PRINCES PRINCIPLE
PROTECTION:
Protect the painful structures from further injury or aggravation. This may range from protective taping and bracing to lumbar and night rolls. It also involves temporary avoidance of the aggravating activities or positions. You must learn to recognize what they are. If it is not possible or practical to avoid these activities then you must be prepared for an increase in your symptoms. However, this increase in your symptoms should only be temporary and does not necessarily mean you have caused any further damage.
REMEMBER: HURT DOES NOT NECESSARILY EQUAL HARM.
REST:
This does not mean stop all activities, but rather to modify your activities to avoid the ones that cause significant pain, muscle spasm, and/or swelling.
An example would be if weight bearing activities, such as walking flare your pain, try changing to a non-weight bearing activity, such as swimming or cycling. This principle of activity modification is very important because it allows you to stay active, while avoiding aggravation of your pain.
Every structure in the musculoskeletal system has a “RESTING POSITION”. When people are experiencing Back Pain the three main positions they tend to rest in are:
Sitting: The human spine is not designed to sit in a chair. It almost does not matter what is hurting in your back; sitting is going to aggravate it. If you cannot avoid sitting then use of a lumbar roll, will help to maintain the normal curve in your low back
Standing: The human spine is a piece of machinery. It is intended to move, and so does not like staying in one place for long periods of time. Often, people with back pain will notice their pain is aggravated if they try to stand still for long periods (e.g. while at a social function or if your job requires you to be on your feet a lot). If you cannot avoid these situations, try to adjust your position on a regular basis. This can be accomplished by:
- shifting your weight from side to side
- introducing frequent, small amounts of walking/movement
- simply by putting one foot up on a stool or footrest and changing positions frequently
Lying: The purpose of going to bed at night is to rest the body. If the position you are sleeping in is correct three rules should hold true. The first rule of thumb is that your pain should never get worse when you first lie down. The second rule is that you should not be woken up during the night because of your pain is getting worse. This is not the same as waking up because you need to go to the washroom and notice that you are still in pain. The third and most important rule is that when you wake up in the morning (before you get out of bed) you should always be in less pain than when you went to bed. If not, then the position you are sleeping in is not the right one for you and needs to be modified (see sleep hygiene article for details on modification of sleeping postures).
The resting positions for other parts of the body are obviously different and are covered elsewhere
ICE/HEAT:
Ice or cold pack use minimizes bleeding and swelling by reducing blood flow to the injured area. Pain is decreased due to the numbing effect of the cold. The most convenient method of icing is to use a gel pack that you keep in your freezer .You can use also use crushed ice.
Do not apply the cold pack/ice directly to the skin as over time, frostbite may occur. Typically, we recommend wrapping the cold pack in a towel.Apply the cold pack to the sore area for 10- 15 minutes, repeating every two to three hours.
As a general rule of thumb, if you find repeated applications of cold either do not ease or relieve your discomfort, or in fact seem to be making your pain worse, try applying heat to the sore area. Heat applied to tight and spasmed muscles can often help them to relax, which can ease your pain. Apply the hot pack to the sore area for 15-20 minutes, repeating every two to three hours.
Again, be careful not to apply heat packs directly to the skin as they can burn you. A common mistake individuals often make is to lie down in bed on an electric heating pad. If you fall asleep it is quite easy to wake up later with a burn!
NSAID:
“NSAID’s” stands for Non-Steroidal Anti-Inflammatory Drugs. This can be in the form of prescription or “Over the counter” medication and can be effective in decreasing inflammation and pain, thus speeding the healing process. All medication should be taken under a physician’s supervision and, as with any medication your doctor gives you or recommends, follow the instructions on the prescription.
COMPRESSION/ELEVATION
Many times when we injure ourselves, such as when we sprain an ankle, there will be a lot of bruising and swelling. Wrapping the injury with a tensor bandage and elevating the injured body part will help reduce this response; thus speeding up our recovery.
EDUCATION
To fully recover, your active participation in your treatment program is essential. This is difficult to do if you do not know what is wrong with you or what to expect in the future. Make sure you understand the nature of your problem. If you are not sure what your pain control techniques are, check with your therapist.
SUPPORT
During stage one; your clinician will also apply treatment techniques to assist you in resolving your pain as quickly as possible. These techniques may include exercise, massage, manipulation, and/or modalities such as Laser, Traction, TENS, IFC, or Ultrasound.