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                                    TRAUMA 
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       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. 
       
