Back Pain.

Figure 5 - Pelvic tilt

Figure 6 - Back erector

Figure 7 - Angry cat stretch

Figure 8 - Double knee pull

Figure 9 - Half sit-up

Figure 10 - Hip kicker

Figure 11 - The correct way to lift

Figure 12 - The incorrect way to lift

Management and treatment

Treatment

More than 85 percent of people with lower back pain improve with minimal treatment in a matter of days. However, if back problems persist, doctors generally prescribe one or more of the following treatments: proper exercise, rest, heat and cold, posture training, weight loss, stress management and relaxation exercises, medication, spinal manipulation and/or surgery.

For some back conditions, the doctor may refer you to another specialist such as an orthopedist, rheumatologist, physiatrist, physical or occupational therapist, psychologist, psychiatrist or surgeon.

Diet

Exercise and therapy

For many people, the key to a healthy back is proper exercise. Some exercises are designed to strengthen your back and stomach muscles, while other exercises are designed to improve your posture. A 30-minute aerobic conditioning program three times a week is ideal for overall fitness. Walking and/or water exercise are highly recommended for most people with back problems.

The right kind of exercise program may help keep your back problem under control. It can make it easier for you to continue doing your daily activities. You may need to take a break from vigorous exercise if it makes your back pain worse. The exercises shown in figures 5-10 and in the movies may help strengthen the back or improve posture. Ask your doctor and physical therapist which exercises you can do to relieve back pain, stay fit, and prevent injuring yourself again.

The Arthritis Foundation and the University of Washington disclaim any liability for loss, personal or otherwise, resulting from the exercises presented here. If you have any leg pain or other evidence of nerve injury, consult you physician before beginning exercises. DO NOT carry out any exercise that makes your back pain worse!

Rest

The most common treatment doctors recommend for severe back pain is bed rest. Different people require different amounts of rest. Usually, two to three days of staying in bed, except to go to the bathroom, will be enough to ease your back pain. You may want to ask the doctor if special pillows or devices are necessary. Sometimes these aids give additional support to your neck, back or feet.

Hot and cold treatments

Many people have found that hot and cold treatments help relieve back pain. You might try both to find out which works better for you.

Heat relaxes muscles and soothes painful areas. There are many ways to apply heat. Some people like hot showers or baths, while others prefer using heat lamps, heating pads or warm compresses. If you have arthritis, heating your muscles first might make it easier for you to do back exercises. Be sure not to fall asleep while using heat.

Cold has a numbing effect. This often helps relieve pain. You might try one of these methods for applying cold:

• an ice bag
• a large ice cube used to massage the area
• a frozen package of vegetables (peas work best)
• a commercially made cold pack.

Be sure not to leave ice on after the skin becomes numb. This could lead to localized frostbite. Do not use cold if you are especially sensitive to it or have decreased circulation or sensation. Read the pain management article for more information about heat and cold.

Posture training

If poor posture is a factor, then posture training may help relieve your back pain. During posture training, an occupational or physical therapist will teach you healthier ways to sit, stand, sleep and lift objects.

Techniques for good posture:

When sitting,

• Sit in a firm chair with armrests to relieve pressure in your back and shoulders.
• Keep your upper back straight and shoulders relaxed. Keep stomach muscles pulled in, and maintain the proper curve in your lower back. You can do this by tightening your stomach and buttocks. Some people are more comfortable sitting with the back of the chair at a 15- to 20-degree angle. A small cushion behind the lower back to maintain the natural curve of the back also can be quite helpful.
• Keep your knees slightly higher than your hips.
• Use a footstool or book under your feet if necessary.
• Keep your feet flat on the floor or other surface.
• Don't sit for a long period of time. Stand up every now and then to stretch tight muscles and give them a chance to relax.

When standing,

• Stand with weight equal on both feet.
• Avoid locking your knees.
• Ease tension in your back by placing one foot on a footstool.
• If you stand for long periods of time, wear flat or low-heeled shoes.
• Keep your back straight by tightening your stomach muscles and buttocks.

When sleeping,

• Lie on your side with your knees bent.
• If more comfortable, place a pillow between your knees while sleeping on your side.
• If you sleep on your back, ask your doctor or physical therapist if placing pillows under your knees would help your lower back pain or make it worse.
• Use a firm mattress.

Body mechanics

To keep good posture while in motion is to use good body mechanics. In lifting, this means that the object lifted is held close to the body and that lifting is done with your legs. The normal back curves are maintained, the legs lift the load. Avoiding twisting your back, particularly when carrying a load, is also important for good body mechanics. Move your feet, do not twist your torso. Avoid the incorrect way; instead, lift correctly (see figures 11 and 12).

• When bending down to lift an object, bend with your knees instead of your back.
• Hold the object close to you.
• Straighten your legs to lift the object.
• Get help with an object that is too heavy.

The type of shoes you wear can also affect your posture. High heels may put more stress on your lower back by changing your posture. You might find it more comfortable to wear low or flat heels. Cushioned-soled shoes also provide "shock absorbency" for your spine.

Movies

• Pelvic tilt (0.21 MB)
• Back press (0.25 MB)
• Back release (0.23 MB)
• Single leg pull (0.20 MB)
• Double leg pull (0.23 MB)
• Elbow press (0.26 MB)
• Hip lift (0.24 MB)
• Lower back rotation (0.23 MB)
• Arm Reach (0.25 MB)

Medications

If your back pain is not relieved using other forms of treatment, your doctor may prescribe medication. The medication chosen depends on the back pain. For example, medications called analgesics can help relieve pain. Other medications called muscle relaxants can help relax tight muscles. If your back pain is caused by arthritis, your doctor can give you medication that will reduce inflammation as well as relieve your back pain. The most common medications prescribed are called nonsteroidal anti-inflammatory drugs (NSAIDs). These medications can reduce inflammation without working like cortisone, the body's anti-inflammation steroid hormone. Aspirin and ibuprofen are NSAIDs. Other NSAID medications are prescribed when needed.

Learn all you can about your medications by asking your doctor or pharmacist questions such as those listed below.

Questions to ask the doctor about medications:

• What will the medication do?
• How long will it take before I notice results?
• What is the name of the medication? Is there a generic brand?
• Are there side effects I should know about?
• How should I take the medication (i.e. before or after meals, with or without food, etc.)?
• How often should I take the medication?
• What should I do if I forget to take a dose at the specified time?

Let your doctor know if you are taking other medications. Sometimes certain medications cannot be taken together.

Surgery

Unproven remedies

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