For some people, back pain is a part of everyday life. For whatever reason, it just lingers on and on for what can seem like an eternity. Some people suffer from recurring pain; any little movement can set it in motion. This is called chronic pain. The following tips are particularly helpful for those with chronic pain, although acute pain sufferers can benefit from them as well.

Lumber up.

Lumber under the mattress will help the lumbar lying on top. “The object is to have a bed that doesn’t sag in the middle when you sleep on it,” says Dr. Fried. “A piece of plywood between the mattress and the box spring will end the sagging problem.”

Drown pain with a waterbed.

A modem waterbed, one that is adjustable and doesn’t make a lot of waves, is excellent for most types of back trouble,” says Dr. Fried.
Dr. Abraham agrees. “In waterbeds you get an equalized change in the pressure on various segments of your body;” he says. “You can lie in one position for the entire night because of this.”

Become a “lazy S” sleeper.

A bad back can’t stomach lying facedown. “The best position for someone resting in bed is what we call the lazy S position,” says Dr. Abraham. “Put a pillow under your head and upper neck keep your back relatively flat on the bed, and then put a pillow under your knees.” When you straighten your legs, your hamstring muscles pull and put pressure on your lower back, he explains. Keeping your knees bent puts slack into the hamstrings and takes the pressure off your back.

Develop fetal attraction.

You’ll sleep like a baby if you sleep on your side in the fetal position. “It’s a good idea to stick a pillow between your knees when you sleep on your side,” says Dr. Fried. “The pillow stops your leg from sliding forward and rotating your hips, which puts added pressure on your back.”

Take an aspirin a day.
It can keep back pain away; claim the experts. Backpain is often accompanied by inflammation around the site ofthe pain, says Dr. Fried, and simple over-the-counter anti-inflammatory drugs, such as aspirin and ibuprofen, can help take it away. “It can even help for a fairly severe amount of inflammation,” he says. Acetaminophen is not as effective because it is not an antiinflammatory drug.

Bark up the right tree.
If you’re looking for a natural antiinflammatory; try some white willow bark, which can be found in capsule form in health food stores, says Dr. Fried. “It is a natural salicylate, the active ingredient that gives aspirin its anti-inflammatory power,” says Dr. Fried. “Taken after meals, it shouldn’t hurt your stomach, and it works very well on mild to moderate back pain. Those who suffer from ulcers and heartburn, however, should not use it.”

Visualize yourself pain-free.

The middle of the night can be the worst time for pain. Pain wakes you up and it keeps you up. “Using visualization is a particularly good thing to do at times like this,” says professor Dennis Turk, Ph.D., director of the Pain Evaluation and Treatment Institute at the University of Pittsburgh School of Medicine.

“Close your eyes and imagine a lemon on a white china plate. See a knife next to it. See yourself pick it up and slice the lemon. Hear the sound it makes cutting through. Smell the aroma. Bring the lemon up to your face and imagine its taste. “This is just one example in how you can use your senses in visualization,” says Dr. Turk. The idea is to bring as much detail to the image as possible. The more involved the image is, the more you are engaged with it and the quicker you will become distracted from the pain.”

Turn your pain upside down.
“Gravity inversion works wonders on back pain,” says Dr. Fried. With this therapy you strap yourself to a special device that tilts back and allows you to hang upside down. “Gradually doing inversion traction with a proper, safe inversion apparatus for 5 or 10 minutes a day will really work to rid you from lower back pain,” he says. You should, however, have your doctor’s okay to use this kind of therapy, especially if you have disk problems. And those with a potential for glaucoma should not use it at all.

Try T’ai chi to untie muscle knots.
T’ai chi is an ancient Chinese discipline of slow; fluid movements. “It’s a great relaxation method that helps the muscles in your back,” says Dr. Abraham, who uses the method himself. “There are a lot of breathing exercises and stretching activities that foster a harmony within the body.”

T’ai chi takes time and self-discipline to learn, but Dr. Abraham feels it’s worth it. “I know it’s strange for an orthopedic surgeon to talk this way, but it’s smart living and it will go a long way in helping people with bad backs.”

“If you have back problems, the root of your problem could be your car seat, says Roger Minkow, M.D., a back specialist and founder of Backworks in Petaluma, California, who redesigns seats for airplane and automobile manufacturers. “German cars can be the worst when it comes to backs,” he says. “American cars are usually bad, too, but you can at least fix them. Japanese cars, on the other hand, have the best seats, followed by the Swedish cars Volvo and Saab.”

Next time you’re in the market for a car, Dr. Minkow suggests testing for cushion comfort as well as cruise-ability The following hints will help you make a wiser choice.

Take a new car for a sit.
“Look for a seat with adjustable lumbar support and adjust the support down as low as it goes,” he says. “See how that feels, and if you need to adjust it, do it from the lowest level.”

Get do-it-yourself comfort.

If you have a car seat that does not suit your back and you drive an American-made car, you probably can fix the situation yourself with little effort. Most American cars have a zipper on the bottom of the back cushion. “Just unzip it and slip a homemade lumbar support inside the car .seat,” he says. Here’s how to do it.

Go to an upholstery shop and buy a cushion of high-resiliency foam, which means 2.5- to 3.5-pound foam with an ILD (indent load deflection) of between 30 to 45 pounds. Cut a strip of foam 5Y2 inches wide by 1 inch thick with an electric carving knife. Then cut its length to fit your car seat width, being sure that you bevel the edge so that when the seat cover rolls over, it won’t roll it up. Shove the foam under the seat cover, then make the necessary adjustments by either raising it or lowering it so that it fits your back over the belt line (not the small of your back). Then zip the cover back up. “It takes about 15 minutes, costs about $3, and works as well as an $80 lumbar support,” Dr. Minkow says.

“For people who suffer daily from back pain, especially if the pain varies throughout the day, exercise can be very beneficial,” says Roger Minkow, M.D., a back specialist and founder of Backworks in Petaluma, California.
If you’re under a doctor’s care for back pain, make sure you get the okay before you begin. Here are some doctor-recommended exercises.

Play press-up.

Press-ups are something like half of a push-up. “Lie on the floor on your stomach. Keep your pelvis flat on the floor and push up with your hands, arching your back as you lift your shoulders off the floor,” says Dr. Minkow.
This will help strengthen your lower back. Dr. Minkow recommends that you do it once in the morning and once in the afternoon.

Move into a crunch.

While you’re on the floor, turn over onto your back and do what’s called a crunch sit-up. Lie flat with both feet on the floor and your knees bent. Cross your arms and rest your hands on your shoulders. Raise your head and shoulders off the floor as high as you can while keeping your lower back on the floor. Hold for 1 second, then repeat.

Swim on dry land.

You don’t need a deep-pile rug to swim on your floor. Lie on your stomach and raise your left arm and your right leg. Hold for 1 second, then alternate with your left leg and right arm as if you were swimming.
This will extend and strengthen your lower back, says Dr. Minkow.

Get into the pool.

“Swimming is great exercise for the back,” reports Milton Fried, MD. “A good exercise for acute low back pain is to get into a warm pool and swim.”

Put your mettle to the pedal.

“Ride a stationary bike with a mirror set up so that you can see yourself,” says Dr. Minkow. “Be sure to sit up straight without slouching. If you have to, raise the handlebars so that you’re not bent over forward.”

Remember-no pain, no gain, no brain.

In doing these or any other exercises, Dr. Minkow advises that you be careful and know your limit. “If the exercise you’re doing hurts or aggravates your condition, don’t do the exercise anymore,” he says. “You’re not going to improve anything by gritting your teeth and doing one more repetition. If you feel fine the day after, or two days after you exercise, then it’s safe to continue exercising.”

Your back will thank you for it. “For an acute problem,” says orthopedic surgeon Edward Abraham, M.D., assistant clinical professor at the University of California, Irvine, California College of Medicine, “the first thing you should do is get some bed rest.” In fact, it may be the only thing you’ll want to do. Any physical act, even getting up to go to the bathroom, may bring you pain. So, for the first day or two, keep activity to a minimum.

Don’t lounge too long.

How long you stay in bed depends on the severity of your pain, says Dr. Abraham. “If you’re still in pain after two days, for example, an extra day in bed won’t hurt. It’s best, however, to get out of bed as quickly as possible. Let pain be your guide.”

“Most people think that a week of bed rest will take away the pain,” adds David Lehrman, M.D., chief of orthopedic surgery at St. Francis Hospital and founder of the Lehrman Back Center in Miami, Florida. “But that’s not so. For every week of bed rest, it takes two weeks to rehabili tate.”

In fact, research at the University of Texas Health Science Center bears this out. Researchers there studied 203 patients who came into a walk-in clinic complaining of acute back pain. Some were told to rest for two full days and others were told to rest for seven days. There was no difference in the length of time it took the pain to diminish in either group, reported Richard A Deyo, M.D., who was one of the researchers and is now director of health services research at Seattle Veterans Admin- istration Medical Center. And those who got out of bed after two days got back to work a lot sooner.
“The length of bed rest doesn’t really affect recovery,” says Dr. Deyo.

“For some people it’s just the most comfortable position for the first couple of days.”

Put your pain on ice.

The best way to cool down an acute flare-up is with ice, says Canadian pain researcher Ronald Melzack, Ph.D., a professor at McGill University. It will help reduce swelling and the strain on your back muscles. For best results, he says, try ice massage. “Put an ice pack on the site of the pain and massage the spot for 7 or 8 minutes.” Do this for a day or two.

Try some heat relief.

After the first day or two of ice, physicians recommend that you switch to heat, says Milton Fried, M.D., founder of the Milton Fried Medical Clinic in Atlanta Georgia. Take a soft towel and put it in a basin of very warm water. Wring it well and flatten it so that there are no creases in it. Lie chest down with pillows under your hips and ankles and fold the towel across the painful part of your back Put some plastic wrap over that, then put a heating pad turned on medium on top of the plastic. If possible, place something on top that will create pressure, like a telephone book. “This creates moist heat and will help reduce muscle spasms,” says Dr. Fried.

Use heat and cold.
For those of you who can’t make up your mind which feels better, it’s okay to use both methods, says Dr. Abraham. It may even have an added bonus. “An in termi ttent regimen of heat and ice will actually make you feel better,” says Dr. Abraham. “Do 30 minutes of ice, then 30 minutes of heat, and keep repeating the cycle.”

Stretch to smooth a spasm.

“Stretching a sore back will actually enhance the healing process,” says Dr. Lehrman. “One good stretch for lower back pain is to gently bring your knees up from the bed and to your chest. Once there, put a little pressure on your knees. Stretch, then relax. Repeat.

“Stretching will help the muscle calm down sooner than just waiting for it to calm down on its own,” says Dr. Lehrman. Roll out of bed. When you do have to get out of bed, doctors advise that you roll out-carefully and slowly. “You can minimize the pain of getting out of bed by sliding to the edge of the bed,” says Dr. Lehrman. “Once there, keep your back rigid and then let your legs come off the bed first. That motion will act like a springboard, lifting your upper body straight up off the bed.”

RELIEF FROM A BACK ATTACK

Back doctors will tell you back pain comes in two forms, acute and chronic. Acute pain comes on suddenly and intensely. It’s the kind you usually experience from doing something you shouldn’t be doing or from doing it in the wrong way. The pain can be from sprains, strains, or pulls on muscles in your back. It can hurt like crazy for several days, but doctors say you can be pain-free without any lasting effects by following these self-help tips.

When the acute phase of the attack has settled down, says Dr. Hass, you need to remove any dead skin. “It houses living fungi that can reinfect you. At bath time, work the entire foot lightly but vigorously with a bristle scrub brush. Pay extra attention to spaces between toes - use a small bottle brush or test- tube brush there.” If you scrub your feet in the bathtub, shower afterward to wash away any bits of skin that could attach themselves to other parts of the body and start an infection there.

Pay attention to toenails.

Toenails are favorite breeding spots for the fungus, says Dr. Hass. He advises that you scrape the undersides clean at least every second or third day. Be sure to use an orange stick, toothpick, or wooden match rather than a metal nail file, which could scratch the nails and provide niches for the fungus to collect in.

Keep applying cream.

Once your infection has cleared up, says Dr. Goodman, you can help guard against its return by continuing to use (less often) the antifungal cream or lotion that cured your problem. This is especially prudent during warm weather. Use your own judgment in working up a schedule-anywhere from once a day to once a week.

Choose proper shoes.

Avoid both plastic shoes and footwear that has been treated to keep water out, says Dr. Copeland. They trap perspiration and create a warm, moist spot for the fungus to grow: Dermatologist Diana Bihova, M.D., a clinical instructor of dermatology at New York University Medical Center in New York City, recommends that you steer clear of any tight, snug, or unventilated footwear and that you never wear boots all day. “Natural materials such as cotton and leather create the best environment for feet, while rubber and even wool may induce sweating and hold moisture. Whenever possible, such as during the summer, wear airy shoes such as sandals,” she says.

Change them often.

Don’t wear the same shoes two days in a row says Dean S. Stem, D.P. M., a podiatrist at Rush-Presbyterian-St. Luke’s Medical Center in Chicago, Illinois. It takes at least 24 hours for shoes to dry out thoroughly. If your feet perspire heavily; change shoes twice a day.

Keep them dry-and clean.

Dust the insides of your shoes frequently with antifungal powder or spray. Another good idea, says Bethlehem, Pennsylvania, podiatrist Neal Kramer, D.P.M., is to spray some disinfectant (such as Lysoll on a rag and use it to wipe out the insides of your shoes. That will kill off any fungus spores living there. Do this every time you take off your shoes, he says.

And air them out! Dr. Hass recommends giving your shoes a little time in the sun to air out. “Remove the laces and prop open the throat of each shoe. You should even leave sandals outdoors to dry between wearings. And wipe the undersides of their straps clean after every wearing to remove any fungi-carrying dead skin. The idea is to reduce even the slightest possibility of reinfection.”

Sock the infection.

If your feet perspire heavily; says Dr. Hass, change your socks three or four times a day. And wear only clean cotton socks, not those made with synthetic yarns. Be sure to rinse them thoroughly during laundering, because detergent residue can aggravate your skin problem. And to help kill fungus spores, says Dr. Kramer, wash your socks twice in extra-hot water.

Powder your toes.

To further keep your feet dry; allow them to air-dry for 5 or 10 minutes after a shower before putting on your shoes and socks, says Dr. Bihova. To speed complete drying, hold a hair dryer about 6 inches from your foot, wiggle your toes, and dry between them. Then apply powder. To avoid the mess ofloose powder, place it in a plastic or paper bag, then put your foot into the bag and shake it well.

And your footgear. Dr. Levine further recommends applying medicated powder - such as Tinactin, Halotex, or Desenex - to your shoes before you put them on.

Cover up in public places.

You can decrease your exposure to the fungus, says Dr. Goodman, by wearing slippers and shower shoes in areas where lots of other people go barefoot. That includes gyms, spas, health clubs, locker rooms, and even around swimming pools. If you’re prone to fungal infections, you can pick them up almost any place that is damp-so be prudent.

Use soothing compresses to cool the inflammation, ease the pain, lessen the itching, and dry the sores, says Dr. Hass. Dissolve one packet of Domeboro powder or 2 tablespoons Burow’s Solution (both available without a prescription) in 1 pint of cold water. Soak an untreated, white cotton cloth in the liquid and apply three or four times daily for 15 to 20 minutes.

Look for a (salty) solution.
Soak your foot in a mixture of 2 teaspoons salt per pint of warm water, says Toronto podiatrist Glenn Copeland, D.P. M. Do this for 5 to 10 minutes at a time, and repeat until the problem clears up. The saline solution helps provide an unappealing atmosphere for the fungus and lessens excess perspiration. What’s more, it softens the affected skin, so antifungal medications can penetrate deeper and act more effectively.

Medicate your foot.

Now’s the time to apply an over-the-counter antifungal medication. According to dermatologist Thomas Goodman, Jr., M.D., an assistant professor at the University of Tennessee Center for Health Sciences in Memphis, the three main types contain either miconazole nitrate (found in Micatin products, for example), tolnaftate (Aftate or Tinactin), or fatty acids (Desenex). ‘Iwo or three times a day; lightly apply one of them to the whole area involved and rub in gently. Continue for four weeks (or for two weeks after the problem seems gone).

Treat your little piggies.

For athlete’s foot between your toes, says Dr. Goodman, apply an aluminum-chloride solution. This clear liquid not only kills fungus but also helps to dry the area and discourage regrowth. Ask your pharmacist to make up a solution of 25 percent aluminum chloride in water. Use a cotton swab to apply the liquid between your toes two or three times a day. Continue for two weeks after the infection clears up. One caution, says Dr. Goodman, don’t use aluminum chloride on skin that is cracked or raw-it will sting like crazy. Heal the cracks first
with an antifungal agent.

Rub in baking soda.

For fungus on your feet, especially between the toes, apply a baking-soda paste, says Suzanne M. Levine, D.P. M., a clinical assistant podiatrist at Mount Sinai Hospital in New York City.Take 1 tablespoon of baking soda and add a little lukewarm water. Rub that on the site of your fungus, then rinse and dry thoroughly. Finish off the treatment by dusting on cornstarch or powder.

This fungus is an equal opportunity affliction. It doesn’t care whether you’re ajock or ajanitor-or even a Jane. (Although men are more likely to catch this pesky infection, women are by no means immune.)foot. Keep it uncovered and at constant rest, even if you have to stay home from work or ignore your household duties to do so. Although the inflammation itself is not dangerous, it can worsen and lead to bacterial infection if you’re not careful.”

Athlete’s foot is caused by an organism that lives on the skin and breeds best under warm, moist conditions. Although balmy climates probably encourage its growth, sweaty footwear is more often the culprit. Once you’ve got it, you’ll need at least four weeks to make headway against a savage case. Worse, it will retum unless you stamp out the conditions that caused it in the first place. So here are some tips on dealing with an active infection and some ways to guard against an encore.

Baby your foot. Athlete’s foot can come on suddenly and be accompanied by cracked skin, oozing blisters, and an intermittent buming sensation, says Frederick Hass, M.D., a general practi tioner in San Rafael, Califomia. “When you’re suffering through this acute stage, baby your
Is That Really Athlete’s Foot?

According to Thomas Goodman, Jr., MD., that rash probably isn’t athlete’s foot if:

• It’s on a child’s foot. (it’s very rare for a child below the age of puberty to have a fungus infection of the foot.)

• It’s on the top of the toes. (Eru ptions on the tops of toes and the top of the foot are probably some form of contact dermatitis caused by shoe material)

• The foot is red, swollen, sore, blistered, and oozing.

Asthmatics given pills that contained the amount of caffeine found in two cups of coffee “could breathe better and their asthma improved,” Dr. Becker found. Caffeine and the popular asthma drug Theophylline are almost identical- your body doesn’t know the difference. He cautions, however, that caffeine is not a substitute for your medication. “We don’t recommend it as a treatment, but in an emergency, when you don’t have your medication around, two strong cups of coffee or hot cocoa ora couple of chocolate bars would be an effective substitute medication that would buy time until you could get to your medicine or
inhaler.”

Enlist 86 in the battle.

Knowledge of the effectiveness of vitamin B6 on asthma came about by accident. When researchers were studying the effects of the vitamin on those with sickle-cell anemia, they discovered that some members of the non-sickle-cell group also had a history of asthma. “When they took 50 milligrams of B, daily, it reduced the severity of their asthma attacks,” says internist Clayton L. Natta, M.D., associate professor of medicine at Columbia University College of Physicians and Surgeons, who conducted the research. “Further study of asthmatics supported the effectiveness of B6,” adds Dr. Natta. Megadoses of vitamin B6 can be toxic and are not recommended, but Dr. Natta says for an adult, “50 milligrams is a safe dose that is given medically all the time.” (For complete safety, use B6 only wi th the approval

listen to your lungs. Of course, the best way to fight an asthma attack is to not have one in the first place. “Recognize your own pattern,” says Dr. Ziering. “Be aware of what your early signs of asthma are. When you see the warning signals and you act right away; you will be able to ward it off. “You don’t suddenly have severe asthma,” he notes. “That’s rare. There is typically a pattern, and you can intervene in that process and stop it in its tracks.” The earlier you act, the less severe the asthma will be.

Use nonaspirin pain relievers.

In medical terms, it’s known as the” aspirin triad,” and it consists of sinusi tis! nasal polyps, asthma, and a sensitivity to aspirin. For some asthmatics, taking aspirin could have life-threatening consequences. “If you have sinusitis and nasal polyps and asthma, I wouldn’t recommend any nonsteroidal antiinflammatory like aspirin or ibuprofen because it could make your asthma worse or even kill you,” says allergist Richard Lockey; M.D., director of the Division of Allergy and Immunology at the University of South Florida College of Medicine, who studied the link. This aspirin sensitivity could just suddenly develop, so it’s best to stay clear of aspirin products altogether, says Dr. Friedlaender. “The problem doesn’t happen when you use acetaminophen,” he says.