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Oh, my aching back! All of us tend to neglect our backs until one day, when we least expect it, we cry, "Oh, my aching back! Why me?" Low Back Pain is one of mankind’s most common ailments. As a back owner, you will find this manual useful in the proper care of your low back. The Back Owner’s Manual is designed to start you thinking about your back and help answer questions you may have. There is no simple solution to back pain. Although your doctor can guide you on the road to recovery, a healthy, painfree back is almost always up to you. Only YOU can improve your posture and learn ways to prevent back strain in your daily activities. Most important, only YOU (with your doctor’s advice) can follow a daily exercise program to build strong supporting stomach and back muscles. The Evolution of Low Back Pain Ever since man had the nerve to assume the upright position and become the "backbone" of society, his low back has suffered. Humans do not have the structural advantage of walking on all fours, and therefore their low backs must bear the brunt of the body’s weight. The low back has also inherited the ever-increasing stress of daily living, poor posture, lack of exercise, and overeating. Most of low back discomfort is not serious and reflects only minor injury, overexertion, or normal aging. When our backs have had enough, unfortunately they cannot just stop working and take a break. Their work goes on, even when they hurt. If we ignore the warning sign of acute back pain and do not adequately care for our backs, the backaches may become chronic (Chronic Low Back Pain) until sooner or later our backs simply collapse -- and so do we! Anatomy of the Healthy Back A healthy back is strong, flexible, and painfree. Its chief functions are to support your upper body, protect your spinal cord, allow flexibility, and provide a point of attachment for your muscles and ligaments. The lower back (lumbar curve) is composed of five vertebrae (L1 through L5) with their associated discs, nerve roots, muscles, and ligaments. The vertebrae and discs in your lower back have the greatest load to bear and are the largest. A healthy back is one that is properly aligned and supported by strong back, hip, and abdominal muscles. Anatomy of Low Back Pain Pain begins when nerve endings receive abnormal stimulation. The brain, the complex computer which sorts out all nerve impulses, interprets the stimulation as pain. In response to pain, back muscles often try to protect the back, and go into spasm to keep the area immobile. Spasm can cause pain if prolonged. Since the bones, discs, ligaments, and muscles of the back are supplied by many nerve endings, there are various, often interrelated conditions which can cause back pain. In addition to the common physical causes, the stress, fatigue, and anxieties of daily life can significantly increase low back pain. Causes of Low Back Pain POOR POSTURE, LACK OF EXERCISE, AND OVEREATING can be your back's worst enemies. Most low back pain is a result of using your back improperly. Poor posture strains the lower back and makes it more vulnerable to injury. A swayback (increased lumbar curve) is a result of weak muscles. Weak and flabby abdominal muscles (pot bellies) deprive your back of its greatest support. Being overweight adds to the strain. BACK STRAINS OR SPRAINS occur when the back’s muscles or ligaments are stretched or torn. Back sprains usually result from common activities done improperly -- such as bending, lifting, standing or sitting. The injury may also occur as a result of wrenching caused by an automobile accident or athletic injury. Back sprains can heal completely if properly treated. Practicing proper back mechanics can prevent most back sprains. SLIPPED OR "RUPTURED" DISCS are notorious for causing severe pain and disability. The semi-solid center of the disc may "slip", shift or bulge, and press on nerve endings in its tough capsule. Or, in more advanced cases, it may actually rupture (herniate) through the capsule like a tire blowout and pinch the spinal nerves ("pinched nerve"). This type of pain radiates down the back of the thigh and leg and is called Sciatica. If pressure or pinching of the spinal nerves continues, actual nerve damage can occur and cause either numbness or muscle weakness in the leg. Most patients with slipped discs do well with non-surgical treatment. However, a small percentage may benefit from special injections to dissolve the disc material (chemonucleolysis) or from surgery (laminectomy and/or fusion). WEAR & TEAR ARTHRITIS (OSTEOARTHRITIS), part of the aging process, is like paying taxes -- most of us can’t avoid it! Osteoarthritis affects the discs and bones of your back in varying degrees. It narrows the discs and can cause irritating spurs on the vertebral bodies, producing pain. However, osteoarthritis is often present with no discomfort at all. Proper use of your back and good posture can significantly decrease the wear and tear arthritis of aging. Why pay more "taxes" than you have to? TENSION AND EMOTIONAL PROBLEMS of everyday living play an important role in back pain. Economic worries, family pressures, and fatigue can actually cause back spasm. If you are willing to accept, understand and work to improve the emotional factors in your life, you will cope better with your back pain and improve your chances for a healthy back. MISCELLANEOUS CAUSES include any condition that may affect the various back structures or nearby areas and cause backache. Some, like birth defects and curvature of the spine ("scoliosis") rarely cause back pain. Others, like male prostate trouble or female problems, are more common. Spondylosis is a general term for degenerative changes in the spine, and is often associated with back pain. Spondylolisthesis occurs sometimes in the lower lumbar spine, and involves one vertebra shifting forward on another. ANY SEVERE OR PERSISTENT BACKACHE SHOULD BE BROUGHT TO YOUR DOCTOR’S ATTENTION. Your Doctor’s Role Your doctor can best help you with your back problem if the cause of your backache is diagnosed and treated early. Accurate diagnosis requires a complete medical history, physical examination, and often laboratory and x-ray studies. Your doctor may be able to make a preliminary diagnosis during your first visit and start treatment aimed at relieving pain or discomfort. In most cases, a final diagnosis is made after completion of all diagnostic tests. HISTORY -- To find clues to your back problem, your doctor will often ask you questions. How did your pain first start? Were you injured? What is the exact location of your pain? Does it stay in one place? Or does it radiate down your thigh and leg? Does coughing or sneezing make it worse? What makes it better? How often does it bother you? What previous treatment have you received? Did it help? What kind of work do you do? How does your back pain interfere? What are your daily home routines, recreational and social activities and habits? Particularly important, what is your general state of mind? PHYSICAL EXAMINATION -- A great deal of information is obtained by looking at your back in various positions and observing your general posture, muscle tone, and range of motion. Areas of local tenderness and muscle spasm are noted. Your doctor also looks for muscular weakness and sensory changes in the lower extremities. To check all possible sources of back trouble, a general abdominal, rectal, and pelvic examination may also be necessary. SPECIAL STUDIES, including laboratory tests and x-rays, may be ordered by your doctor after completion of your history and physical examination. Routine x-rays of your back only reveal bone changes and do not show sprains or many disc problems. If your doctor suspects a disc problem, a myelogram may be needed. A special dye is injected into the spinal canal that will allow the disc to show up on x-rays. Other tests that are beneficial in determining problems of the lumbar spine include electromyography (EMG), a nerve and muscle study; computerized tomography (CT scan), a special x-ray that provides cross-sectional views of the body; and magnetic resonance imaging (MRI), which produces vivid images of body tissue without using x-rays. Use Good Body Mechanics Do’s -- Maintain normal back curves! Don’ts -- Avoid swayback! Lifting Do: Bend with your knees, not your back! Lift with your legs and hold object close to your body. Lift objects only chest-high. When load is heavy, get help and plan ahead to avoid sudden load shifts. Always be sure of your footing. Don’t: Bend over with legs straight or twist while lifting. Avoid trying to lift above shoulder level. These positions can cause injury. Standing / Walking Do: Stand with one foot up; change positions often. Bend with knees to maintain normal back curves. Walk with good posture keeping head high, chin tucked in, pelvis forward, toes straight ahead. Wear comfortable shoes. Don’t: Stand in one position too long. Don’t bend forward with straight legs, or walk with poor posture. Don’t wear high-heeled or platform shoes when standing or walking for long periods. Driving Do: Move car seat forward to keep knees bent and higher than hips. Sit straight; drive with both hands on the wheel. A small cushion behind the back may be helpful. Don’t: Drive sitting far back from the wheel. Stretching for the pedals and wheel increase low back curve and strain. Sitting Do: Sit in chairs low enough to place both feet on the floor with knees higher than hips. You may cross your legs or put your feet up on a stool. Sit firmly against back of chair. Don’t: Slump. Don’t sit in a chair that’s too high or too far from your work -- avoid leaning forward and arching your back. Sleeping Do: A good night’s sleep on a firm mattress is good for you and your back. Sleep on your side with knees bent, or on your back with a pillow under your knees. Don’t: Sleep or lounge on soft, sagging, no-support mattresses or cushions. Swayback and back strain will result, especially when sleeping on your stomach. Back Helpers Learn and practice good posture and body mechanics. Maintaining a good lumbar curve is important to good back care. Test your posture by standing with your back against a wall. There should only be minimal space between your back and the wall. A lazy slouched posture or "military" position increases the curves in your back. Many people develop poor posture early in life. Teenagers may tend to slouch to be "cool". Tall girls and boys may try to look shorter by slumping. Short people try to look tall and generally have good posture. Good posture does prevent backaches. Stand tall. Tuck chin in. Move pelvis. Straighten the curve in your neck by standing tall with your chin slightly tucked in. Tuck in your stomach and move your pelvis so that the curve of your back is partially reduced. Tighten the muscles in your buttocks and bend your knees slightly. These positions can relieve your back by moving the pelvis and straightening the spine: 1.) (At work or home) Stand in a comfortable position. Place hands in the low back area and bend backward. Hold 30 seconds to 1 minute. 2.) (At work or home) Lean forward in your chair and lower your head to your knees for 2-5 minutes. 3.) (At home) Lie on your back, flat on the floor and place your legs on a chair. A pillow under your legs will make you more comfortable. For maximum relief, this position should be held for 15 minutes. Back Supporters Next to good posture and a willingness to help your back, the greatest support you can give your back is building strong and flexible supporting muscles through a good exercise program. Some people think that because their arms and legs are strong, their backs are too. Not true! The role of your back muscles resembles that of guide wires that support a growing tree. If the wires are strong and taut, the tree will grow straight and be flexible. If, however, the wires are loose, the tree may become crooked -- or, in the case of your spine, swayback may result. Before you start any therapeutic exercise program, a complete doctor’s evaluation is recommended so that the correct exercises for your individual back problem may be selected. Your doctor may advise a recovery period before you start your program, and may refer you to a physical therapist. Your Physical Therapist’s Role Physical therapists are specially trained to evaluate and treat low back problems. Treatment may be found in hospital departments or outpatient clinics. Following evaluation, your therapist will plan a program to treat your particular problem. Treatment may include different machines that produce either heat, cold, or electric stimulation. Other equipment may apply traction to your lower back. Therapists may also utilize special exercises or perform gentle movement of the vertebrae called mobilization. Exercise Program Here are a few simple but important suggestions for a successful back exercise program: If you are recovering from a back problem, follow the exercises your doctor or physical therapist has recommended to avoid possible further injury.  These exercises, done regularly, will help keep a healthy back strong and fit. Exercise every day. Occasional exercising may actually be harmful to your back. Reserve 30 minutes each day, preferably 15 minutes in the morning and 15 minutes at night. Don’t exercise if you are having pain. Don’t overdo it at first. Consult your physician or physical therapist if you experience pain while exercising. Begin your exercises in the starting position (lying flat on your back, with arms by your sides and legs bent comfortably with knees up) with a warm-up period lasting 2-3 minutes: limber up by moving your arms and legs and alternately tightening and relaxing your muscles. Remember, any therapeutic exercise program will probably be graduated. Check with your doctor or physical therapist for instructions on any necessary program changes.Knee-to-Chest Raise To help limber up a stiff back and hips: 1. Assume starting position. 2. Raise right knee to chest. 3. Hold, count to five. 4. Repeat 5 times. 5. Repeat steps 1-4 with left leg. 6. Repeat steps 1-4 with both legs. Note: Don’t lift legs with arms or hands. Pelvic Tilt To strengthen front and back muscles, reducing swayback and beginning mobility: 1. Assume starting position. 2. Firmly tighten buttock muscles. 3. Hold, count to five. 4. Relax buttocks. 5. Repeat 5 times. Note: Keep lower spine flat against floor. Single Leg Raise To help limber up, stretch hamstring: 1. Assume starting position. 2. Slowly raise right leg as high as you comfortably can. 3. Hold, count to five. 4. Return leg to floor. 5. Repeat 5 times. 6. Repeat steps 1-5 with left leg. Note: Don’t swing legs up fast or use hands to help. Half Sit-ups To strengthen abdominal muscles: 1. Assume starting position. 2. Slowly raise head and neck to top of chest. 3. Reach both hands forward, place on knees. 4. Hold, count to five. 5. Slowly return to starting position. 6. Repeat 5 times. Note: Keep head in line with shoulders. Elbow Props To maintain the normal lumbar curve and to strengthen low back muscles: 1. Lie on your stomach. 2. Turn your head to one side and relax your arms at your sides. 3. Relax in this position for three to five minutes. 4. Then prop on elbows, maintaining this position for a period of two to three minutes. 5. Return to starting position and relax for one minute. 6. Repeat 5 times. Note: Keep your lower back completely relaxed. Hamstring Stretch To limber up tight hamstring and back muscles: 1. Assume sitting position with your legs straight and feet upright; heels no more than six inches apart. 2. Bend from the hips to get an easy stretch. 3. Hold for 20 seconds. 4. Repeat 5 times. Press Ups ADVANCED EXERCISE (Check with your doctor or therapist!) To help maintain the normal lumbar curve and to strengthen low back muscles: 1. Lie on your stomach. 2. Do a partial push-up, keeping pelvis on the floor. Hold, count to five. 3. Ease yourself back to the starting position. 4. Repeat 5 times. Note: Relax lower back and legs. Hip Hyperextension ADVANCED EXERCISE (Check with your doctor or therapist!) To stretch, strengthen hip, buttock, and back muscles: 1. Lie on stomach, with your head on your crossed arms. 2. Stiffen straight left leg. 3. Slowly raise leg from hip. 4. Return leg to floor. 5. Repeat 5 times. 6. Repeat steps 1-5 with right leg. Note: Don’t lift pelvis to raise leg. Keep leg straight. The Road to Recovery After you have consulted your doctor and a diagnosis of your back problems is completed, you will be ready to start on your road to recovery. LAP 1 begins with the initial treatment of your back pain and muscle spasm, and may include bed rest, local heat or cold, massage, electrical nerve stimulation, back support, and medications. The importance of complete bed rest, if prescribed, cannot be overemphasized.A Hospital Detour may be necessary in some cases to ensure bed rest. Traction may also be used. Trips to the physical therapist may be suggested to help you complete the first lap. You will reach a Dead End! if you have poor motivation, exhibit poor cooperation, or if you become consumed with self-pity. LAP 2 revolves around learning good posture and body mechanics at work, home and play. Weight reduction may be advised and a graduated therapeutic exercise program begun.A Surgical Detour may be indicated occasionally for severe disc problems that have not responded to non-surgical treatment and/or in cases of progressive nerve damage. Special diagnostic studies may be ordered. Expectations for surgery should be realistic -- in most cases, definite improvement results, but an operated back is not a new back. Certain limitations and adjustments in your work and lifestyle will usually be necessary. Spinal Injections may be recommended in some cases as an alternative to surgery. An Occupational Therapist may be recommended to aid you in returning to your routine activities at home and work. LAP 3 never ends -- it is a maintenance program that includes any changes in home or work routines necessary to avoid back strain and, most important, the continuation of your daily exercises.REMEMBER ... success in reaching your destination -- a painfree, healthy back -- depends on continually keeping your back in good repair. Back Owner’s Maintenance Guide Maintain your normal back curves by being constantly aware of your posture and correcting it. Avoid excessive swayback at all times. Help relieve unnecessary back strain by keeping your weight down and exercising regularly to build strong supporting muscles. Lift with your legs -- not your back -- by squatting and bending your knees. Hold the object as close to your body as possible. Sleep on your back or side, on a firm mattress. Do not bend straight over, turn or twist to pick up something, even if it is a light object -- don’t lift or carry anything heavier than you can manage with ease. Stand with one foot elevated on a box or stool. Don’t slouch or bend forward when sitting or driving. See your doctor as soon as possible for any persistent back pain. Check with your doctor’s office if you have any further questions. Stay fit and trim. Exercise regularly. Walking or swimming are excellent forms of workout.this booklet was distributed by: El Paso Orthopaedic Surgery Group 1700 Murchison Dr. El Paso, TX 79902 (915) 533-7465 copyright 1977, 1981, 1983, 1984, 1985, 1986 by: Krames Communications 312 90th Street Daly City, CA 94015-1898 (415) 994-8800 all rights reserved; lithographed in Canada 7707/8703 |
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