The American Physical Therapy Association Book of Body Repair & Maintenance

Hundreds of Stretches & Exercises for Every Part of the Human Body

Steve Vickery and Marilyn Moffat

Holt Paperbacks

The American Physical Therapy Association Book of Body Repair & Maintenance
PART I
CHAPTER ONE
The Back
If your back hurts right now, you probably don't care that back pain is the most common cause of "loss of activity" for adults under 45 ... or that it's estimated that as many as 80 percent of American workers suffer back pain at some time during their careers ...or that back pain is the most frequent medical complaint in America next to the common cold ...or that back pain costs us $60 billion annually in medical expenses and lost productivity.
What you care about is that your back hurts.
No one can promise miracles. But reading this chapter and following its recommendations--and, if necessary, working with a physical therapist--just might soothe your aching back.
And if you happen to be one of the lucky people who've never "thrown their back out," you have even more reason to read on. Preventing back problems is a lot easier and cheaper than treating them.
How the Back Works
The back functions as the central link of a kinetic chain that includes the head, jaw, neck, upper back, shoulders, and arms at one end and the legs and feet at the other. All of these different areas of the body are interrelated and depend on each other for correct functioning and movement. This is one reason why a healthy back is so important: it affects virtually every other part of the body in one way or another.
The spinal column, which runs the length of your back, provides basic structural stability to your body. Both your rib cage and pelvis are anchored to the spine, and you depend on the spine for the ability to perform some of the body's most essential movements: bending forward, backward, and to the side, and twisting or rotating.
The main section of the spine is constructed of 24 cylindrical bones, or vertebrae, extending from the back of the head to the pelvis. When looked at from the side, the stacked vertebrae form three natural curves from head to pelvis, with the neck at the top forming a gentle "C" curve, the upper back a gentle backward "C" curve, and the low back another gentle "C" curve. Pairs of bony projections called facets connect the rear sections of each vertebra to form a series of interlocking joints. The vertebrae are the building blocks of the spinal column. Each facet joint has its own synovial membrane that surrounds the joint and secretes a tiny amount of lubricating synovial fluid. And the joint surfaces are covered with a smooth articular cartilage that facilitates movement in the region.
The major portion of the spine is divided into three sections of vertebrae: the 7 cervical vertebrae in the neck region; the 12 thoracic vertebrae of the upper and middle back; and the 5 lumbar vertebrae of the low back. The cervical vertebrae, which are the smallest, are discussed in detail in Chapter 2--The Neck. The thoracic vertebrae, to which the ribs are attached, are midway in size between the cervical and lumbar vertebrae.
The thick, stronger lumbar vertebrae are the largest vertebrae and are designed to take the great stresses of weight, support, and movement put on the low back. The lumbar region usually takes the most "punishment" (for example, through improper lifting) of any area of the back.
At the very end of the spinal column are the sacrum and the coccyx. The sacrum is a fusion of five vertebrae that attaches the spine to the pelvis; the point of attachment (to a part of the pelvis known as the ilium) is called the sacroiliac joint. The coccyx, also known as the "tailbone," is a fusion of three to five very small vertebrae at the very base of the spine.
Between the vertebrae are shock-absorbing disks. They vary in thickness and size. Each disk is made up of a jelly-like center and a thick outer sheath of tough fibrocartilage.
Carved out within the bodies of the vertebrae is a sheltering canal (the spinal canal) for the spinal cord--the nerve impulse transmitter between the brain and the rest of the body. Major nerve roots branch off from the spinal cord and pass through openings in the vertebrae called foramina. These nerves allow our muscles to contract and allow us to perceive sensations such as touch, temperature, and pain. One of the most significant of these is the sciatic nerve--actually made up of five nerve roots coming from the lumbar spine--which runs all the way down the leg, from the low back and through the buttock to just below the ankle. (Because of this, pain in the hip, buttock, and leg is sometimes the symptom of a problem in the back.)
Muscles in the back, neck, and abdominal region, as well as the shoulder and leg muscles, all work together to keep the spine stabilized and aligned properly while still giving the back mobility. Among the more important of these are the erector spinae group, a deep layer of muscles runningalong each side of the spine. These are aided by other, even deeper muscles in the back. Flexible fibrous cords of tissue called tendons--technically, extensions of the muscle--attach the back muscles to the spine and the abdominal muscles to the rib cage and pelvis.
Ligaments, tough bands of fibrous tissue, provide stability and reinforcement by binding each pair of vertebrae together; several long ligaments run the entire length of the spinal column, both in front and back. The spine is further reinforced by joint capsules, fibrous and connective tissue material that surrounds the facets.
What Can Go Wrong
When people complain of a "bad back," they're usually talking about problems in the low back (lumbar region). And for good reason: your low back bears the brunt of bending, stooping, sitting, and especially, lifting. In addition, the lumbar area is very flexible. This flexibility, while essential, leaves the low back particularly susceptible to injury. The thoracic spine is not entirely invulnerable; indeed, due to a loss of bone mass, it can become increasingly fragile as we grow older. The sacrum and coccyx do suffer bruises and (occasionally) fractures due to falls, but though painful, they're rarely serious.
While some back problems may arise as the result of a specific traumatic incident--a fall, sports injury, or car accident--others seem to appear out of nowhere. In cases where there's no obvious cause for pain, the culprit is often the cumulative stress, strain, and abuse from years of poor posture and bad body mechanics. The triggering incident may be so trivial as to go unnoticed. This can make diagnosis of a specific back ailment tricky even for health professionals. While many back problems are often associated with aging, younger people also endure their share of back troubles--whether they stem from injuries, poor posture, or poor body mechanics. Disease and infection, too, can sometimes strike young backs just as it does more commonly older ones.
Back pain comes in many varieties. It can be dull, sharp, constant, intermittent, shooting, tingling like "pins and needles"--even a burning sensation. It is also highly variable, ranging from mild discomfort to agonizing pain. And although pain may strike just the back itself, a number of back problems are accompanied by irritation of the sciatic nerve, which sends hot shooting pain into the hip, buttock, or leg. This particular variety of pain, called sciatica, may come on quickly and usually affects only one side of the body.
Some back conditions, such as mild strains and sprains (see here--see here), call for simple home treatments like rest and ice. Others demand more advanced physical therapy techniques: carefully and scientifically tailored exercises to strengthen the back and improve range of motion; adjustments of the posture; mobilization; and perhaps approaches (modalities) like ultrasound and electrical stimulation as well. Still other problems require surgery or other major interventions, although these, too, are usually complemented with an exercise program designed by a physical therapist as part of the rehabilitation stage. In every instance, however, you should look to your physician or physical therapist to make a diagnosis and determine treatment.
Muscles in the back (especially those in the low back) are frequent sites of back dysfunction. Certainly the mildest such dysfunction, if it can even be called that, is the tendency of these muscles--like muscles throughout the body--to become stiff or tight in response to heavy back activity. Similar muscle tightness, especially in the low back, may be produced by simple emotional stress. The result is usually minor, short-term achiness and may be no cause for concern. (On the other hand, muscle tightness does diminish the back's range of motion, which, unless the muscles are warmed up and stretched, puts the back at risk of injury when called upon to push beyond that range.)
More worrisome is the accumulation of excess lactic acid and other chemicals in the back muscles whenever they are subject to excessive stress over prolonged periods of time, whether it be from poor posture, from leaning over a computer, or from holding the back in a fixed position. The cellular and chemical responses to excessive stress almost inevitably lead to muscle inflammation, the development of hard knots of muscle called trigger points, and pain. Unfortunately, the effects of such irritation are cumulative over time; what starts out as a mild twinge may wind up as a full-blown backache. And this may strike the lumbar or thoracic region or both.
Tearing of the muscles may result from direct trauma or overuse (as from engaging in sports or some other physical activity) and possibly prolonged poor posture or poor body mechanics. A muscle strain, sometimes inaccurately called a "pulled muscle," occurs when the muscle has been overstretched or overexerted and may have microscopic tearing as its cause. When the tearing is more severe, it is called, simply, a muscle tear, which may be partial or complete. When a muscle is strained or torn, the blood vessels in the muscle are strained or torn as well, causing inflammation in the surrounding tissue. The symptoms of strains and tears vary only in degreeand may include pain, inflammation, bleeding into the surrounding tissues, and muscle spasm (see here ). Strains, however, are often mild and require little more than a few days of rest.
Strains and tears often trigger muscle spasm--the sudden, intense, involuntary contraction of muscle tissue. Although very painful, a muscle spasm is the body's natural mechanism for protecting injured tissue by acting as a brace. In cases of major injury, the spasm may be so intense that the back will lean sharply to one side or flatten the normal curve of the lumbar spine. Because it is a protective mechanism, spasm is present in a wide range of back disorders. Spasm may also be caused by damage to nerves that run through the back.
Not unlike the muscles, the ligaments that support the back's joints can be overstretched--that is, pushed beyond their normal limits--or may sustain tears ranging from microscopic to major. This injury, a sprain, can afflict any of the back's ligaments and can be produced by trauma (like a fall), overuse (from activities such as gymnastics or ballet), the cumulative impact of poor posture, or poor body mechanics (like lifting heavy objects incorrectly). One common back sprain appears in the ligaments that bind the facet joints together. As usual, the lumbar region is the most vulnerable, especially to injuries caused by overuse. But the sacroiliac joint is also a frequent site of sprain, especially those due to falls or twisting; in women the ligaments of the sacroiliac joint may become lax during pregnancy or during certain phases of the menstrual cycle. With sprains, the pain may be localized or it may radiate down the buttocks and into the leg. If overstretched ligaments are not holding a joint firmly in place, there may also be a feeling of slippage. Over time the joint may become stiff and restricted.
The facet joints are subject to the degenerative changes associated with arthritis, which can lead to both pain and stiffness. This condition can be the result of early trauma to the joints, but there is a wide range of possible causes. One form of arthritis is rheumatoid arthritis, a disease whose origin is not fully understood (but which may be the result of autoimmune mechanisms or viral infections). Although some cases of rheumatoid arthritis are relatively benign, in extreme cases the joints become so swollen that they essentially fuse together. This is a serious and often debilitating condition. Physical therapy is necessary to help maintain mobility and flexibility in the region.
A far more widespread form of arthritis in the facet joints is osteoarthritis, the degeneration of the articular cartilage and a wearing down of the joint surfaces. In some cases osteoarthritis may result in the buildup of spurs (deposits of bony tissue) on the vertebrae. And if these bone spurs develop in the area occupied by the spinal nerves (a condition known as spinal stenosis) and encroach on the spinal cord or the nerves branching off it, the result can be severe pain not just in the back but in the legs as well (especially when standing upright). In older people osteoarthritis can also lead to a forward curvature of the thoracic spine.
Osteoarthritis has a number of possible causes, including trauma, overuse, degenerative disk disease (see here), and inactivity. But by far the most common is degeneration of the joint due to age, typical (though not inevitable) among middle-aged individuals. Although it sometimes has no symptoms at all, osteoarthritis may well lead to general stiffness and low back pain from mild to severe.
The osteoarthritis-related degenerative changes to the disks, joints, and vertebrae of the spine, common among people over 40, are known generally as spondylosis. This condition requires an X-ray to accurately diagnose. Flare-ups are commonly treated with rest and immobilization of the spine, followed by exercises and postural training provided by a physical therapist. Only in extreme cases is surgery necessary.
Disk problems are perhaps the most familiar of all low back ailments. "Slipped disk" is a catch-all term for herniated, bulging, protruding, extruded, or ruptured disks--terms that have been used to describe various degrees of a similar problem. Generally speaking, a herniated disk is one whose contents have been pushed beyond the normal boundaries.The pressure of the disk center against its outer sheath can sometimes lead to a bulge of this wall. In severe cases the disk wall actually breaks; the gelatinous contents of the disk then spill into the surrounding area and put pressure on the wall, the ligaments, and the nerve root itself. Sometimes this can lead to nerve inflammation.
Herniated disks often display no symptoms and can go unnoticed by those who have them. But in some cases the result of any herniated disk can be numbness or tingling down the legs (if the nerves are irritated) or even sharp pain. Herniated disks are also the most common cause of sciatica (see here). Furthermore, depending on the degree of disk bulging or rupture, part of the protective cushion between the vertebrae in question may be gone permanently. The facet joints may then meet with increased wear and become damaged; this is another contributor to osteoarthritis (see here).
Herniated disks often result from poor body mechanics during daily activities (such as poor lifting techniques) and bad posture. Sports injuries are another common cause, particularly from sports that require running,jumping, twisting, or extreme flexibility (such as gymnastics). The loss of disk thickness due to aging or degeneration (see here) tends to make the disks more vulnerable.
A herniated disk is usually diagnosed with the help of imaging techniques such as magnetic resonance imaging (MRI). Physicians often recommend rest, medications, and other noninvasive techniques to relieve any pain. Surgery is usually reserved for cases in which all other treatments fail.
The disks are also susceptible to degenerative disk disease, which is, like joint degeneration, a typical if not inevitable function of aging. As we reach our late twenties or early thirties, the gelatinous center of the disk begins to dry out and becomes more fibrous. Eventually the disk may dry up completely. Although degenerative disk disease and degenerative joint disease are often a part of the aging process, they don't necessarily produce major symptoms.
The low back may also develop spondylolisthesis, in which one vertebra slips forward (subluxates) on top of another. Most often this involves the bottom lumbar vertebra slipping forward over the sacrum, although it can also happen elsewhere in the lumbar region. Spondylolisthesis may be the result of trauma, spinal fracture, or arthritis (see here). This malalignment of the spine may produce symptoms ranging from mild low back pain to sciatica (see here) to muscle spasm (see here)--or it may produce no symptoms at all.
Like all bones, the vertebrae are subject to fracture as a result of trauma, like a fall or a collision. Surprisingly, fractured vertebrae may go undetected. Often fractures cause pain (local or radiating) and joint impingement. In some cases fractures can cause damage to the spinal cord, perhaps the most serious injury the back can sustain. For this reason even the suspicion of a spinal fracture should be treated as a major medical emergency demanding immediate professional attention.
Fractures can, of course, happen to anyone, but they are more likely among people who suffer from osteoporosis. This disease, most commonly found in older women, causes bones to become weak and brittle. And even those who do not sustain a traumatic back injury sometimes suffer compression fractures, causing a forward curvature of the thoracic spine.
A variety of posture-related back problems--from minor aches and pains to sprains to arthritis--can also be found in people with scoliosis. This is a condition in which the spine as a whole, when viewed from behind, is skewed into the shape of a "C" or an "S" instead of displaying a straight vertical line. It first shows up most often in girls and young women aged 9to 14 who are undergoing growth spurts, though it may occur in boys as well. Its causes are usually not known, although there is more and more evidence of its being an inherited disorder. Early treatment is essential to prevent a mild case of scoliosis from turning into a lifetime of trouble.
Taking Care of Your Back
As with many other parts of the body, proper posture is an important factor in maintaining a healthy back. By preserving the straight vertical alignment of the spine, proper posture minimizes stress on the muscles, tendons, ligaments, and disks of the back. Proper posture should be observed as much as possible while standing, sitting, and lying down; those activities that disrupt proper posture for an extended period, or that do so repeatedly, should be avoided. (This admonition should not, however, interfere with normal vigorous activities such as sports, which are in fact much encouraged.)
Although to some people proper posture seems to come almost naturally, for most of us it takes cultivation (and sometimes even professional guidance). For detailed information on recognizing and developing proper posture, see Chapter 10--Posture.
Another important factor in back maintenance is a proper gait. The term "gait" refers to your particular manner of walking or running, and a proper gait is a manner of walking or running that displays symmetry, rhythm, and even leg and foot alignment. And while there is no one proper gait, gaits that do not meet these criteria may increase stress on the low back and on other parts of the body (like the hip, knee, ankle, and foot) as well. This is particularly true for serious athletes and anyone else who does a lot of running.
Like proper posture, a proper gait comes naturally to many people, while others may need to cultivate it. In some instances a proper gait is not even attainable without the right tools, like corrective footwear. For more information on identifying and developing a proper gait, see Chapter 11--Gait.
Yet another essential ingredient in maintaining a healthy back is proper body mechanics in the various activities of daily life. With regard to the back, proper body mechanics means using the body, and the different parts of the body in ways that are consistent with the smooth functioning of the joints, muscles, ligaments, disks, and other structures of the back. Among other things, this means knowing how to lift and carry heavy objects properly, not holding your back in a fixed position for prolonged periods, and being careful never to twist the trunk when reaching for something.As with proper posture, proper body mechanics can significantly reduce the risk of many back problems.
Proper body mechanics are by no means always self-evident; occasionally they may even be counterintuitive. For most of us they need to be learned and consciously adopted. For detailed information and instructions on identifying and developing proper body mechanics, see Chapter 12--Body Mechanics.
Although they represent slightly different ways of thinking about the body, posture, gait, and body mechanics are closely related phenomena. Indeed, proper posture and a proper gait are practically prerequisites of proper body mechanics, because in their absence you are always undermining the smooth functioning of your joints, muscles, tendons, and ligaments. In fact, some of the poor biomechanical habits most harmful to the back are poor postural and gait habits.
Weight control is a factor that's easily overlooked when it comes to keeping your back healthy. But, in fact, excess weight can significantly magnify the stress on the lumbar spine. That excess weight generally settles around the stomach, and so the muscles that should be working to keep the back in alignment have to support the added pounds as well. To avoid this burden on your back, it's important to remain within your appropriate weight range. (Your weight also has implications for other parts of your body.) For more information, see Chapter 13--Body Weight.
Keeping your back healthy also calls for strength in the muscles that help to keep the back stable, moving, and well aligned, including not just the back muscles but the leg muscles and especially the abdominals as well. The less developed your muscle strength, the narrower the range of physical activities you are capable of performing--or capable of performing without putting stress on your back. As a result, many common practices of everyday life, from lifting up a child to pushing open a heavy door, become riskier than they should be. Furthermore, a certain amount of strength is necessary simply to hold the back upright, especially with proper posture. A balance of strength in the back, legs, and abdomen is important too so that one area need not compensate for weakness in another.
Back Inactivity
In one form or another, excessive stress on the back is certainly the most familiar cause of injury to the muscles and joints. Another cause, however, is only slightly less threatening: simple inactivity. Failure regularly to use the muscles of the trunk (back and abdomen) and to bring the spine to the limits of its range of motion through moderately vigorous activity makes the region particularly susceptible to sudden overuse, poor posture, and other kinds of stress. The joints stiffen; ligaments and muscles may contract; good blood flow is inhibited. Even more noteworthy, inactivity may make the back more susceptible to general joint degeneration.
The effects of inactivity tend to be magnified with age. And it is inactivity, more than aging itself, that leads to the conditions generally associated with growing older, like osteoarthritis. Regular exercise--walking, swimming, or golf, for example--may well keep these problems at bay. Indeed, an elderly person who is active may have a "younger" back than an inactive person in his thirties.
Endurance in the muscles that support the back is also essential. Endurance is the ability of the muscles to contract (that is, be in use) over time. The less developed a muscle's endurance, the shorter the amount of time it can be called upon to contract before it tires--forcing other, often more vulnerable parts of the body to do its job and putting itself and those other parts at risk of injury. Since a range of common activities, includingmany sports and work activities (and even holding the body upright with proper posture), calls upon our muscles to contract over extended periods, a certain level of endurance is absolutely vital.
Flexibility in the muscles, tendons, and ligaments is just as critical as muscle endurance and strength. The less flexible your muscles and ligaments, the more susceptible they are to the natural (and often painful) tightening that comes from everyday activities. And the more susceptible they are to injury when called upon to perform many common practices--from twisting around to look behind you to fielding a ground ball. As with endurance and strength, this flexibility must be distributed among all the muscles that support the back.
Appropriate strength, endurance, and flexibility for your back (and other parts of your body as well) may be achieved through a regular program of exercise. For more information, see Chapter 15--Strength, Endurance, and Flexibility.
Although sports and other vigorous activities are highly recommended, they do put the back at greater risk of injury, even for those who generally have good endurance, strength, and flexibility in the muscles. The twisting and bending common in many sports and activities, from softball to gardening, make the back vulnerable to a range of minor and major problems. While the risks tend to increase the older you are and the more intense your workout, it is nevertheless a good idea for anyone to fully prepare the back for such a workout: warm up through gentle aerobic activity (such as walking for 5 or 10 minutes, being sure to move the arms) and then stretch the back muscles.
Still, common sense is the best line of defense against injury. If you don't play sports or engage in similar physical activities regularly, it is important not to push yourself too much when you do. And if you do experience any pain in the back, stop what you're doing at once. To try to "play through it" is to risk injury.
For more information on protecting your back and other parts of your body from injury during particular sports, see Chapter 16--Sports.
Like sports, many lines of work carry considerable risks of back injury due to strain or overuse. Needless to say, just about any sort of heavy labor that involves bending, lifting, and carrying (like construction work or furniture moving) falls into this category. So, too, do jobs that involve standing for long hours or, worse, leaning forward frequently, like drafting, dishwashing, and some assembly-line work. Many back problems are associated with sitting at a desk all day, which places constant stress places on thelumbar spine. If you hold an occupation of this sort--even if your muscle endurance, strength, and flexibility are good--it is a wise precaution to first warm up and then stretch the back muscles before beginning your workday and several times throughout the day.
It's also important as much as possible to configure your physical work environment so that it does not force you to use poor body mechanics. Drafters, for example, might raise their drafting tables; dishwashers or assembly-line workers might put down a low footstool on which to set one foot. If you work at a desk, it is essential that your chair be appropriately supportive and that both chair and desk be at proper heights.
Finally, if your occupation does subject your back to strain and overuse, be sure to take a break of at least several minutes every hour. And if you feel any tightness or stiffness at all, stretch the muscles a bit (see below). In fact, to head off problems, you may want to try this routine even if you don't have tightness or stiffness.
For more information on protecting your back and other parts of your body from injury during work activities, see Chapter 17--Work.
When Problems Occur
No matter how well you treat your back, occasional temporary tightness and stiffness are inevitable, especially as you grow older. After all, everyday life can be grueling on the back; we sit at computer terminals all day, stand for long periods on crowded buses, sleep on too-soft hotel mattresses. One way to ease your discomfort is with a few focused stretching exercises, which will bring back some badly needed flexibility and blood flow to your tired or aching muscles. (See the box, "Quick-Relief Back Stretches," at right.)
Massage, which increases blood flow to the region while warming and stretching the back's muscle and soft tissue, may also work nicely. Although electric hand-held massagers and various nonelectric massage rollers are available on the market, you're much more likely to get a sensitive massage from someone just using the hands.
Quick-Relief Back Stretches
The stretches below may ease (and sometimes even head off) common back tightness and stiffness, especially tightness and stiffness caused by repetitive stress or overuse from daily activities. Feel free to do them as often as you wish. Detailed instructions and appropriate illustrations can be found in Chapter 19--Flexibility Exercises. These exercises are especially valuable if you work long hours at a desk. (They may also help with muscle spasm.) If your back tightness and stiffness produce more than minor discomfort, consult your physical therapist before attempting them. Be sure to warm up your muscles prior to doing these exercises by, for instance, getting up and walking around your office.
• Seated Low Back Stretch (see here)
• Seated Spinal Twist (see here)
• Extended-Arm Side Stretch (see here)
• Stretch and Reach (see here)
Sometimes a bout of back stiffness or soreness can be traced directly to a particular instance of poor posture or poor body mechanics.This is often the explanation for pain that occurs during a specific activity--brushing your teeth, for example, or stepping into a pair of pants. If this is the case, double-check your posture and body mechanics; you might find that a simple adjustment will quickly eliminate the problem. If discomfort tends to strike just after you've gotten out of bed, it may be an indicationyou need to change bad sleeping habits.
If your back stiffness and soreness persist for more than a week, it's a good idea to have your back checked by a physical therapist or physician.
Beyond temporary soreness and stiffness, it is not unlikely that you will experience more serious back problems of one sort or another at some point in your life even if you have a generally healthy back. The normal wear and tear of everyday living has its cumulative effects. Age, too, takes its toll, and with it may come thinning disks (with their associated problems) and possibly osteoporosis and other dysfunctions. Many people will sustain an occasional fall or have an accident that may bring sprains, muscle tears, herniated disks, or even fractures. Anyway, few of us can claim perfect back maintenance, which makes us especially vulnerable to a whole range of back problems.
Because a particular bout of back pain may be a sign of any number of ailments, it is essentially impossible to diagnose a problem yourself--and just as impossible to figure out how to deal with the problem. Instead, it is best to see a physical therapist or physician at the first sign of trouble, no matter how innocent-seeming. This is usually an obvious course of action in the case of a traumatic event, like when your back "goes out" trying to move a piece of furniture or, worse, when you take a bad spill on the ice or down a flight of stairs. In these cases you should seek immediate professional attention. In such urgent situations it's also a good idea to know some basics of first aid. But because of the possibility of a broken back or spinal cord damage, you should always take a traumatic back injury very seriously. Indeed, one cardinal rule of first aid is, Never attempt to move a person who has suffered possible spinal trauma. (See Appendix A--First Aid Basics.)
Even if it's not the result of a traumatic event, any case of severe back pain--or of acute pain, numbness, or weakness in the legs, which may indicate a serious back problem--also demands immediate professional attention (and, if appropriate, first aid).
Pain-Relief Devices
The marketplace is loaded with elaborate devices meant to combat back pain--like inversion swings, arc-shaped tables, and oversized rubber balls (for lying down on). While some of these may be effective at times, there is no easy cure for most problems related to the low back. Under no circumstances should you use these products without consulting a health professional.
Milder degrees of back pain, if persisting for more than a few days or recurring, should also be evaluated by a physical therapist or physician. This includes the "common cold" of back problems, minor low back pain, a dull ache that usually lasts, on and off, for a few days (at least initially). Since minor low back pain is generally the eventual result of back or abdominal muscle weakness and improper body mechanics and poor posture, it can easily develop into a chronic condition if not addressed. Of equal concern is the possibility that minor low back pain is the symptom of a more involved problem.But take heart! Most people recover soon from their episodes of low back pain. In fact, research shows that nine out of ten people recover within one month.
In the meantime, minor back pain may be managed by heeding a few simple tips. Rest may provide some relief by allowing strained muscles to heal. Lie down on a firm supporting surface on your back or side, choosing the position most comfortable to you--as long as you maintain the proper alignment of the spine (see Chapter 10--Posture). Many people even find it beneficial to lie on the floor with both legs bent and the calves set up on a chair. (Lift your legs gently and one at a time.) This particular position places the least amount of compressive force on your lumbar disks. Sitting certainly is not dangerous, but it generally puts more stress on the back than does standing. So while you're recovering, you may want to spend less time sitting or at least make your sitting more comfortable by supporting the curve of your low back with a pillow or by using a chair that has a slightly reclining back. Prolonged bed rest of more than a couple of days, however, is not recommended; it actually weakens the back and could cause your discomfort to last longer. A gradual return to normal activities is best. Continuing to walk, even in the initial stages, may be helpful.
For the first day or two after the appearance of minor back pain, you may apply ice to the affected area. The ice numbs the pain temporarily and may reduce or prevent swelling. One good method for applying ice is to put crushed ice in a sealable plastic bag with a little water, then cover the bag with towels. (A bag of frozen peas or corn works well too; refrigerated towels can be used in a pinch.) To avoid harming the skin or underlying tissues, apply the ice for only 15 to 20 minutes at a time, with 20 to 40 minutes between applications.
After a period of using ice, you may try moist heat, applied to the back in a 20-minutes-on/20-minutes-off cycle. Moist heat tends to relax tense muscles, offering some relief from pain and stiffness. Warm showers or warm, moist towels work well for this. Heating pads, although not highly recommended, are also acceptable, but take care that the heat is not too intense for you.
For some people nonsteroidal anti-inflammatory drugs (NSAIDs) may be very effective in easing back pain. This class of drugs includes aspirin and ibuprofen, both of which are widely available without prescription. Like all drugs, however, NSAIDs have potentially dangerous side effects. Ask your doctor or pharmacist before taking NSAIDs, and follow the directions on the label.
When you first experience back pain, try to make a mental note of when and where you were and what you were doing when it occurred. This information may be important in helping your physical therapist make a diagnosis.When addressing a particular back problem, your physical therapist has a wide range of techniques to draw upon. But--depending on the physical therapist's examination and evaluation--a back rehabilitation program will almost certainly incorporate strength, endurance, and flexibility exercises; attention to improved postural alignment, gait, and body mechanics; and weight management.
Copyright © 1999 by Round Stone Press, Inc., and American Physical Therapy Association