Back Pain

THE LITTLE BOOK OF BACK PAIN Don’t allow back pain to rule your life.

BACK PAIN FACTS:        

80% of people will suffer from serious back pain in their lives, mostly LOWER back pain. Back pain is the second most common medical complaint, after the common cold. Back injuries cause an estimated 180 million lost days of work annually. Over 400,000 people in the UK receive Social Security payments for back injury. In the UK, 1.1 million people are disabled by back pain. The direct health care costs of back pain sufferers in the UK (1988) was over £ 1,500 million. Bending and lifting is the number one cause of serious back problems. Depression is often a major problem for people with chronic back pain.

If you've ever suffered from chronic back pain or been off work for a week or two with acute back pain, you are in the company of around 5 million other sufferers in the UK

annually who are forced to consult their GP about back pain or a related condition

What kind of conditions can cause back pain ? Height/Weight ratio: If you are above the recommended weight for your height, losing weight can have a significant impact on reducing the strain you place on your back muscles. Back pain most commonly affects the lower, lumbar region of the spine. This is normally due to excessive strain on the muscles, ligaments and small joints of the skeleton. Quite often overweight people are also unfit, and have poor muscle tone, which puts them at increased risk, over and above having to support a heavier load. Remember: Putting on Weight is a Pain in the Back. Rheumatoid Arthritis: This is an inflammatory disease which causes the synovial membrane linings in the joints to become thickened, inflamed and to produce excess synovial fluid leading to redness, stiffness, swelling and pain. Areas of inflammation cause bone to become worn and distorted. When trying to deal with pain in other areas, sufferers often lose site of how distorted they have become, and twisting awkwardly to avoid injury transfers the strain to the back, usually the lower back, with obvious consequences. Sciatica: Sciatica causes, sometimes mild, but more often severe pain in the buttock, and down the back of one leg. This is the result of the sciatic nerve being compressed or damaged, usually at the vertebral level, by a prolapsed (slipped) inter-vertebral disc, which presses on the root of the sciatic nerve where it joins the spinal cord. There are two sciatic nerves, left and right, but usually sciatica only affects one leg at a time. Sometimes, in serious cases, it can affect both legs.

What causes the back pain from a bulging disc? The pain comes from two main sources: 1. The disc itself has nerves in its outer fibers. When a disc has been injured and is bulging and swollen, these nerves become irritated and send out pain messages to your brain. The pain you feel is usually deep and achey and is located in the central area of the spine or just slightly off to one side or the other of the spine. 2. If the bulging disc or disk herniation is large enough, the spinal nerves too will be irritated, which causes pain running down to the buttocks, thigh, leg or foot. This is called “sciatica.” How far down the leg the pain travels depends on which nerves are involved.

Back to Basics: Back Tips to Prevent Back Strain. Lifting Techniques: Examples of lifting include: Shopping, dustbin, washing basket, making the bed, children, vacuuming the stairs.            

Never lift anything you don't have to. Never lift a box or container without first finding out what's inside it. Don't rely on the picture on the box. Check the size of the container and ascertain it's likely weight. Know where you are going with the load and check your path will be clear. Never be afraid to ask for help. Use a trolley, wheelbarrow or other mechanical device to transport loads whenever possible. Stand square to the load and as close as is comfortable. Don't over reach and pull it toward you. Stand stable with your feet apart and solidly on the floor. Bend your knees to reach the load. Never bend forward at the waist (you'll take all the extra weight on your lumbar area). Lift the load using the power of your legs. Never twist your body to the side when lifting, or lowering. Once you have the load, face the direction of your movement. Do not twist at the hips.

Carrying Techniques: Examples of carrying include: Groceries, furniture, hot saucepans, laundry, luggage, children.         

Wear sensible footwear to prevent slipping or tripping. Maintain a firm hold on the object. Keep the load close to your body. Don't twist. Look ahead to ensure your way is clear. Bend your knees when picking up and putting down again. Suitcases or bags that can't be divided should be switched from side to side. Not by swinging the load around to the other hand, but by putting down and picking up again. Stop frequently to rest and take note of what's going on with your back. Use a shopping trolley whenever possible.

Carrying/Moving Heavy Objects: Examples of moving heavy objects include: Moving furniture (including sliding), changing a car tyre, mowing the lawn.      

Don't move what you don't have too, get help whenever possible. Use a trolley, wheelbarrow or other mechanical device if possible. Stand squarely to the object. Maintain a firm hold on the object. Bend your knees to give you power. Use your legs to push or pull. Never jerk a load to get it moving. Use firm steady pressure.

Sitting: Examples of sitting include: Reading a book, eating a meal, computing, driving, watching TV.       

Sit comfortably in the chair, so that you feel fully supported. Adjust the chair for your position or comfort. Distribute your weight evenly. Don't sit twisted or leaning to one side or the other. Feet should touch the floor. Use a cushion or platform if not. Avoid sitting with a wallet in your back pocket. It can force the sacrum out of alignment or encourage you to sit at an angle to relieve the pressure. Don't allow yourself to become locked in the sitting position. Get up and move around often.

Ironically, forty percent more weight is placed on the spine when you are sitting as opposed to standing. So sitting for prolonged periods is not the best thing to do for your back.

Standing for long periods: Examples of standing include: Waiting in a queue, showering, waiting for a bus, washing dishes, ironing.      

Change position frequently. Shifting your weight from one leg to the other. Relieve the pressure on one leg at a time by resting it on a step, stool, or position one foot 'ballet' style, to keep your balance. Stand on a rubber mat or carpet. Wear sensible footwear, avoiding high heels. Pay attention to your posture. Try not to strain arch your back, especially when looking up. Fatigue will quickly set in.

Sleeping or Lying: Examples include: In bed, on a therapist's couch, settee or floor.     

Change position frequently. Shifting from left to right. This avoids the spine straining, especially on an old mattress. Get appropriate advice about whether you need a soft or a firm mattress. Firming up a mattress is easy, place a board underneath it. Don't sit up from lying down by squeezing your tummy muscles, unless you are used to this movement. To get out of bed, roll to the side, pull knees up, swing legs over the edge and push up with both arms. When sitting at the side of the bed it should be possible to just stand up.

Kneeling or Bending: Examples of kneeling and bending include: Gardening, washing floor, finding lost items, dressing, playing with children.       

Bend your hips and knees, NOT your back. Pay attention to your back if bending or kneeling. Check for signs of pulling, pain and squelching, or unexplained clicks. Over weight people can strain their back when kneeling because the spine is forced to sag. Consider using a reach grab (like the park keepers litter tool) for picking things up. Consider using a long handle trowel, fork or rake, rather than bending. Scrape or sweep multiple items into a pile, then, if light enough, pick them all up at once. Use both your knees and one hand and establish a 'tripod' to support yourself when working.

Reaching: Examples of reaching include: Hanging out the washing, changing a light bulb, washing windows, making the bed, fetching from the top shelf of a cupboard, painting, lopping trees.      

Make sure you are on a firm floor. Do not over-reach. Use steps, ladder or scaffolding to allow you to work at a height that avoids reaching too far. Position yourself so that you are close to your work. Use long handles tools to avoid straining, such as for paint rollers or when dusting. Keep both feet firmly on the ground or step of your ladder. Don't over-reach so that you have to balance on one foot.

Use Easy Reach Tools: Many hardware shops now sell long handled tools. Examples of their use includes: Sweeping with a brush, raking the lawn, digging, lopping, window washing, mopping.      

Choose good quality, light-weight tools. Make sure you are standing squarely to the work, feet apart and in a stable posture. Hold the handle close to your body, so that you aren't unbalanced by leverage. Never over-reach, twist or use your trunk or back to apply pressure to a tool. Unbalanced twisting is a major cause of back injury. Some tools are dual purpose and have long handles that screw into shorter tools such as paint rollers, dusting mops or long handled dustpan and brush. Use your legs to give you power, not your back.

Driving: Examples of driving aids that are available include: Lumbar rolls, cushions, wedges, heated seating.    

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Always wear your seatbelt. Use any of the above accessories to make your driving position easier and more comfortable. Make sure you are able to adjust the seat in any position, vertically or horizontally, for comfort, and correct placement. Make sure your lower back is supported squarely in the seat. Badly designed or broken car seats are a major cause of postural distortion in a car, mainly because you can't adjust the wheel or pedals to accommodate the new seat position. What does alter, is YOU! Avoid sitting with a wallet in your back pocket. It can force the sacrum out of alignment or encourage you to sit at an angle to relieve the pressure. On long journeys, stop regularly to move and stretch as often as you can. If you have back problems or get regular attacks, give some thought to an automatic car. Use your mirrors (interior and exterior) to full advantage, to avoid twisting. Use the local car wash. Swishing a soapy mop around, and up, and under, is no job for a matchstick back. (You can probably tell, I'm talking from experience now!)

In some patients, addiction to painkillers is becoming a tragic side effect of persistent back pain and failed back surgery. To cope with extreme back pain, some doctors are prescribing large doses of addictive painkillers and patients are finding themselves having to "kick a habit" they never dreamed they could fall victim to. Although some classes of painkillers are useful at the outbreak of a crisis, to help patients relax their muscles, they do not offer a solution in the long run. Nor does surgery, except to prevent the risk of paralysis in the worst cases. An average of 75% of the patients returns to their GP with new complaints of back pain within five years from the date of surgery! Therefore, there is really only one good remedy :

PREVENTIVE AND HEALING EXERCISES. Benefits of exercise are well documented and accepted within the medical community. In addition, it has been suggested that increased levels of fitness may reduce an individual's risk for developing low back pain and spinal injury. People who are fit tend to recover from injuries more quickly than those who are not active physically. It is a good idea to develop strength in the abdominal and back muscles as when properly exercised, these muscles form a 'brace' which protects the spine, and in particular, the lower vertebrae, from stress and strain.

low back care : preventing (low) back attack The time to take care of low back pain problems is before they occur. The "ounce of prevention is worth a pound of cure" philosophy holds when it comes to low back pain. By using proper lifting techniques, maintaining the appropriate body weight and tone, keeping the back and body muscles strong, and keeping good posture, many back injuries and episodes of low back pain could be avoided. The cost to employers each year, due to low back pain problems alone, is in the order of several billion dollars.

General Spine Maintenance Tips The spine has three curves.  The cervical spine has a natural lordosis (with the spine arched backwards).  The thoracic spine, a natural kyphosis (with the spine slightly flexed forward).  And the lumbar spine has a natural lordosis. These curves allow for the center of gravity to be placed over ones feet. Disruption of one of these curves places an undue strain upon the other curves. Disruption of the curves can come from chronic poor posture, or from lifting incorrectly. When lifting objects, it is important to remember to bend with the knees and hips, thus allowing the legs to do the work, taking stress off of the spine. To reduce the strain or "torque" on the spine, hold the object as close to the body as possible. Bending at the waist, keeping the legs straight at the knees, places a large amount of strain on the spine, and in particular the low back. Don't do this!! BEND AT THE KNEES. In addition, one should tighten the abdominal muscles when lifting, taking more pressure off the low back.

Proper Form Before taking on any new exercise regimen, please, make sure you are using proper form. Improper form, for stretching, strength training, and cardiovascular activities, could mean tearing and injuring tendons, ligaments, and muscles. And the goal of exercise is to strengthen you, not injure you. So USE GOOD and PROPER FORM.

Posture, Posture, Posture, … Avoid staying too long in any position which causes the natural curves of the spine to be distorted. Change positions often, whether sitting, standing or lying down. Sitting can actually put a moderate amount of strain on the low back, and it is important to get up and walk around frequently. Sit straight up, not hunched over. A lumbar support may help with this. When standing for a long period of time, keep the spine straight, again aligning the center of gravity over the feet. It is often helpful to place on foot on a box or some other object, as it takes pressure off the low back and the sacro-iliac joints. Also remember to shift legs. Switch feet periodically, every thirty minutes. When sleeping, if on one's side, a pillow between the knees can take strain off the low back. When driving, sit straight up, not slumped. Keep the seat far enough forward, so that your knees are slightly bent. Wear comfortable shoes, especially if you will be on your feet for a long time. Try to wear high heels as infrequently as possible, as it distorts the curves of the spine, and places increased stress on the low back. To remember the proper posture when standing, try to keep the ears, shoulders, hips and ankles in a straight line.

Carrying a Load If you must lift, keep the objects close to your body. Avoid twisting when you are carrying heavy objects. Remember, bend at the knees, not at the waist.

INCORRECT FORM

CORRECT FORM

What can you do for back pain relief? This article is going to assume that you are already under the care of a doctor and you are trying to solve your problem with some sort of medical – chiro-practic - physical therapy treatment. (For obvious reasons, you should never start exercising without prior consent of your therapist) Although you may be in the middle of a back pain relief program, you may still be experiencing pain. So what to do while you’re waiting for this treatment to “kick in” and make you feel better?

1. You have a pain crisis – What do you do ?

If you are alone:  

Keep your cell phone close at hand Just walk around the table, don’t leave the house until you are certain that your back has stabilized.

2. Exercises to prevent (lower) back pain 1. Hot shower, hot wet towels or moist heating pad for 15 minutes 2. Knee to chest stretch While lying flat on your back with your knees bent, grab one knee with both hands and gently pull it back towards your chest. This is a very basic yet effective hip stretch. Start out slow; don't force your leg back; simply apply a gentle pulling motion. gradually pull the knee further and further towards your chest. Hold this stretch for at least 10 seconds. Repeat 5 – 10 times with each knee.

3. Disc & sciatica relief position while lying on ice Remove ice after 10 minutes, Keep laying in this position for 30 – 60 minutes

4. Spinal Bending Flexing the lower spine (bending forward) increases the size of the passageways between the vertebrae and allows the irritation or impingement to resolve. This is why people with back pain often feel better when bending forward (such as leaning on a cane, walker or shopping cart) than standing up straight. Some spine specialists favour flexion exercises only (forward bending), arguing that the opposite movement (backward bending or back-stretching) injudiciously promotes weight-bearing on the affected disc(s).

Most specialists however, amongst which the North American Spine Society and the famous Dr. Mckenzie do not agree. According to them, the goal of the exercises is not only to stretch the spine, but also to strengthen all the surrounding muscles and to contribute to keeping the spine flexible. Hence, basic exercises are not complete unless side-bending and back stretching is included. Just like with all other exercises however, patients should consult their spine specialist or chiropractor and adapt the selection, frequency and intensity of their exercises to their personal situation. Even when respecting a schedule composed by their specialist, increased pain during exercises should always be taken seriously and be discussed with the specialist as soon as possible.

Back stretches Back stretches target the abdomen and lower back muscles. Place hands with fingers in the small of back. Bend backward as far as tolerated, pressing inward with fingers. Hold for 1-2 seconds. Repeat 10 times,

Consider Practicing Yoga

Buttocks and Pelvis The buttocks and pelvis muscles are an important part of core conditioning and should be a part of every back pain therapy program. These muscles are often overlooked in favor of their abdominal and back muscle counterparts. The following exercises are common among Pilates, Yoga, Chiropractic and physical therapy practitioners to strengthen and stabilize the pelvis.

5. Bridge Lie flat on your back with your knees bent and feet flat on floor. Push down with your feet while lifting the buttocks off the floor. Hold the pose while tightening your buttocks for a few seconds then lower. Repeat 10-20 times.

Alternate #1 for more advanced users: After you lift your buttocks of the floor, gently oscillate your pelvis up and down a few inches several times before lowering. Alternate #2: Swiss ball version.

Place feet on therapy ball and push buttocks off of floor.

6. Donkey kick Assume a hands and knees position on floor. Lift one leg up and extend up and out. Hold for a few seconds then lower and lift the other leg. Repeat 10-20 times each leg. Alternate #1: When lifting the leg, bend the knee at a 90 degree angle and push your foot towards the ceiling.

Alternate #2: Perform the kicks in rapid succession for 20 seconds, rest for 10 seconds then repeat for 2-4 sets.

7. Opposite arm / leg reach For more advanced users, as an alternate to the Donkey Kick : After you lift your leg and extend it up and out, also lift and extend the opposite arm. Repeat 10-20 times, alternating leg and arm at each exercise.

Try this exercise to strengthen your buttocks. It will increase your core strength and assist in stabilizing your lower back.

8. Cat Pose Start on all fours, knees under hips, hands under shoulders. Inhale, dropping chin to chest, tilting pelvis under while rounding back like a cat (as shown). Exhale, lifting chin toward ceiling and arching back in opposite direction. Repeat 10 times.

9. Cobra Lie facedown with elbows bent and close to body, palms down. Inhale, simultaneously lifting chest and left leg until left foot is about 12 inches off floor (as shown). Exhale, lowering chest and leg to start position. Repeat with right leg for one rep. Do three to five reps.

10. Sit and Bounce on a Therapy Ball  

Simply sit on the ball with feet flat on ground. Take care to sit correctly

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Now gently bounce up and down. You do not want to bounce vigorously. All you need to do is create a small, gentle oscillations up and down.

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This causes the disc to compress and decompress over and over to help with water exchange (imbibition). Perform this exercise for 5-10 minutes as part of your regular daily exercises for lower back pain.

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There are many more ways in which you can use the Therapy Ball to strengthen your back and abdomen

Top 10 Ball Exercises Ball Crunch Lie with the ball resting under the mid/lower back and place hands behind the head or across the chest. Contract your abs to lift your the torso off the ball, pulling the bottom of your ribcage down toward your hips. As you curl up, keep the ball stable.

Superman Begin on the ball with your hands and knees on the floor, back straight and abs tight. Slowly raise right arm and left leg up until level with the body, holding your balance and keeping torso tight. Lower back down and repeat with the left arm and right leg. Take your time--this exercise will challenge your balance!

Ball Pushup Kneel on the floor with the ball in front of you and roll forward on it, walking the hands out to where you can comfortably support your body with the abs in, shoulders retracted and the body in a straight line. Place the hands a bit wider than shoulders and check to make sure you're not sagging in the middle.

Back Extension Lie face down with ball under your hips and lower torso. Place your hands behind your head or at your sides and stay on your knees or toes. Slowly roll down the ball and then roll back up, lifting your chest off the ball. Bring your shoulders up until your body is in a straight line without hyper-extending.

Wall Squat Stand with feet wide, toes out at about a 45-degree angle and place an exercise ball behind your lower back for support. If you choose to hold weights, you can keep them at your sides or prop them on the hips. Bend the knees and lower into a squat, keeping the knees in line with the toes. Lower down as far as your flexibility allows and push into the heels to go back to starting position.

Hip Extension Lie down with feet heels propped on ball. Keeping abs tight, slowly lift your hips off the floor (squeezing the glutes) until body is in a straight line. Hold for a few seconds and lower. For added intensity, lift the hips and then take one leg off the ball, hold for a moment and lower. Repeat, lifting the other leg off the ball.

Ball Roll Outs Start by lying on the ball face down. Walk out with your hands as far as you can keeping your balance as best you can (out to your knees or further if possible).

Keeping your abs tight roll out as far as you can and repeat.

Ball Circles Sit on the ball and place your hands on the ball for balance or place them behind your head (more difficult). Slowly begin to move your hips in a circle to the right and left keeping your abs tight. Start with small circles and as you get comfortable do larger circles.

Seated Balance Sit on the ball with the spine straight and abs in. Place the hands on the ball or behind the head (harder) and lift the right foot off the floor, holding it in the air for 5 or more seconds. Lower and repeat on the other side. Keep the abs in to help keep your balance

Ball walks Sit on the ball and place the hands on either side for balance. Contract the abs and slowly walk the feet forward as you slide the back down onto the ball. Continue walking the feet forward until you're in a bridge position with the head and shoulders supported by the ball, hips lifted. Walk all the way back until you're seated again and repeat. If this feels difficult, hold onto a wall for balance and only walk forward a bit at a time until you feel more comfortable.

IMPORTANT All the information in this bundle has been found on the internet. I am not a doctor, nor a chiropractor, nor in any way specialized in treatment of back pain or any other medical disorder. I don’t know anything about the human body, (sports) training or massage. I never received any medical education. So please, consult your GP, chiropractor or Spine Specialist before executing any of the exercises listed in this handout.