increase blood flow to aid in in healing and reduce swelling. However deep tissue injuries in the case of sudden back trauma may have small amounts of bleeding or swelling in very deep layers of tissue which neither cold nor heat will reach, so the benefits are not completely resolved among all members of the medical community. If the pain is close to the skin, ice packs may deaden surface nerves and provide some relief from pain but little actual accelerated healing. The application of mild heat treatments to stiff or inactive muscles prior to exercise or physical rehabilitation is, however, usually a reasonable suggestion. Chronic trauma is the other category to be considered. Chronic means recurring injury or damage. Many sources have been identified as possible origins of chronic back trauma such as poor posture, disease, a gradually aging disc or even a bad mattress and sleeping position. Chronic trauma can also affect an area of the back which has previously suffered a sudden injury. Back braces and supports are sometimes prescribed in cases of chronic trauma. In certain injuries, a brace is an absolute necessity for proper healing or at least a return to normal function. However the continuous use of a back brace for treatment of chronic back pain is usually an unwise course - a bit like wearing a cast for a broken arm long after the arm is healed. In fact prolonged wearing of a back brace can allow further deterioration of weak back muscles which benefit from use, exercise and a full range of motion. Braces are more properly used to immobilize portions of the back following surgery or severe fractures. A better course of action in the case of chronic back pain, is sensible muscular conditioning and specialized exercises performed EXACTLY as recommended by a physician. Amazingly, even ruptured discs and deteriorating vertebrae are less painful when a proper regimen of physical reconditioning is attempted under the supervision of a physician and exercise therapist. Once an exercise plan has begun, it can usually be continued at home and at work with occasional monitoring by the physician. This tutorial is merely a starting point! For further information on back care and back pain, be sure to register this software ($25.00) which brings by prompt postal delivery a printed, illustrated guide to back pain written by a physician plus two software disks. From the main menu select "Print Registration Form." Or from the DOS prompt type the command ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO Box 1506, Mercer Island, WA 98040. If you cannot print the order form, send $25.00 to the above address and a short letter requesting these materials. End of chapter.