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Back Pain Exercises

Exercises to minimize problems with back pain

You can minimize problems with back pain with exercises that make the muscles in your back, stomach, hips and thighs strong and flexible. Some people keep in good physical condition by being active in recreational activities like running, walking, bike riding, and swimming. In addition to these conditioning activities, there are specific exercises that are directed toward strengthening and stretching your back, stomach, hip and thigh muscles.

Before beginning any exercise program, you should discuss the program with your doctor and follow the doctor's advice. It is important to exercise regularly, every other day. Before exercising you should warm up with slow, rhythmic exercises; if you haven't exercised in some time, you can warm up by walking. Inhale deeply before each repetition of an exercise and exhale when performing each repetition.

Exercises to strengthen your muscles

Wall slides to strengthen back, hip, and leg muscles

Stand with your back against a wall and feet shoulder-width apart. Slide down into a crouch with knees bent to about 90 degrees. Count to five and slide back up the wall. Repeat 5 times.

Leg raises to strengthen back and hip muscles.

Lie on your stomach. Tighten the muscles in one leg and raise it from the floor. Hold your leg up for a count of 10 and return it to the floor. Do the same with the other leg. Repeat five times with each leg.

Leg raises to strengthen stomach and hip muscles

Lie on your back with your arms at your sides. Lift one leg off the floor. Hold your leg up for a count of 10 and return it to the floor. Do the same with the other leg. Repeat five times with each leg. If that is too difficult, keep one knee bent and the foot flat on the ground while raising the leg.

You can also sit upright in a chair with legs straight and extended at an angle to the floor. Lift one leg waist high. Slowly return your leg to the floor. Do the same with the other leg. Repeat five times with each leg.

Partial sit-up to strengthen stomach muscles

Lie on your back with knees bent and feet flat on floor. Slowly raise your head and shoulders off the floor and reach with both hands toward your knees. Count to 10. Repeat five times.

Back leg swing to strengthen hip and back muscles

Stand behind a chair with your hands on the back of the chair. Lift one leg back and up while keeping the knee straight. Return slowly. Raise other leg and return. Repeat five times with each leg.

Exercises to decrease the strain on your back

Lie on your back with your knees bent and feet flat on your bed or floor. Raise your knees toward your chest. Place both hands under your knees and gently pull your knees as close to your chest as possible. Do not raise your head. Do not straighten your legs as you lower them. Start with five repetitions, several times a day.

Stand with your feet slightly apart. Place your hands in the small of your back. Keep your knees straight. Bend backwards at the waist as far as possible and hold the position for one or two seconds.

Cauda Equina Syndrome

Low back pain is common and usually goes away without surgery. But a rare disorder affecting the bundle of nerve roots (cauda equina) at the lower (lumbar) end of the spinal cord is a surgical emergency. An extension of the brain, the nerve roots send and receive messages to and from the pelvic organs and lower limbs. Cauda equina syndrome (CES) occurs when the nerve roots are compressed and paralyzed, cutting off sensation and movement. Nerve roots that control the function of the bladder and bowel are especially vulnerable to damage.

If you don’t get fast treatment to relieve the pressure, CES may cause permanent paralysis, impaired bladder and/or bowel control, loss of sexual sensation and other problems. Even if the problem gets treatment right away, you may not recover complete function.

Causes

CES may be caused by a ruptured disk, tumor, infection, fracture or narrowing of the spinal canal. It may also happen because of a violent impact such as a car crash, fall from significant height or penetrating (i.e., gunshot, stab) injury. Children may be born with abnormalities that cause CES.

Diagnosis and treatment

Although you need early treatment to prevent permanent problems, CES may be difficult to diagnose. Symptoms vary in intensity and may evolve slowly over time. See your doctor immediately if you have:

• Bladder and/or bowel dysfunction, causing you to retain waste or be unable to hold it.
• Severe or progressive problems in the lower extremities including loss of or altered sensation between the legs, over the buttocks, inner thighs and back of legs (saddle area), and feet/heels.
• Pain, numbness or weakness spreading to one or both legs that may cause you to stumble or have difficulty getting up from a chair.

To diagnose CES, the doctor will probably evaluate your medical history, give you a physical examination and order multiple imaging studies.

Medical history: Describe your overall health, when the symptoms of CES began and how they impact your activities.

Physical exam: The doctor assesses stability, sensation, strength, reflexes, alignment and motion. He or she may ask you to stand, sit, walk on your heels and toes, bend forward, backward and to the sides, and lift your legs while lying down. The doctor might check the tone and numbness of anal muscles. You may need blood tests.

Imaging: You may get X-rays, MRIs (magnetic resonance imaging) and CAT scans (computerized tomography) to help the doctor see the problem.

Surgery

If you have CES, you may need urgent surgery to remove the material that is pressing on the nerves. The surgery may prevent pressure on the nerves from reaching the point at which damage is irreversible.

Living with CES

Surgery won’t help if you already have permanent nerve damage. In this case, you can learn how to make living with CES more tolerable. Some suggestions:

• In addition to medical personnel, you may want to get help from an occupational therapist, social worker, continence advisor or sex therapist.
• Involve your family in your care.
• To learn all you can about managing the condition, you may want to join a CES support group.

Managing bladder and bowel

Some bladder and bowel function is automatic, but the parts under voluntary control may be lost if you have CES. This means you may not know when you need to urinate or move your bowels, and/or you may not be able to eliminate waste normally. Some general recommendations for managing bladder and bowel dysfunction:

Bladder: Empty the bladder completely with a catheter 3-4 times each day. Drink plenty of fluids and practice regular personal hygiene to prevent urinary tract infection.

Bowel: Check for the presence of waste regularly and clear the bowels with gloved hands. You may want to use glycerin suppositories or enemas to help empty the bowels. Use protective pads and pants to prevent leaks.

Fracture of the Thoracic and Lumbar Spine

Fracture of one or more parts of the spinal column (vertebrae) of the middle (thoracic) or lower (lumbar) back is a serious injury usually caused by high-energy trauma like a car crash, fall, sports accident or act of violence (i.e., gunshot wound). Males experience the injury four times more often than females do. The spinal cord may be injured depending on the severity of the fracture. Symptoms include:

• Moderate to severe back pain made worse by movement.
• In some cases when the spinal cord is also involved, numbness, tingling, weakness or bowel/bladder dysfunction.

When you fracture the thoracic and lumbar spine, surgery or bracing is often necessary. Often, patients also have other life-threatening injuries. People with osteoporosis, tumors or other underlying conditions that weaken bone can get a spinal fracture with minimal trauma or normal activities of daily living.

Emergency treatment

Never attempt to move a person with a spinal injury, because movement can cause more damage. Call 911 immediately. Rescue workers know how to properly immobilize people with injuries and safely take you to the hospital for evaluation and treatment.

Doctor’s evaluation

After checking heart rate, breathing and other vital signs, a doctor locates the fractured part(s) of the spine and determines the extent of damage. He or she finds out exactly how the vertebra broke (fracture pattern) and whether you have nerve (neural) injury and/or spinal instability.

The doctor considers what caused the injury, gives you a physical/neurological examination and takes X-rays to show inside the body.

History. Every detail you can recall about what caused the injury may help the doctor. Sometimes rescue workers or other witnesses can supply more information. Did an accident eject the patient from a vehicle? Was there windshield or steering column damage? Was the person using a lap and/or shoulder seat belt? Did an airbag deploy?

Examination. The doctor carefully removes your clothing and immobilizes the body with a spine board for complete physical examination. This may include checking for swelling, bruising and other signs of injury to the head, chest, abdomen and back; evaluating strength, motion and alignment of arms and legs; feeling for tenderness on each rib and along the entire length of the spine; testing the tone and sensation of rectal muscles; and other evaluations.

You may also need a neurologic examination. This may include tests of sensory (i.e., temperature, pain and pressure sensitivity), motor (i.e., muscle strength) and reflex (i.e., knee jerk) functions of the nervous system. If you have neurologic damage, certain tests can show whether you may recover some function (incomplete deficit) or not (complete deficit).

Imaging. X-rays of the entire spine from multiple angles may be necessary to see bone alignment and check for damage to soft tissue. Sometimes you may also need CT (computed tomography) or MRI (magnetic resonance imaging) scans to help the doctor better visualize the injury.

Classification

Doctors classify fractures of the thoracic and lumbar spine based upon pattern of injury:

• Compression fracture: While the front (anterior) of the vertebra breaks and loses height, the back (posterior) part of it does not. This type of fracture is usually stable and rarely associated with neurologic problems.
• Axial burst fracture: You lose height on both the front and back of the vertebra in this type of fracture, often caused by a fall from height in which you land on your feet.
• Flexion/distraction (chance) fracture: The vertebra is literally pulled apart (distraction), such as in a head-on car crash in which the upper body is thrown forward while the pelvis is stabilized by a lap seat belt.
• Transverse process fracture: This type of fracture results from rotation or extreme sideways (lateral) bending and usually does not affect stability.
• Fracture-dislocation: This is an unstable injury involving bone and/or soft tissue in which one vertebra may move off the adjacent one (displaced).

Treatment

Treatment goals include protecting nerve function and restoring alignment and stability of the spine. The doctor determines the best treatment method based upon fracture type and other factors.

Non-surgical: Doctors usually treat compression and some burst fractures without surgery. If you have a simple compression fracture, you may need to wear a hyperextension brace for sitting and standing activities for 6-12 weeks. You should walk and do other exercises while healing and may take medication for pain. If you have a transverse process fracture, you may need to wear a thoracolumbar corset along with doing an aerobic walking program.

Surgical: Some injuries require more aggressive treatment. You may need steroids if the spinal cord is injured. You may need surgery if you have an unstable burst fracture, flexion-distraction injury or fracture-dislocation. Surgery realigns the spinal column and holds it together using metal plates and screws (internal fixation) and/or spinal fusion.

Herniated Disk

You’ve probably heard people say they have a "slipped" or "ruptured" disk in the back. What they’re actually describing is a herniated disk, a common source of lower back pain.

Disks are soft, rubbery pads found between the hard bones (vertebrae) that make up the spinal column. In the middle of the spinal column is the spinal canal, a hollow space that contains the spinal cord and other nerve roots. The disks between the vertebrae allow the back to flex or bend. Disks also act as shock absorbers.

The outer edge of the disk is a ring of gristle-like cartilage called the annulus. The center of the disk is a gel-like substance called the nucleus. A disk herniates or ruptures when part of the center nucleus pushes the outer edge of the disk into the spinal canal, and puts pressure on the nerves.

How this condition develops

Disks have a high water content. As people age, the water content decreases, so the disk begins to shrink and the spaces between the vertebrae get narrower. Also, the disk itself becomes less flexible. Other conditions that can weaken the disk include:

• wear-and-tear
• excessive weight which can squeeze the softer material of the nucleus out toward the spinal canal
• bad posture
• improper lifting
• sudden pressure (which may be slight)

The fibrous outer ring may tear. As the disk material pinches and puts pressure on the nerve roots, pain results. Sometimes fragments of the disk enter the spinal canal where they can damage the nerves that control bowel and urinary functions.

Recognizing symptoms

Low back pain affects four out of five people. So pain alone isn’t enough to recognize a herniated disk. However, if the back pain is the result of a fall or a blow to your back, don’t hesitate to contact a doctor. The most common symptom of a herniated disk is sciatica, a sharp, often shooting pain that extends from the buttocks down the back of one leg. This is caused by pressure on the spinal nerve. Other symptoms include

• Weakness in one leg
• Tingling (a "pins-and-needles" sensation) or numbness in one leg
• Loss of bladder or bowel control (If you also have weakness in both legs, you could have a serious problem. Seek immediate attention.)
• A burning pain centered in the back

Diagnosing a herniated disk

Your medical history is key to a proper diagnosis. You may have a history of back pain with gradually increasing leg pain. Often a specific injury causes a disk to herniate. A physical examination can usually determine which nerve roots are affected (and how seriously). A simple x-ray may show evidence of disk or degenerative spine changes.

Treatment options

Conservative treatment usually works. Most back pain will resolve gradually with simple measures. Bed rest and over-the-counter pain relievers may be all that’s needed. Muscle relaxers, analgesic and anti-inflammatory medications are also helpful. You can also apply cold compresses or ice for no more than 20 minutes at a time, several times a day. After any spasms settle, you can switch to gentle heat applications.

Any physical activity should be slow and controlled so that symptoms do not return. Take short walks and avoid sitting for long periods. Exercises, such as those described in the Low Back Exercise Guide on this web site, may also be helpful in strengthening back and abdominal muscles. Learning to stand, sit, and lift properly is essential to avoiding future episodes of pain.

Other treatments

• If conservative treatment fails, epidural injections of a cortisone-line drug may lessen nerve irritation and allow better participation in physical therapy. These shots are given on an outpatient basis over a period of weeks.
• In certain very carefully selected cases, the injections may use chymopapain, an enzyme that dissolves portions of the disc so it no longer presses on the nerve.
• MRI or CT scans (imaging tests to confirm which disk is injured) or an EMG (a test that measures the electrical activity of muscle contractions to show nerve or muscle damage) may be recommended if pain continues.
• Surgery may be required if a disk fragment lodges in spinal canal and presses on a nerve, causing a loss of function. The traditional surgical treatment is called a laminectomy and involves removing a portion of the vertebral bone. The surgery is performed under general anesthesia with an overnight hospital stay.
• Newer surgical techniques are minimally invasive and use a local anesthetic. Surgery is performed on an outpatient basis and you should be able to return to work in two to six weeks.

 

How to Prevent Back Pain

Four out of five adults will experience significant low back pain sometime during their life. Work-related back injuries are the nation's number one occupational hazard, but you could suffer back pain from activities at home and at play, too.

Are you at risk?

You are most at risk for back pain if:

• your job requires frequent bending and lifting
• you must twist your body when lifting and carrying an object
• you must lift and carry in a hurry
• you are overweight
• you do not exercise regularly or do not engage in recreational activities
• you smoke

If you are a caregiver for an ill or injured family member, you are at greatest risk for back pain when:

• pulling the person who is reclining in bed into a sitting position
• transferring the person from the bed to a chair
• leaning over the person for long periods of time

The American Academy of Orthopaedic Surgeons has developed tips to help you reduce your risk of back pain. Whether you are lifting and moving a person or a heavy object, the guidelines are the same.

• Plan ahead what you want to do and don't be in a hurry.
• Spread your feet shoulder-width apart to give yourself a solid base of support.
• Bend your knees.
• Tighten your stomach muscles.
• Position the person or object close to your body before lifting.
• Lift with your leg muscles. Never lift an object by keeping your legs stiff, while bending over it.
• Avoid twisting your body; instead, point your toes in the direction you want to move and pivot in that direction.
• When placing an object on a high shelf, move close to the shelf. Do not stand far away and extend your arms with the object in your hands.
• Maintain the natural curve of your spine; don't bend at your waist.
• When appropriate, use an assistive device such as a transfer belt, sliding board or draw sheet to move a person.
• Do not try to lift by yourself something that is too heavy or an awkward shape. Get help.

How to prevent back pain

• Use the correct lifting and moving techniques.
• Exercise regularly to keep the muscles that support your back strong and flexible.
• Don't slouch; poor posture puts a strain on your lower back.
• Maintain your proper body weight to avoid straining your back muscles.
• Keep a positive attitude about your job and homelife; studies show that persons who are unhappy at work or home tend to have more back problems and take longer to recover than persons who have a positive attitude.

IDET (Intradiscal Electrothermal Annuloplasty)

Practically everyone suffers from back pain at some point. Sometimes the pain results from pressure on nerves, sometimes from spinal fractures, and sometimes from problems with the cushioning discs that separate the bones of the spine. Depending on the cause of the pain, treatment can be as simple as rest and exercise, or as complex as major surgery. Usually, simpler methods are tried first; if they are not successful in relieving the pain, more aggressive treatments can be used.

A relatively new treatment for back pain resulting from problems within the cushioning discs is intradiscal electrothermal annuloplasty, also called intradiscal electrothermal therapy (IDET). This outpatient procedure applies high heat directly to the inside of the disc. It is a less expensive and less invasive procedure than spinal surgery, but it is not appropriate for everyone who has low back pain.

Disc anatomy

Discs are cushioning tissues located between each vertebra of the spine. The disc has a soft center (nucleus) surrounded by tougher ligament tissue (annulus). As we age, the outer ligament tissue begins to fray and tear from use or injury. This allows nerves and small blood vessels from the soft center to seep into the injury site, triggering pain receptors in the ligament tissue. The result is discogenic back pain.

Discogenic pain differs from a ruptured or herniated disc because the pain originates within the disc and does not come from nerves or other structures. Discogenic pain is confined to the back and does not radiate down the legs.

Diagnosis

In addition to interviewing you about the pain, the physician will take your medical history and give you a physical examination. Tests that can help determine the source of the pain include X-rays, magnetic resonance imaging (MRI), computed tomography (CT) scans and discography.

Discography is used to identify the painful disc. In this test, the physician pierces the disc with a thin needle and injects a contrast dye. X-rays show whether the dye enters the disc’s outer tissues. Discography is called a provocative test because it will provoke pain in an injured disc.

IDET

IDET is usually reserved only for patients who have tried aggressive, non-operative techniques to relieve their pain without success. Because this is a relatively new procedure, you should make sure that the practitioner you see is adequately trained in using the equipment. The procedure itself takes about one hour to complete. A local anesthetic and intravenous pain relievers are used.

• The physician uses an X-ray machine (fluoroscope) to see the spinal structures.
• A hollow needle is inserted into the painful disc. A thin heating wire (electrothermal catheter) is passed through the needle into the disc, and maneuvered into place around the outer edge of the central nucleus.
• The wire is heated slowly to a temperature of about 194 degrees Farenheit (90 degrees Celsius) for about 15 minutes.

Heat can potentially contract and shrink the fibers that make up the disc wall, closing any tears.

The heat can also potentially cauterize (burn) tiny nerve endings in the disc, making them less sensitive to pain.

• After the wire and needle are removed, there is a short observation period before the patient is released.

Postoperative treatment

Although IDET is much less invasive than most back surgeries, it will still take several weeks for healing to occur. Pain relief is not immediate; pain may actually increase for a day or two after surgery. But gradually the pain from the procedure itself should diminish.

After the IDET procedure, you will need to rest for a few days and limit the time you spend sitting. You may need to wear a back support for several weeks. You will also need to participate in a physical therapy program. If your job is sedentary does not involve lifting or manual labor, you may be able to return to work in a week or so; otherwise it may be several months before you can resume your activities. You will not be able to participate in rigorous recreational activity or do any heavy lifting or twisting for at least six months after the procedure.

IDET is not recommended if you have severe disc degeneration, nerve compression, spinal instability and/or narrowing of the spinal column (spinal stenosis). IDET is not yet covered by many insurance plans.

The long-term results of this procedure are still unknown. IDET was introduced in 1997 and case series without controls have reported encouraging results. However, these results need to be confirmed in prospective, randomized trials. Additionally, there is debate about how the procedure actually works. Not every patient will benefit from IDET treatment. Some patients continue to experience back pain and may eventually have other surgical procedures.

Kids and Backpacks

Back to school should not mean backaches and pains, but for kids who use backpacks, it could mean a visit to the physician’s office. In fact, overloaded backpacks have received a lot of attention in schools. Everyone from parents to school administration staffs have started to voice concern about their use.

More than 13,260 injuries related to backpacks were treated at hospital emergency rooms, doctor’s offices and clinics in the year 2000, according to estimates and projections of the U.S. Consumer Product Safety Commission.

The extra stress placed on the spine and shoulder from the heavy loads that children carry in their backpacks is causing muscle fatigue and strain. Excessive weight in backpacks could cause some children to develop bad habits early in life like poor posture or excessive slouching.

As part of its Prevent Injuries America!® national injury prevention campaign, the Academy suggests the following guidelines:

• Use a hip strap for heavier weights.
• Use a back pack with padded, wide straps and a padded back.
• Use both of the back pack's straps, firmly tightened, to hold the pack two inches above your waist.
• Engage in exercises to condition your back muscles. Ask an orthopaedic surgeon for advice.
• Use the correct lifting techniques. Remember, bend with both knees when picking up a heavy back pack.
• Place the heaviest items close to your back.
• Neatly pack your backpack, and try to keep items in place.
• Try to make frequent trips to your locker, between classes, to replace books.
• Consider purchasing a backpack with wheels.
• Purchase a second set of books for home.

Kyphosis (Curvature of the Spine)

Few things are more troublesome to parents than their child’s posture. An exaggerated rounding to the back is especially upsetting. Although some degree of curvature to the spine is normal, the term "kyphosis" (kI-fO-sis) is usually applied to the exaggerated curve that results in a rounded or hunched back.

Kyphosis may develop for several reasons. Slouching and poor posture can stretch spinal ligaments, thus increasing the natural curve of the spine. This postural kyphosis usually begins to develop during adolescence. It is more common among girls than boys and rarely causes pain. Exercises to strengthen the abdomen and stretch the hamstrings may help correct postural kyphosis. As posture improves, the kyphosis naturally diminishes.

Another type of kyphosis may develop in later life as a result of osteoporosis. As the bones of the spine weaken and thin, they begin to deteriorate and compress upon each other. The result is a "dowager’s hump." Other serious forms of kyphosis may result from congenital defects or disease.

Congenital kyphosis

In some infants, the spinal column does not develop properly. The bones may not form as they should, or a bone bar may develop between two vertebrae and cause progressive kyphosis as the child grows. Children born with conditions such as spina bifida usually have severe kyphosis. If kyphosis is present from birth, it will continue to worsen as the child grows. Surgical treatment and consistent follow-up are needed to maintain a more normal curvature.

Scheuermann’s kyphosis

Scheuermann’s (shoe-er-mans) kyphosis is named after the Danish radiologist who first described this condition. Like postural kyphosis, it often becomes obvious during the teen years. However, Scheuermann’s kyphosis is more common among boys than girls. It is not generally painful, although it does present a cosmetic deformity. The only sure way to tell the difference between postural kyphosis and Scheuermann’s kyphosis is with X-rays. The vertebrae and disks will appear normal in postural kyphosis, but irregular and wedge-shaped in Scheuermann’s kyphosis.

Scheuermann’s kyphosis usually affects the upper (thoracic) spine, although it can also occur in the lower (lumbar) back area. If pain is present, it is usually felt at the apex of the curve. Activity or long periods of standing or sitting can aggravate the pain.

Diagnosis and treatment

Usually, a visit to the doctor is precipitated by a scoliosis screening at school, concern about the cosmetic deformity of a rounded back, or pain combined with poor posture. The doctor may ask the child to bend forward so that he or she can see the slope of the spine. X-rays of the spine will show if there are any bony abnormalities, and will enable the doctor to measure the degree of the curve. Any curvature over 50 degrees is considered abnormal.

Treatment will depend on the reason for the deformity. Most teens with postural kyphosis will "grow out" of the condition as they grow up and their posture improves. An exercise program may also help.

An initial program of conservative treatment that includes exercises, anti-inflammatory drugs and rest is also recommended for patients with Scheuermann’s kyphosis. If the child is still growing, the doctor may prescribe wearing a brace until skeletal maturity is reached. Surgery may be recommended if the curve is greater than 75 degrees. The goal of surgery is to reduce the degree of curvature by straightening and fusing the spinal segments together.

Lifting Techniques for Home Caregivers

If you are taking care of a spouse or family member at home, you are at greatest risk for back pain when you are:

• Pulling a person who is reclining in bed into a sitting position.
• Transferring a person from a bed to a chair.
• Leaning over a person for long periods of time.
• Always keep the person who is being moved close to your body.
• Keep your feet shoulder-width apart to maintain your balance.
• Use the muscles in your legs to lift and/or pull.
• When you lift or move a person, maintain the proper alignment of your head and neck with your spine. Maintain the natural curve of your spine; don't bend at your waist.
• Avoid twisting your body when carrying a person.
• If the person is too heavy, get help.

Sitting up in bed

To move a person lying in bed to a wheelchair, put the chair close to the bed and lock the wheels. If the person is not strong enough to push up with his or her hands to a sitting position, place one of your arms under the person's legs and your other arm under his or her back. Move the person's legs over the edge of the bed while pivoting his or her body so the person ends up sitting on the edge of the bed. Keep your feet shoulder-width apart, your knees bent and your back in a natural straight position.

Standing up

If the person needs assistance getting into the chair, face the patient, place your feet shoulder-width apart and bend your knees. Position the person's feet on the floor and slightly apart. The person's hands should be on the bed or on your shoulders. Place your arms around the person's back and clasp your hands together, Nurses, physical therapists and others in hospitals often use lifting belts which are fastened around a person's waist. The caregiver grasps the belt when lifting the patient. Hold the person close to you, lean back and shift your weight.

Sitting down

Pivot toward the chair, bend your knees and lower the person into the chair. The person should have both hands on the arms of the chair before lowering him or her down.

Preventing Back Pain at Work and at Home

Plan ahead what you want to do and don't be in a hurry. Position yourself close to the object you want to lift. Separate your feet shoulder-width apart to give yourself a solid base of support. Bend at the knees. Tighten your stomach muscles. Lift with your leg muscles as you stand up. Don't try to lift by yourself an object that is too heavy or an awkward shape. Get help.

To lift a very light object from the floor, such as a piece of paper, lean over the object, slightly bend one knee and extend the other leg behind you. Hold on to a nearby chair or table for support as you reach down to the object.

Whether you're lifting a heavy laundry basket or a heavy box in your garage, remember to get close to the object, bend at the knees and lift with your leg muscles. Do not bend at your waist. When lifting luggage, stand along side of the luggage, bend at your knees, grasp the handle and straighten up.

While you are holding the object, keep your knees slightly bent to maintain your balance. If you have to move the object to one side, avoid twisting your body. Point your toes in the direction you want to move and pivot in that direction. Keep the object close to you when moving.

If you must place an object on a shelf, move as close as possible to the shelf. Spread your feet in a wide stance, positioning one foot in front of the other, to give you a solid base of support Do not lean forward and do not fully extend your arms while holding the object in your hands.

If the shelf is chest high, move close to the shelf and place your feet apart and one foot forward. Lift the object chest high, keep your elbows at your side and position your hands so you can push the object up and on to the shelf. Remember to tighten your stomach muscles before lifting.

When sitting, keep your back in a normal, slightly arched position. Make sure your chair supports your lower back. Keep your head and shoulders erect. Make sure your working surface is at the proper height so you don't have to lean forward.

Once an hour, if possible, stand and stretch. Place your hands on your lower back and gently arch backward.

Preventing Back Pain: Tips for New Moms

Complaints of back pain by pregnant women are common. Usually, the pain diminishes within two weeks after delivery. But back pain may return as you begin lifting and carrying the infant on a daily basis. As the infant grows, the weight load increases and back pain can result.

Caring for an infant puts stress on your back. Initially, you may be lifting the 7- to 10-pound baby up to 50 times a day. By the time the child is a year old, you are lifting and carrying 17 pounds. Two years later, you will be lifting a 25- to 30-pound child.

Here are ten ways that new mothers can help reduce their risk of injury and back pain. Many of these tips also work well with new fathers!

1. Begin exercising soon after delivery to restore muscle tone to the abdominal and back muscles. While the baby is napping, take 10 minutes to do stretching exercises on the floor each day. This will help restore hip and back flexibility.
2. Try to return to your normal weight within six weeks after giving birth.
3. Do not stretch your arms out to pick up the baby. Bring the baby close to your chest before lifting. Avoid twisting your body.
4. To pick up a child from the floor, bend at your knees—not at your waist. Squat down, tighten your stomach muscles and lift with your legs.
5. Remove the high chair tray when you are trying to put the baby in or take the baby out of the high chair.
6. When lifting the child up out of the crib, put the crib side down and pull the child toward you. Do not bend over the crib side and lift the baby over the top.
7. Consider using a "front pack" to carry the baby when you are walking.
8. Do not carry a child on your hip; this overloads the back muscles.
9. To avoid upper back pain from breastfeeding, bring the baby to your breast, rather than bending over the baby. While you are nursing, sit in an upright chair rather than a soft couch.
10. Do not stand outside the car and try to place the child in the car seat. Kneel on the back seat as you place the baby into the car seat. Consider trading in your sporty two-door model for a four-door vehicle, which will make it easier for you to place the child in the car seat.

If you had a Caesarian-section (C-section) delivery, wait six weeks or until you get the permission of your obstetrician before you begin exercising. Additionally, the risk of back pain is greater among young, overweight women.

Sciatica

If you suddenly start feeling pain in your lower back or hip that radiates down from your buttock to the back of one thigh and into your leg, your problem may be a protruding disk in your lower spinal column pressing on the roots to your sciatic nerve. Sciatica (lumbar radiculopathy) may feel like a bad leg cramp that lasts for weeks before it goes away. You may have pain, especially when you sit, sneeze or cough. You may also feel weakness, "pins and needles" numbness, or a burning or tingling sensation down your leg. See a doctor to have your condition diagnosed and start a course of treatment.

You’re most likely to get sciatica when you’re 30-50 years old. It may happen due to the effects of general wear and tear, plus any sudden pressure on the disks that cushion the vertebrae of your lower (lumbar) spine. The gel-like inside (nucleus) of a disk may protrude into or through the disk’s outer lining (annulus). This herniated disk may press directly on nerve roots that become the sciatic nerve. The nerve may also get inflamed and irritated by chemicals from the disk’s nucleus. About one in every 50 people experience a herniated disk. Of these, 10-25 percent have symptoms lasting more than six weeks. About 80-90 percent of people with sciatica get better, over time, without surgery.

Treatment

The condition usually heals itself if you give it enough time and rest. Tell your doctor how your pain started, where it travels and exactly what it feels like. A physical exam may help pinpoint the irritated nerve root. Your doctor may ask you to squat and rise, walk on your heels and toes or perform a straight leg raising test or other tests. Most cases of sciatica affect the L5 or S1 nerve roots. Later, X-rays and other specialized imaging tools such as MRI (magnetic resonance imaging) may confirm your doctor’s diagnosis of which nerve roots are affected.

Treatment is aimed at helping you manage your pain without long-term use of medications. First, you’ll probably need at least a few days of bed rest while the inflammation goes away. Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, aspirin or muscle relaxants may also help. You may find it soothing to put gentle heat or cold on your painful muscles. Find positions that are comfortable, but be as active as possible. Motion helps to reduce inflammation. Most of the time, your condition will get better within a few weeks. Sometimes, your doctor may inject your spine area with a cortisone-like drug. As soon as possible, start physical therapy with stretching exercises to help you resume your physical activities without sciatica pain. To start, your doctor may want you to take short walks.

You might need surgery only if after 3 months or more of treatment you still have disabling leg pain. A part of the herniated disk may be removed to stop it from pressing on your nerve. The surgery (laminotomy) may be done under local, spinal or general anesthesia. You have a 90 percent chance of successful surgery if most of your pain is in your leg. Avoid driving, excessive sitting, lifting or bending forward for at least a month after surgery. Your doctor may give you exercises to strengthen your back.

Following treatment for sciatica, you will probably be able to resume your normal lifestyle and keep your pain under control. However, it’s always possible for your disk to rupture again. This happens to about 5 percent of people with sciatica.

Emergency situation

In rare cases, a herniated disk may press on nerves that cause you to lose control of your bladder or bowel. If this happens, you may also have numbness or tingling in your groin or genital area. This is an emergency situation that requires surgery. Phone your doctor immediately.

Scoliosis in Children and Adolescents

Many schools regularly conduct scoliosis screenings among students. Usually these screenings occur during the middle school years. If your child receives a referral for scoliosis based on a school screening, here are some facts you should know.

Scoliosis

• Is a sideways curvature of the spine that makes the spine look more like an "S" or "C" than a straight "I".
• Can cause the bones of the spine to turn (rotate) so that one shoulder or hip appears higher than the other.
• Can run in families, although the exact cause of most cases of scoliosis is unknown (idiopathic).
• Can occur at any age. Infantile scoliosis occurs in children less than 3 years old, and may result from a birth defect, disease of the nerves and muscles (such as muscular dystrophy or cerebral palsy), injury, infection or tumors. Juvenile scoliosis occurs in children between the ages of 3 and 10 years old and is not common. Adolescent scoliosis occurs after the age of 10 years old and is the most common type.
• Does not usually cause any pain.
• Occurs about equally in boys and girls, but girls are more likely to have a severe, progressive curve that will require treatment.

Diagnosis

• Requires a thorough medical history to determine if any other problems may be causing the spine to curve.
• Includes a comprehensive physical examination. The doctor will ask your child to bend forward, which will show any deformities. He or she will also check for any limb-length discrepancies, abdominal muscle strain or other potential causes.
• Is confirmed with an X-ray of the spine. The physician will measure the degree of the curve as shown on the X-ray. The type of treatment required depends on the kind and degree of the curve, the child’s age, the number of years of growing until the child reaches skeletal maturity and the type of scoliosis.

Treatment

• Observation: This option may be appropriate if the angle of the curve is not severe (less than 20 degrees) or if the child is near skeletal maturity. However, the doctor will want to recheck the curve on a regular basis to see that it is not getting any worse. He or she may ask that you come back every 3 to 6 months for re-examination. Most cases of scoliosis referred through school screening will fall into this category.
• Bracing: The goal of bracing is to prevent curves from getting worse. Bracing can be effective if the child is still growing and has a curve of less than 30 degrees. There are several types of braces that reach to the underarm or higher. Your orthopaedist will recommend a brace and tell you how long it should be worn each day. Wearing a brace does not affect participation in activities such as sports or exercise.
• Surgery: If the curve is more than 50 degrees and the child is still growing, the doctor may recommend surgery. Before the operation, your child can donate some of his or her own blood to reduce the risk of infection. The surgery requires a bone graft from the hip, ribs or a bone bank and may use a series of rods, hooks, screws or wires to straighten the spine. Patients can walk about on the second or third day, are discharged from the hospital within a week and can rapidly resume their daily activities. A return to some sports is possible in 6 to 9 months.

Long-term Effects

If left untreated, scoliosis can have some long-term effects. Depending on the degree of curvature, the condition can worsen during adult life. In addition to curving, the spine can begin to rotate, contributing to diminished lung capacity and the development of restrictive lung disease. Cosmetic concerns are significant to many patients. The incidence of back pain among patients with scoliosis approximates that of the general population.

Spinal Fusion

Spinal fusion is a "welding" process by which two or more of the small bones (vertebrae) that make up the spinal column are fused together with bone grafts and internal devices such as metal rods to heal into a single solid bone. The surgery eliminates motion between vertebrae segments, which may be desirable when motion is the cause of significant pain. It also stops the progress of a spinal deformity such as scoliosis. A spinal fusion takes away some of the patient’s spinal flexibility. Most spinal fusions involve relatively small spinal segments and thus do not limit motion very much. Spinal fusion is used to treat:

• Injuries to spinal vertebrae.
• Protrusion and degeneration of the cushioning disk between vertebrae (sometimes called slipped disk or herniated disk).
• Abnormal curvatures (such as scoliosis or kyphosis).
• Weak or unstable spine caused by infections or tumors.

About 258,000 spinal fusions were performed in 1999. About 119,000 procedures involved the upper (cervical) spine. About 139,000 involved the lower (lumbar) spine.

Bone is the most commonly used material to help promote fusion. Generally, small pieces of bone are placed into the space between the vertebrae to be fused. Sometimes larger solid pieces of bone are used to provide immediate structural support. Bone may come from:

• The patient (autogenous bone).
• A bank of bone harvested from other individuals (allograft bone).

Autogenous bone is generally considered superior at promoting fusion. But drawbacks to using it include extra surgery to remove bone from the patient’s body such as the hip or pelvis. Allograft bone is available from bone banks. Other bone graft substitutes are being developed, but have yet to be proven as cost effective substitutes for autogenous bone graft for general use.

After the fusion procedure has been performed, the adjacent spinal segments are held immobile to allow fusion to progress. Immobilization is achieved through internal fixation devices or external bracing or casting. Both forms of immobilization may be necessary at times.

Risks for any surgery include bleeding and infection. Additional risks for spinal fusion surgery include urinary difficulties (retention) and temporary decreased or absent intestinal function. Patients can best prepare for spinal fusion surgery by:

• Thoroughly consulting with their doctor before surgery.
• Banking their blood.
• Achieving good nutritional status before and after surgery.
• Following a recommended exercise program before and after surgery.
• Maintaining a positive mental attitude.
• Stopping smoking.

There is usually pain for the first few days after surgery. Pain medication will be given regularly, perhaps by a patient-controlled analgesia (PCA). The patient will probably have a urinary catheter.

The fused spine must be kept in proper alignment. The patient will be taught how to move properly, reposition, sit, stand and walk. While in bed, the patient will be instructed to turn frequently using a "log rolling" technique in which the entire body is moved as a unit, not twisting the spine. The patient may be discharged from the hospital with a back brace or cast. The family will be taught how to provide care at home.

Spinal Stenosis

Back aches and pains are a health concern for millions of people. Nearly 12 million Americans annually see their doctors because of back aches and pains. There may be many reasons for backaches and pains. One cause could be spinal stenosis.

Stenosis means narrowing. In spinal stenosis, the spinal canal, which contains and protects the spinal cord and nerve roots, narrows and pinches the spinal cord and nerves. The result is low back pain as well as pain in the legs. Stenosis may pinch the nerves that control muscle power and sensation in the legs.

Causes of spinal stenosis

There are many potential causes for spinal stenosis, including:

• Aging. As you get older, the ligaments (tough connective tissues between the bones in the spine) can thicken. Spurs (small growths) may develop on the bones and into the spinal canal. The cushioning disks between the vertebrae may begin to deteriorate. The facet joints (flat surfaces on each vertebra that form the spinal column) also may begin to break down.
• Heredity. If the spinal canal is too small at birth, symptoms may show up in a relatively young person.
• Changes in blood flow to the lumbar spine.

Symptoms of spinal stenosis

• Pain and difficulty when walking, aggravated by activity.
• Numbness, tingling, hot or cold feelings, weakness or a heavy and tired feeling in the legs.
• Clumsiness, frequent falling, or a foot-slapping gait.

Diagnosing spinal stenosis

These symptoms also can be caused by many other conditions, which makes spinal stenosis difficult to diagnose. There is usually no history of back problems or any recent injury. Often, unusual leg symptoms are a clue to the presence of spinal stenosis.

If simple treatments, such as postural changes or nonsteroidal anti-inflammatory drugs, do not relieve the problem, your orthopaedic surgeon may request special imaging studies to determine the cause of the problem. An MRI (magnetic resonance image) or CAT (computed tomography) scan may be requested. A myelogram (an X-ray taken after a special fluid is injected into the spine) may be arranged. These and other imaging studies provide details about the bones and tissues and assist the orthopaedic evaluation.

Treatment

Conservative treatment

• Changes in posture. People with spinal stenosis may find that flexing the spine by leaning forward while walking relieves their symptoms. Lying with the knees drawn up to the chest also can offer some relief. These positions enlarge the space available to the nerves and may make it easier for stenosis sufferers to walk longer distances.
• Medications. Sometimes the pressure on the nerves is caused by inflammatory swelling. Nonsteroidal anti-inflammatory medication such as aspirin or ibuprofen may help relieve symptoms.
• Rest, followed by a gradual resumption of activity, also can help. Aerobic activity such as bicycling is often recommended.
• Losing weight can also relieve some of the load on the spine.

When stenosis causes severe nerve root compression, these treatments may not be enough. Back and leg pain may return again and again. Because many stenosis sufferers are unable to walk even short distances, they often confine their activities to the home.

Surgical treatment

If conservative treatment does not relieve the pain, your orthopaedic surgeon may recommend surgery to relieve the pressure on affected nerves. In properly selected cases, the results are quite satisfactory, and patients are able to resume a normal lifestyle.

Spondylolysis and Spondylolisthesis

The most common cause of low back pain in adolescent athletes is a stress fracture in one of the bones (vertebrae) that make up the spinal column. Technically, this condition is called spondylolysis (spon-dee-low-lye-sis). It usually affects either the fourth or the fifth lumbar vertebra in the lower back.

If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the vertebra can start to slip out of place. This condition is called spondylolisthesis (spon-dee-low-lis-thee-sis). In adults, spondylolisthesis is usually caused by degenerative disk disease and often affects women over 40 years of age. If too much slippage occurs, the bones may begin to press on nerves and surgery may be necessary to correct the condition.

Causes

• Genetics: There may be a hereditary aspect to spondylolysis. An individual may be born with thin vertebral bone and therefore be vulnerable to this condition. Significant periods of rapid growth may encourage slippage.
• Overuse: Some sports, such as gymnastics, weight lifting and football, put a great deal of stress on the bones in the lower back. They also require that the athlete constantly over-stretch (hyperextend) the spine. In either case, the result is a stress fracture on one or both sides of the vertebra.
• Spondylolisthesis may also develop because of degenerative changes in the vertebral joints and certain medical conditions such as cerebral palsy.

Symptoms

• In many people, spondylolysis and spondylolisthesis are present, but without any obvious symptoms.
• Pain usually spreads across the lower back, and may feel like a muscle strain.
• Spondylolisthesis can cause spasms that stiffen the back and tighten the hamstring muscles, resulting in changes to posture and gait. If the slippage is significant, it may begin to compress the nerves and narrow the spinal canal.

Diagnostic tests

• X-rays of the lower back (lumbar) spine will show the position of the vertebra. Usually, spondylolisthesis occurs in the last lumbar vertebra, just above the tailbone (sacrum).
• If the vertebra is pressing on nerves, a CT scan or MRI may be needed before treatment begins to rule out any other contributing conditions.

Treatment

Initial treatment for spondylolysis is always conservative. The athlete should take a break from the activities until symptoms go away, as they often do. Anti-inflammatory medications such as ibuprofen may help reduce back pain. Occasionally, a back brace and physical therapy may be recommended. Epidural steroid injections may also help alleviate inflammation and ease pain. In most cases, activities can be resumed gradually and there will be few complications or recurrence. Stretching and strengthening exercises for the back and abdominal muscles can help prevent future stress fractures.

Periodic X-rays will show whether the bone is continuing to slip. Surgery may be need if slippage continues, or if the back pain does not respond to conservative treatment and begins to interfere with activities of daily living. This is more often the case with degenerative spondylolisthesis.

Usually, two procedures are performed, one to relieve the nerve compression and the second to ensure spinal stability. The first procedure, called a decompressive laminectomy, removes part of the bone that is pressing on the nerves. This reduces irritation and inflammation, but increases the instability of the spine. Hence the need for the second procedure, called spinal fusion.

In spinal fusion, a piece of bone is transplanted to the back of the spine. As the bone heals, it fuses with the spine and helps to stabilize it. Sometimes, an internal brace of screws and rods is used to hold the vertebra together as the fusion heals.

The Spine

Nearly 12 million visits are made to physician offices each year because of back problems. Eight out of 10 people will experience back pain at some point in their lives. Low back pain is one of the most frequent problems treated by orthopaedic surgeons.

What is the lower back?

Your lower back is a complex structure of vertebrae, disks, spinal cord, and nerves, including:

• five bones called lumbar vertebrae - stacked one upon the other, connecting the upper spine to the pelvis
• six shock absorbers called disks - acting both as cushion and stabilizer to protect the lumbar vertebrae
• spinal cord and nerves - the "electric cables" which travel through a central canal in the lumbar vertebrae, connecting your brain to the muscles of your legs
• small joints - allowing functional movement and providing stability
• muscles and ligaments - providing strength and power and at the same time support and stability

How does the spine work?

The lower or lumbar spine is a complex structure that connects your upper body (including your chest and arms) to your lower body (including your pelvis and legs). This important part of your spine provides you with both mobility and strength. The mobility allows movements such as turning, twisting or bending; and the strength allows you to stand, walk and lift. Proper functioning of your lower back is needed for almost all activities of daily living. Pain in the lower back can restrict your activity, reduce your work capacity and diminish your quality of life.

What are the common causes?

Low back pain can be caused by a number of factors:

• Protruding Disk
• Age
• Osteoporosis and Fractures
• Low Back Sprain and Strain

The muscles of the low back provide power and strength for activities such as standing, walking and lifting. A strain of the muscle can occur when the muscle is poorly conditioned or overworked. The ligaments of the low back act to interconnect the five vertebral bones and provide support or stability for the low back. A sprain of the low back can occur when a sudden, forceful movement injures a ligament which has become stiff or weak through poor conditioning or overuse.

Prevention

Back pain caused by lifting can be prevented if you use proper lifting techniques and exercise regularly to improve your muscle strength and overall physical condition. The normal effects of aging that result in decreased bone mass, and decreased strength and elasticity of muscles and ligaments, can't be avoided.

However, the effects can be slowed by:

• exercising regularly to keep muscles that support your back strong and flexible
• using the correct lifting and moving techniques
• maintaining your proper body weight; being overweight puts a strain on your back muscles
• avoid smoking
• maintaining a proper posture when standing and sitting; don't slouch

Staying in shape

You can reduce the risk of back pain if you stay in good physical shape.

Recreational activities such as swimming, bike riding, running or walking briskly will keep you in good physical condition. There also are specific exercises that are directed toward strengthening and stretching your back, stomach, hip and thigh muscles as well as exercises to decrease the strain on your lower back. Consult your physician about a proper exercise program.

 

Source: American Academy of Orthopaedic Surgeons

Disclaimer

The material on SLOC.org is for informational purposes only and is not a substitute for medical advice or treatment for any medical conditions. You should promptly seek professional medical care if you have any concern about your health, and you should always consult your physician before starting a fitness regimen.