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Outdoor First Aid

Treating Aches and Pains

A personal perspective on healing back, joint and other body pains.

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Back To Anatomy

Let’s examine the back. With feet as the foundation, the back constitutes the structural support for those with intact spinal integrity. The human spine, a marvelously intricate column of 33 bones (vertebrae) woven together with ligaments and muscles, gives strength yet flexibility to the body. By restricting motion to within definite bounds, the bones provide protection for the delicate spinal cord, the superhighway of nerves running down the center of the vertebrae.

The top seven bones of the spine work with the muscles of the neck to carry the head. These cervical vertebrae are the smallest and most flexible in the spinal column. Twelve thoracic vertebrae have ribs attached to them that gird the chest cavity and lend extra strength to the midback. Because the bottom two thoracic vertebrae are attached to ribs that float freely in front–the first 10 ribs attach to the sternum in front–the low thoracic spine provides a lot of rotational freedom.

But the lower back, with five lumbar vertebrae, has the largest components of the spine and bears the greatest load with the least flexibility and, consequently, gets the most votes as Area Most Likely to Hurt.

Below the lumbar spine, a lump of bones called the sacrum holds the pelvis in place. Finally, the functionless little coccyx reminds us, perhaps, that we once extended farther in that direction. The five fused bones of the sacrum the and four of the coccyx brings the total to 33.

On To Treatment

It takes surprisingly little strain on your back, if the angle is right, to tear muscles. About 5.5 million per year in the United States miss work because of back strain. The resulting agony can be debilitating. It’s generally several days before the pain goes entirely away, but almost everyone can make themselves functional in a couple of days by following a recognized routine.

  1. Rest. Very important. Rest on your side or your back with thick padding underneath your knees.
  2. Heat. A warm compress or hot water bottle applied to the back, or a hot bath (if you can figure out how to pull it off in the woods) will help ease the pain. Some people react better to an application of cold to the lower back, but use of heat is indicated for most of us.
  3. Massage. Get someone to work on your lower-back muscles.
  4. Drugs. Consult your physician for prescription muscle relaxants.

A doctor friend of mine, who insists on remaining anonymous, suggests moderate doses of alcohol can be beneficial. Alcohol, he says, blunts pain, increases circulation, and is less addictive than some muscle relaxants (e.g. Valium).

If the pain doesn’t go away, or if pain, tingling, numbness, or paralysis begins to creep down your legs, it’s time to forget the snowy outdoors for a while and find a physician.

Pretrip Prevention

Prevention, as always, is the best treatment for back pain. “Not surprisingly, most people who injure themselves,” writes Casey Terribilini, a doctor of chiropractic in the San Francisco Bay area (Journal of Emergency Medical Services, May, 1993), “do so by doing too much too soon or by not working out regularly.” Exercise often and moderately: brisk walking, swimming, jogging, biking, paddling. And shed extra bodyweight. There will be enough of a load on your back without packing fat around your waist.

“Exercises that increase flexibility and strengthen the trunk (abdomen) and hips,” continues Dr. Terribilini,” also help maintain a healthy back.” Here are five daily exercises you can do to buy insurance against back injury.

  1. Lie flat on your back and pull one knee to your chest. Hold the knee-to-chest position for about 10 seconds. Repeat with the other knee. Do 10 repetitions for each leg.
  2. Stay flat on your back and bend your knees. Do an abdominal crunch by raising your head, shoulders, and arms off the floor toward your bent knees. Do not raise your lower back off the floor, which would put too much pressure on your back and decrease the benefit to your abdominal muscles. Hold each crunch for several seconds. How many? Until your abs burn. Your goal is three or four sets of 25 to 30 crunches.
  3. Lie on your stomach and get into a prepushup position, hands on the floor just above your shoulders. Now arch your back but keep your pelvis on the floor. Hold for about 10 seconds. Repeat 10 times.
  4. In the same position, extend your arms above the floor. Raise one arm and the opposite leg about 6 inches off the floor and hold for about 10 seconds. Alternate sides. Keep repeating until you feel burning in your muscles being.
  5. Roll over and sit up with your legs extended in front of you. Stretch your hamstrings by keeping your legs on the floor, knees slightly flexed, and reaching gently for your toes. Do not bounce. Hold this stretch for 10 to 15 seconds and repeat several times.

These exercises can be performed after a back injury to help get your muscles working again. Do them slowly and gently and only if they do not increase your pain.

How To Prevent Injury

  • Loosen up before lifting anything heavy, especially in the morning.
  • Keep your back straight and use your legs, not just back and arms, to lift the load.
  • Get the load well balanced before stepping out. An option is to have someone help you lift the load and get it balanced.
  • Take frequent rest breaks with the load off your back.
  • Reverse the lifting procedure when you drop the load.

Don’t Overuse Joints

It all started for me a couple of winters ago. Sitting by the fire after a day on the snow, my right elbow ached and burned like it was in the fire instead of near it.

So now a look at joints.

Almost all voluntary movement in the human body involves tendons moving across joints. Look at the inside of your wrist and make a fist. The stringy cords that you see shifting under the skin are tendons. These particular ones connect the muscles of your forearm to your wrist and fingers, allowing them to work.

Tendons are attached to muscles on one end and to bones at an insertion point on the other. On the way from muscle to bone, the tendon passes through a tendon sheath, which is attached to the underlying bone. When the muscle flexes it contracts, shortening and drawing the tendon toward the muscle. The sheath stabilizes the tendon and acts as a pulley. Without the tendon sheath the tendon would straighten as a rope does when it is tied to a weight and pulled. The tendon sheath keeps the tendon near the bone, increasing the efficiency of the system and preventing us from looking funny when we flex a muscle.

The sheath secretes synovial fluid, the same viscous, slimy fluid that keeps joints lubricated and your lungs stuck effortlessly to your chest wall while allowing the lungs to move freely as the chest wall moves.

When you’ve ski-poled your way on snowshoes up many a slope–gripping the pole, shoving with elbow and shoulder–a tendon may be overworked. The sheath tries to keep things running smoothly by secreting more fluid, but the sheath can’t expand to hold the increase in fluid, so the tendon is compressed. The tendon and the sheath swell and inflammation begins. Now the tendon calls for more lubrication and the sheath responds with more fluid and the problem increases each time that particular tendon is used. What develops is tendinitis. Or, as some medical books spell it, tendonitis. Even though no tendon is immune to trouble, some parts of your body are more susceptible than others–shoulders, wrists, and elbows, for example.

Tendinitis Types

In my case, the muscles of the forearm that allow the wrist to be cocked up–the muscles of wrist extension–had begun to microscopically tear loose from the outside of my elbow where the muscle attaches to the bone. This place where muscle attaches to bone is not technically a tendon since it does not run through a sheath, but the pain is similar and referred to by the same term of “tendinitis.”

Another insidious form of tendinitis attacks the tendons that hold the upper-arm bone to the shoulder, usually when the shoulder has been overworked in some kind of overhead work, such as reaching up a steep slope to plant a pole. The tendons at the back of the shoulder rub the underside of the shoulder blade until they are raw. You can get the same result from a sudden, violent movement, such as falling on an outstretched arm.

A more severe type of tendinitis can occur if you ignore the developing problem until calcium salts grow in an inflamed area. The sharp pieces of calcium irritate the bursa sac, the tough bag that surrounds all joints to hold the lubricating synovial fluid. The irritated bursa starts to overproduce fluid. Eventually, the entire sac becomes inflamed and tense, and the whole joint aches. At this point the standard treatment of tendinitis may not work.

Let Joints Heal

The standard treatment is simple: Don’t use the joint until it gets better. There is little chance it will hurt if you don’t move the inflamed tendon. And, without use, the tendon will finally heal. Application of cold packs several times a day for about 20 minutes helps speed the healing by reducing the swelling, and over-the-counter anti-inflammatory drugs will also reduce pain and improve the rate of mending. You can also benefit by massaging the offending tendon, but rub it only one way since back-and-forth rubbing can cause further damage.

Like most people, I found I didn’t have time to let my elbow rest. Hey, winter doesn’t last forever. The pain and disability got worse during following months, and, in the end I went to my doctor. I received a painful cortisone injection in the joint that begins to knock down the inflammation in a few hours. I wore a removable splint on my lower arm for six weeks that kept me from moving my wrist. I took 800 milligrams of the OTC, anti-inflammatory ibuprofen three times each day. I got better.

This is what you should do. If it hurts to use a joint, especially after using it a lot, you should consider the possibility that you have tendinitis. If you probe the joint and find a point that hurts when pressed, you should know you have tendinitis. Make every effort to not use that joint for the next few days. Put a cold pack on the painful spot three or four times a day for two or three days. After the days of cold treatment, start using the joint, but not to the point of pain. Mild use stimulates healthy, healing circulation and keeps the joint from stiffening. Start daily doses of an anti-inflammatory such as ibuprofen or aspirin. If the problem persists for two weeks, consult your physician.

And, in the meantime, consult your brain, the one that has grown much larger than that of our hunched ancestors. Get in shape. Stay in shape. Warm up before stressing and straining muscles and joints. Most of the aches and pains of snowshoeing are preventable.

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