1 - Back in Action - Skills

Goals Information Skills Drills Questions Review

 Skills to Master

Begin taking control of your back problem by mastering the following skills. These strategies are provided to supplement your visits to the clinic. Not all choices are appropriate for everyone. Perform only the items recommended by your doctor or therapist.

Positions of Comfort

Your therapist may give you ideas about how to position your back to ease pain and give the problem area a chance to heal. These positions help take pressure off the sore area by supporting your trunk or limbs.

Stomach Lying

Rationale

There is a medical myth that lying on your stomach is always a bad idea when you have back pain. Certainly, it is not for everyone with back pain, but some people find that it helps to ease their back pain. Lying on your stomach can "unload" the discs. This position can also relax muscles and improve nutrition to the structures of the back.

Description

Lie face down on a supportive mattress or couch. You may need to place a pillow under your stomach to keep your back from sagging too far forward.

Recommendations

Follow the advice of your doctor and therapist for best results.

Concerns

If the pain in your back or legs worsens, discontinue lying on your stomach. Be sure to notify your healthcare provider at your next clinic visit.

Back Lying

Rationale

Lying on your back with your knees supported bends (flexes) the back slightly. A flexed position of the low back takes pressure off the sore joints in the spine. It also widens the bony canals where the spinal nerve roots pass between the vertebrae, which can help take pressure off spinal nerve roots. Lying on your back may also provide relief from a flare-up of low back pain.

Description

Lie on your back with your knees supported over a rolled pillow, chair, or padded box. You may be instructed to lie directly in front of a couch with your thighs pointing straight up and your lower legs resting on the seat of the couch.

Recommendations

Follow the advice of your doctor and therapist for best results.

Concerns

Be aware of changes in your back or leg pain. If symptoms worsen, you may need to use a smaller bolster under your knees. If you still have pain, discontinue this position, and notify your healthcare provider at your next clinic visit.

Self-Treatments

Most patients who learn ways to take care of their back pain soon begin to self-manage their back problem. The ideas listed here are given to supplement the treatments you receive during clinic visits.

Relaxing and Breathing

Rationale

Back pain can be physically and emotionally draining. Relaxation strategies used in combination with breathing exercises can help control back pain and its accompanying stress.

Description

Deep breathing from the diaphragm muscle just under your rib cage helps air to reach even the lower lobes of your lungs. Deep breathing to a slow, relaxing count can help muscles relax. It also brings much-needed oxygen to sore tissues. Use one of the restful positions mentioned earlier. Turn down the lights. Put on some relaxing music. Place your hands lightly over your abdomen. Now breathe slowly and deeply using your diaphragm. Feel the rhythm as your abdomen gently rises and falls. Use visual imagery to help you relax. Try to visualize each of your muscles relaxing one after another. Appropriate breathing will also be important as you begin doing other back exercises.

Recommendations

Follow the advice of your doctor and therapist for best results.

Concerns

For best results, be sure you are positioned comfortably. Avoid breathing too fast. When you complete a session of relaxing and breathing, take your time getting up. Remember that your muscles are in a relaxed state. Resume normal activities gradually.

Safe Postures

Proper sitting posture is addressed in this session. Depending on your back condition, your healthcare provider may ask you to avoid sitting whenever possible. When you do sit, support yourself with good alignment. Try not to stay in one position for too long. Take breaks often to get up, stretch out, and move around.

Sitting

Rationale

A slight inward curve of the low back balances the spine and protects it from unnecessary strain. This alignment relaxes the tissues of the spine. Awkward sitting postures, like slouching, or staying in one position for too long can make back pain worse. A balanced sitting posture can help control your symptoms and protect your back.

Description

When possible, choose a comfortable chair that supports the natural inward curve of the low back. Otherwise, place behind your low back a rolled towel, pillow, or commercial back support. Avoid slouching by keeping your low back against the back of the chair or support. Your shoulders should be relaxed, and your hips and knees should be bent at right angles (90 degrees). Your feet should be kept flat on the floor or supported by a footrest. Avoid sitting with your legs straight out in front of you, such as when sitting in a bathtub.

Recommendations

Follow the advice of your doctor and therapist for best results.

Concerns

Sitting should be avoided when a disc is causing back problems. Studies show that sitting raises pressure markedly within the disc. Don't slouch when you sit. For example, avoid sitting on a soft couch where your lower spine collapses into flexion. Also, avoid getting stuck in one position. Get up, stretch, and move around.

Safe Movements

Taking extra care as you move during routine activities is important when controlling back pain. The strategies used to move safely are called "body mechanics."

Log Rolling

Rationale

Like a log that rolls as a single unit, the "log roll" is a way to get in or out of bed without twisting your spine. Twisting the spine, even with something as simple as getting out of bed in the morning, can put extra strain on the spine. The key to the log roll is that the spine is held steady and secure in its neutral position as you lie down and get up.

Description

To get out of bed, roll your whole body to one side as a unit, like the rolling of a log. Then let your legs ease off the edge of the bed toward the floor. At the same moment, push yourself up into a sitting position while keeping your back steady. Reverse this process when you lie down. Use this strategy during clinic visits when asked to get on or off the treatment table.

Recommendations

Follow the advice of your doctor and therapist for best results.

Concerns

When sitting up out of bed, keep your legs from dropping off the edge of the bed. You need to move slowly in order to control the movement and to keep your back in a neutral position as you sit up. If you still feel back pain when using the log roll, ask your healthcare provider to watch as you log roll. Perhaps he or she can give you additional tips to avoid pain.

Coughing and Sneezing

Rationale

Coughing and sneezing can take a toll on your sore low back. Rapid trunk flexion and forceful abdominal pressure, which are common during a violent coughing spell or sneeze, can actually herniate a weakened spinal disc. Positioning your back before you cough or sneeze may protect your back from pain and further injury.

Description

Just before you cough or sneeze, lean back slightly while placing one hand behind your back for support. At the very moment you cough or sneeze, bend your knees slightly. Another way is to place your back against a wall or door jamb as a way to keep your back straight so it doesn't lurch forward when you cough or sneeze.

Recommendations

Follow the advice of your doctor and therapist for best results.

Concerns

A forceful cough or sneeze can cause back pain to flare. It can also put a weakened disc at risk of injury. Take a few seconds to position your back before coughing or sneezing. Let your healthcare provider know if you still feel pain or worry when you cough or sneeze.

Exercises

Exercise is vital to spine health. People who stay active after a bout of back pain do better than those who take bed rest or who limit their activity for fear of hurting their back. Even basic exercises can be used to get you moving safely. Safe exercises promote healing and control pain. Follow the advice of your therapist when doing your exercises. If pain worsens, let your therapist know during your next treatment session.

Stretches

Stretching is the basis for muscle balance in the spine. Flexibility exercises address areas of muscle tightness that may be causing a muscle imbalance. Gentle stretching is a way to relax muscles and ease pain. As your flexibility improves, you may find it easier to do other exercises and to keep better body alignment when doing your activities throughout the day.

Goals Information Skills Drills Questions Review






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